Claims Representative

Published: | Updated: July 1, 2017

Definition - What does Claims Representative mean?

Claims representatives are people who work for insurance companies to investigate and settle claims. They examine the facts, damages incurred, and evaluate whether a loss is covered and legitimate. One of their most important roles is making sure fraudulent claims do not get paid out. As for eligible claims, they also calculate the benefit amount to pay out to policyholders.

Insuranceopedia explains Claims Representative

Claims representatives serve an important purpose in the insurance business because they are basically the gatekeepers between the insured and the insurer. They act as the filter through which legitimate claims get paid out and fraudulent or non-qualifying claims do not. If a claims representative needs more information about a particular claim to make a decision, then they can investigate further. For example, they might call doctors, employers, or others involved in the policyholder's claim to get more relevant information to help them determine the legitimacy of a claim and amount of damages incurred.


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