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Claims Service Representative Jobs (NOW HIRING)

State of Virginia

Claims Service Team Leader

Richmond, VA · On-site +1

$66K/yr

Claims Service Team Leader Apply now Job no: 5106117 Work type: Full-Time (Salaried) Location ... Every claim represents a person or family navigating trauma, crisis, or loss. Our Team Leaders play ...

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How much do claims service representative jobs pay per hour?

As of Jun 12, 2026, the average hourly pay for claims service representative in the United States is $19.85, according to ZipRecruiter salary data. Most workers in this role earn between $16.83 and $21.63 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Claims Service Representative, and why are they important?

To thrive as a Claims Service Representative, you need strong analytical skills, attention to detail, and a background in insurance or a related field, often supported by a high school diploma or associate degree. Familiarity with claims management software, CRM systems, and sometimes insurance adjuster licensing is typically required. Excellent communication, problem-solving abilities, and empathy help build trust with clients and resolve claims efficiently. These skills ensure accurate claims processing, customer satisfaction, and compliance with industry regulations.

What does a Claims Service Representative do?

A Claims Service Representative assists customers by processing and managing insurance claims. They review claim details, gather necessary documentation, and communicate with claimants to ensure all required information is obtained. Their role involves verifying policy coverage, investigating claims, and coordinating with other departments or adjusters if needed. The goal is to resolve claims efficiently while providing excellent customer service and ensuring compliance with company policies.

What is the difference between Claims Service Representative vs Claims Adjuster?

AspectClaims Service RepresentativeClaims Adjuster
CredentialsHigh school diploma or equivalent; some roles may prefer insurance licensesHigh school diploma; state licensing or certification often required
Work EnvironmentCustomer service centers, insurance officesField or office-based, investigating claims
Job FocusAssisting policyholders, processing claims, providing informationEvaluating damages, determining claim validity, settling claims

Claims Service Representatives primarily handle customer interactions, processing claims and providing information. Claims Adjusters focus on investigating and evaluating claims to determine payouts. Both roles require insurance knowledge and customer service skills, but their responsibilities differ in scope and focus.

What are some common challenges faced by Claims Service Representatives, and how can they be managed effectively?

Claims Service Representatives often encounter emotionally charged situations when assisting clients who have experienced losses. Managing high call volumes while maintaining empathy and accuracy can be challenging. To handle these aspects effectively, it's important to develop strong communication skills, practice active listening, and utilize time management strategies. Most teams offer regular training and support from supervisors to help representatives navigate complex claims and maintain a positive customer experience.
More about Claims Service Representative jobs
What cities are hiring for Claims Service Representative jobs? Cities with the most Claims Service Representative job openings:
What states have the most Claims Service Representative jobs? States with the most job openings for Claims Service Representative jobs include:
What job categories do people searching Claims Service Representative jobs look for? The top searched job categories for Claims Service Representative jobs are:
Claims Service Representative jobs near you
Infographic showing various Claims Service Representative job openings in the United States as of June 2026, with employment types broken down into 99% Full Time, and 1% Part Time. Highlights an 88% Physical, 1% Hybrid, and 11% Remote job distribution, with an average salary of $41,287 per year, or $19.8 per hour.

Claims Services Representative 1/Trainee 1/2 - NYHELPS

StateJobsNY

Liverpool, NY • On-site

$53K - $85K/yr

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 9 days ago

Job description

Duties Description Under the general supervision of a Claims Services Representative 2 responsibilities include, but are not limited to:
• Oversee all aspects of workers compensation claims processing from inception to closing
• Initially determine the compensability of claims and files appropriate documentation with the Workers Compensation Board (WCB)
• Calculate and adjust reserves consistent with case analysis over the anticipated life of the claim
• Recommend cases for appeal to WCB
• Negotiate and/or make recommendations regarding lump sum settlements
• Issue payments and requests for reimbursement where claims for supplemental benefits are involved
• Review awards to ensure the correct recipient and rate of compensation
• Schedule or waives medical examinations as necessary
• Analyze medical bills to determine causality, levels of treatment, necessity for treatment, appropriateness of fees and procedure codes, and apportionment status
• Respond to requests for home modifications, home health care personnel, medication, and medical supplies and appliances
• Negotiate billing adjustments with medical care providers and suppliers applying workers compensation fee schedules and rules
• Identify and initiates referrals to the Legal Department
• Review case activity and determine when a claim can be retired
• Specific duties to be discussed at time of interview.
Minimum Qualifications For appointment via NY HELPs:
• Claims Services Representative Trainee 1: Four years of experience* processing Workers Compensation or Disability Benefits including Paid Family Leave claims.
• Claims Services Representative Trainee 2: Five years of experience* processing Workers Compensation or Disability Benefits including Paid Family Leave claims
• Claims Services Representative 1: Six years* of experience processing Workers Compensation or Disability Benefits including Paid Family Leave claims.
*An associate degree may substitute for two years of experience; a bachelor's degree may substitute for four years of experience; a master's degree may substitute for five years of experience; and a doctorate may substitute for six years of experience.
For competitive appointment:
• Transfer: Current New York State employee with one year of permanent competitive class service in a title eligible for transfer under Section 70.1 of Civil Service Law.
Appointments via transfer must not result in a second, consecutive transfer with an advancement of more than two S-grades or one M-grade. Eligible titles for transfer to Claims Services Representative Trainee 1 include, but are not limited to: Investigator 1, Assistant Insurance Fund Services Representative, Program Aide. Eligible titles for transfer to Claims Services Representative Trainee 2 include but are not limited to: Administrative Specialist Trainee 2, Claims Services Representative DB Trainee 2, Underwriter Trainee 2. Eligible titles for transfer to Claims Services Representative 1 include, but are not limited to: Administrative Specialist 1, Claims Services Representative 1 DB, Underwriter 1.
• Reinstatement: Candidates who have held the title of Claims Services Representative Trainee 1, Claims Services Representative Trainee 2, or Claims Services Representative 1, or a transferable title, may be eligible for consideration for reinstatement.
For 55b/55c Program appointment:
• This position may be designated 55 b/c and is subject to verification of applicant eligibility. For more information on this program, please visit the 55b/c Recruitment Resources Center
Please be advised that the New York State Insurance Fund (NYSIF) does not offer sponsorship for employment visas to employees or potential employees. Candidates sponsored for employment by an organization should be aware of their sponsorship status and the relevant expiration date(s) of that sponsorship before applying to this position. NYSIF is not currently enrolled in eVerify, which is a requirement for certain types of employment verifications.
Additional Comments For candidates new to NYS, the starting salary for this position will be the bottom of the range displayed and is not subject to negotiation. For candidates that are current NYS employees, salaries are calculated in accordance with NYS Civil Service Law, OSC Payroll rules and regulations, and negotiated union contracts.
Fringe Benefits:
• Competitive compensation
• Future career growth potential
• Open and supportive team-based environment
• Plentiful vacation, personal, and sick time off
• Paid state and federal holidays
• Affordable health insurance plans
• Dental and vision benefits provided at no additional cost
• Retirement options
• Public Student Loan Forgiveness (PSLF)
• Possibility of telecommuting, flextime, and Alternative Work Schedules (AWS)
NY HELPS Program:
This title is part of the New York Hiring for Emergency Limited Placement Statewide Program (NY HELPS).
For the duration of the NY HELPS Program, this title may be filled via a non-competitive appointment, which means no examination is required but all candidates must meet the minimum qualifications of the title for which they apply.
At a future date, it is expected employees hired under NY HELPS will have their non-competitive employment status converted to competitive status, without having to compete in an examination. Employees will then be afforded with all the same rights and privileges of competitive class employees of New York State. While serving permanently in a NY HELPS title, employees may take part in any promotion examination for which they are qualified.
About NYSIF:
For more information about NYSIF, including our mission, commitment to diversity, equity, and inclusion, and efforts to fulfill Executive Order 31, please visit www.nysif.com.
If you are a person with a disability and wish to request that a reasonable accommodation be provided for you to participate in a job interview, please send an email to NYSIF's Reasonable Accommodations mailbox at ra@nysif.com.
Some positions may require additional credentials or a background check to verify your identity.
Name Megan Veltman
Telephone
Fax 518-437-1618
Email Address hr@nysif.com
Address
Street 15 Computer Dr West
City Albany
State NY
Zip Code 12205
Notes on Applying Please submit your resume to hr@nysif.com, referencing the Vacancy ID # in your subject line.

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