Claims Representative
What Does Claims Representative Mean?
Claims representatives are professionals employed by insurance companies to investigate and settle claims. They assess the facts of each case, evaluate the damages incurred, and determine whether a loss is covered and legitimate. One of their primary responsibilities is to prevent fraudulent claims from being paid out. For eligible claims, they also calculate the appropriate benefit amount to be paid to policyholders.
Insuranceopedia Explains Claims Representative
Claims representatives play a crucial role in the insurance industry as they serve as the gatekeepers between the insured and the insurer. They act as a filter, ensuring that legitimate claims are paid out while fraudulent or non-qualifying claims are denied. If a claims representative requires additional information to decide on a specific claim, they can conduct further investigations. For instance, they might contact doctors, employers, or others involved in the policyholder’s claim to gather relevant information that helps determine the legitimacy of the claim and the amount of damages incurred.
