Claims Customer Service Representative

Insurance Administrative Solutions•Clearwater, FL

About The Position

The Claims Customer Service Representative receives, organizes, and uses information about benefits, contract coverage, and policy decisions to provide prompt, courteous customer service that meets or exceeds service standards. The representative interprets contract benefits in accordance with claims processing guidelines and serves policyholders, agents, providers, attorneys, other carriers, and internal colleagues. The role requires clear documentation, professional communication, and collaboration to support accurate responses and efficient service.

Requirements

High school diploma or GED equivalent.
0–2 years of proven customer support experience.
Strong phone contact handling skills and active listening.
Familiarity with Microsoft Office products.
Ability to adapt and respond to different types of people and tasks.
Excellent communication and documentation skills.
Ability to multitask, prioritize, and manage time effectively and efficiently.
Reliable transportation and the ability to be punctual and dependable.

Nice To Haves

Insurance background preferred.
Prior call center experience preferred.
May have an agent license, but no active appointments.

Responsibilities

Interpret contract benefits accurately for policyholders, agents, and providers.
Provide claim status information to policyholders or providers.
Send refund request letters and follow up as necessary.
Prepare correspondence for customers.
Answer calls according to company policy in a helpful, professional, and timely manner.
Place outgoing calls as needed to provide or obtain information.
Document calls in writing or online while they are in progress.
Transfer calls to employees in other departments as needed to meet customer needs.
Document policy files or imaging systems with related material to maintain a clear and concise audit trail.
Participate in cross-training and group training sessions to support team efficiency and service standards.
Communicate claims processing system problems to the appropriate people.
Maintain positive and professional contact with policyholders, service providers, agents, attorneys, other carriers, peers, management, and internal support areas.
Communicate with the Supervisor, Team Lead, and team members to ensure accurate responses and avoid duplicated efforts.