What does a Claims Service Specialist do?

Claims service specialists assist customers in filing insurance claims, frequently serving as the initial and main point of contact with the customer. They answer questions, review policies and other documents, and provide guidance to ensure claims are submitted in the proper manner to help ensure prompt and efficient processing. They may also serve as a liaison to coordinate communications with adjusters, attorneys, and other insurance agents.

Claims service specialists typically have at least a high school diploma, although a college degree or completion of a technical/business training program is an advantage. Many insurance companies have training programs where they provide instruction for specialists with limited experience. These positions require meticulous attention to detail and excellent customer service skills, as well as strong verbal and written communication skills.

What responsibilities are common for Claims Service Specialist jobs?
  • Escalate claims issues/concerns to senior team members and/or management.
  • Maintain claim files and document claim file activities in accordance with established procedures.
  • Execute edits within charge review to achieve account resolution.
  • Generate reports to monitor the type of errors and their frequency.
  • Resolve all correction requests accurately and in a timely approach.
  • Review and analyze all information and submit request for payment of claims within company guidelines to supervisor.
  • Consult with Supervisor on more complex coverage and technical matters.
  • Maintain current knowledge of local industry repair procedures and local market pricing.
  • Review content in development to ensure functional specifications defined are executed.
  • Assist or prepare files for lawsuit, trial, or subrogation.
  • Carry out duties in compliance with all state and federal regulations and guidelines.
  • Adhere to high standards of professional conduct consistent with the delivery of superior service.
  • Initiate and conduct follow-ups via proficient use of claims systems and related business systems.
  • Investigate losses, identify coverage, evaluate liability and damages, review and analyze documents and legal pleadings.
  • Open, close and adjust reserves according to company practices designed to ensure reserve adequacy.
What are the typical qualifications for Claims Service Specialist jobs?
  • Bachelor's Degree in business.
  • Strong problem solving, time management, and critical thinking skills.
  • Proficient with Microsoft Office Suite.
  • Advanced understanding of HIPAA regulations and privacy protocols.
  • Requires careful attention to detail.
  • Basic understanding of writing protocol
Work/Life Balance
3.4 ★
Total Pay--
Career Opportunity
3.3 ★
Avg. Experience8+ years

How much does a Claims Service Specialist make near United States?

$49,196 /yr
Total Pay

Base Pay


Additional Pay


 / yr
Most Likely Range
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Claims Service Specialist Career Path

Learn how to become a Claims Service Specialist, what skills and education you need to succeed, and what level of pay to expect at each step on your career path.

Claims Service Specialist

Years of Experience Distribution

0 - 1
2 - 4
5 - 7
Not including years spent in education and/or training

Claims Service Specialist Insights

Read what Claims Service Specialist professionals have to say about their job experiences and view top companies for this career.
Suncorp GroupSuncorp Group
Senior Claims Officer
Aug 2, 2023

“Stressful workload which is not reflective of industry pay Workload is unattainable”

Metrix InsuranceMetrix Insurance
Claims Executive
Feb 22, 2022

“If you're energetic about forging a career in insurance then you could do really well for yourself at Metrix.”

Bexar CountyBexar County
Refund Specialist
Aug 19, 2022

“Consistent work and a reliable paycheck.”

Infinx HealthcareInfinx Healthcare
Pre-Authorization Specialist
Aug 5, 2022

“Nope nothing to say if u do work from home employee oriented”

ReqRoute, Inc.ReqRoute, Inc.
Remote Claims
Jan 16, 2023

“the pay is not the best”

Advanced Call Center TechnologiesAdvanced Call Center Technologies
Claims Resolution Specialist
Aug 21, 2022

“Good job to work at”

Holston Medical GroupHolston Medical Group
Pre-Authorization Specialist
Jan 9, 2022

“Good people to work with”

Davies GroupDavies Group
Technical Claims Handler
Apr 18, 2022

“Great people to work with”

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Claims Service Specialist Interviews

Frequently asked questions about the roles and responsibilities of a Claims Service Specialist

The most similar professions to Claims Service Specialist are:
  • Claims Analyst
  • Claims Adjuster
  • Claims Examiner
  • Claims Manager

Related Careers

Claims Analyst
No skills overlap
Claims Adjuster
No skills overlap
Claims Examiner
No skills overlap
Claims Manager

Claims Service Specialist Jobs