Claim Adjuster Resume
Summary : Seeking a position with a growing or established forward-thinking organization: focus on building and developing relationships to outperform the competitor. As an accomplished and result-oriented Sales Business Developer Manager, deliver revenue growth as well as significant competitive leads through relationship consultative selling; build and solidify competitive position, and improve profitability.
Skills : Customer Service, Microsoft Office, Investigations, Project Management, Relationship Building, Teamwork, Team Leader, Negotiation, Sales.
- Retrieves assigned medical, dental, and vision claims from system quenu.
- Evaluates circumstances of a claim such as eligibility, other insurance, accidents and injuries, subrogation, loss of time, utilization of medical services, out-of-sequence deductibles, the need for voids and adjustments, fraud and abuse possibilities.
- Resolves claim and pay or deny benefit as appropriate and within quality and quantity standards set by the department.
- Maintains positive relationships with the participants in the course of routine claim correspondence and contact.
- Certificate of Achievement in recognition of having perfect monthly quality and annual financial audits for 11 years to date.
- Maintain rigorous production and quality standards set by department.
- Detail-oriented, Computer/PC familiarity with good keying abilities, In-depth knowledge of benefits, claim processing and claim procedures.
Professional In Life
Sr. Claim Adjuster Resume
Summary : Proven ability to utilize inspiring leadership, personal drive, creative vision, and analytical skill to yield successful delivery of both team and individual goals, actively contributing to organizational growth.
Skills : MS Office, Powerpoint, Excel, Excellent Communication Skills, Excellent Customer Service Skills, Outlook, Adobe, Skype, Powerpoint.
- Understands concepts of coverage, policy interpretation, exposure recognition and liability determination to analyze and move claims towards resolution using best practices.
- Identifies exposures and refers files or features for triage to the appropriate level including referring injury claims to the appropriate level.
- Contacts insured, claimants including guest passengers to rule out any physical damage, first party medical, or injury claims.
- Obtains information and investigates the facts of loss to make a liability determination.
- Assigns material damage features as needed and may handle all customer questions to conclusion.
- Use expert systems to evaluate facts of loss and impact on liability.
- Documents files to include all key activities, contacts made, statements taken, including a full outline covering all aspects of the claim and requirements for resolution and process claims with Esurance claims systems.
- Identifies and transfers total loss features to the Total Loss Unit for handling.
Claim Adjuster III Resume
Summary : 15+ years of Medical, Vision, and Disability Claims Provided excellent, compassionate customer service to members and physician's offices inquiring about benefits and claim status. Proficient in using Word and Excel.
Skills : Microsoft Office, Word, Excel, 10-key,Basys Claims Processing System.
- Adjudicated claims for the benefits offered to union members according to plan guidelines and the summary plan description.
- Evaluated the data on claim applications, birth and death certificates, physician's statements, employer's records and vocational evaluation reports.
- Interviewed and corresponded with claimants and agents to elicit information, correct errors and omissions on claim forms.
- Authorized payment of valid claims and notified claimant of denied claim and appeal rights.
- Reevaluated evidence and procured additional information in connection with claims under appeal.
- Re-analyzed cases requiring investigation of claimant's continuing eligibility for benefits.
- Adjudicated short-term disability claims after verifying wage and correct documentation from employer, employee, and physician.
- Examined claim form and other records to determine insurance coverage.
Claim Adjuster II Resume
Objective : 15+ years of Medical, Vision, and Disability Claims Provided excellent, compassionate customer service to members and physician's offices inquiring about benefits and claim status. Proficient in using Word and Excel. Adjudicated claims using the Basis claims processing system.
Skills : Improvisational Acting; Presentations.
- Identify and respond to systemic flaws and assign responsibility for success and failure to the appropriate personnel.
- Support and enforce compliance with the Quality program from all sectors for continual improvement.
- Implement committee decisions in strict conformance with proper HR practices and company policies.
- Analysis of survey data compared to characteristics of the move to identify strengths & weaknesses and respond.
- Develop and maintain a system to report monthly on employee performance, and to affect that performance.
- Manager of Claim Prevention Responsibilities included: Negotiation and settlement of high-profile, delicate and difficult claims.
- Writing and distributing best practice training programs to be presented at 14 service centers nationwide.
Claim Adjuster I Resume
Headline : To begin a career as a insurance claim adjuster in customer service oriented environment where public relation skills and hard working approach will have valuable application in insurance procedures.
Skills : Customer Service, Claims Processing, Microsoft Office.
- Investigation of claims to determine liability and negotiation and settlement of assigned claims, in a fast-paced environment.
- Investigate and process medical claims, monitor medical bills for errors or uncovered items, negotiate bills when appropriate, and authorize the payment of medical claims.
- Monitor for fraudulent claims, and confer with patients and doctors to gather additional information when necessary.
- Calculate premiums and establish payment methods.
- Explain features, advantages and disadvantages of various policies to promote sale of insurance plans.
- Confer with clients to obtain and provide information when claims are made on a policy.
- Work in office settings, handling the paperwork and using computers to complete tasks.
Claim Adjuster/Specialist Resume
Summary : A proven leader with a passion for fostering meaningful relationships and employee advancement. Offers experience in coaching both individual employees and team leaders in customer service and retention, along with productivity and workload management.
Skills : Microsoft, Epic.
- Work in a fast paced claims environment providing unsurpassed customer service with a top rated insurance company.
- Investigate and evaluate complex claims involving questions of coverage, liability, property damage, injury and litigation.
- Apply knowledge of policies, procedures, laws, statutes and insurance regulations.
- Recognize the need for independent experts and other vendors.
- Coordinate with company attorneys to reach settlements, attend mediations and trials.
- Duties include conducting thorough investigations, making sure reserves are adequate, evaluating settlements and creating claim resolution strategies.
- Worked with team members as well as other departments in the company to move claim to a conclusion.
Claim Adjuster/Advisor Resume
Summary : Detail-oriented, and organized with extensive training in transcription. Highly effective in handling confidential information.
Skills : Excel, Computer Skills, Windows Xp, Telephone Skills, Faxing, Scanning, Outlook.
- Handled workers compensation claims for high profile companies such as A&P Supermarkets.
- Managed an average of 160 pending claims at one time from opening to final settlement.
- Processed older claims transferred from a prior TPA.
- Analyzed claims to determine extent of company's liability.
- Made approval or denial decisions and negotiated settlements with claimants in accordance with policy provisions.
- Collaborated with insurance agents and interview claimants to correct errors, rectify omissions and investigate questionable issues.
- Detected potential problems or trends that require additional review, investigation or research and refers to Claim Manager for resolution.
Claim Adjuster/Clerk Resume
Headline : To work in an environment where can utilize outstanding customer service skills. Licensed claims adjuster with litigation experience. Worked as a senior claims examiner for Insurance and worked as a supervisor.
Skills : Microsoft Office, Word, Excel, 10-key,Basys claims processing system.
- Reviewed new losses, explained coverage to insured, attorney and claimants.
- Discussed and established coverage, adjusted appropriate reserves as it relate to the specific loss.
- Referred claim to claim assistant to request police reports.
- Utilized Accurint, and ISO data base's to clear coverage.
- Investigated claim information to rule out claimants own PIP source.
- Utilized Reflections and eMedical software applications to send letters, update claimant information, set reserves, and pay authorizations with direction for processor to pay claims.
- Obtained insured's or claimant's statements as it relates to the facts of loss.
Associate Claim Adjuster Resume
Objective : Over 5 years of experience working in the insurance field as a representative in an agent office, a claim adjuster for a TPA handling claims for a variety of clients, and a claims Administrator/Adjuster for a Self-Insured Company.
Skills : Microsoft Office, Customer Service, Data Entry, Data Entry, Claims Processing, Computer Skills, Computer Literate, Networking, Networking, Networks, Networks.
- Adjust and process medical claims per business guidelines and procedures.
- Determine if claim information is correct by reviewing data.
- Resolve claim edits, review history records and determine benefit eligibility.
- Review and perform on projects per business instructions and business analyst.
- Meets and maintains all accurate records, training classes and timekeeping records.
- Address issues to next level of supervision as appropriate.
- Bring In Knowledge from IBC and Amerihealth NJ as their new contract.
- Provided positive skills for their new line of business.
Claim Adjuster Resume
Summary : Successful Client Manager, Senior Consultant, Team Management, Client Services, Managed Care, and Data Analysis professional, with over 12 years of relevant experience. Proven track record of consistently conducting multiple and major tasks with a high level of professionalism. Distinguished for contributing productively to all aspects of work with pride and integrity. Demonstrated ability to work efficiently independently and within a team.
Skills : Clinical Counseling Therapist, Data Analysis, Consulting, Market Research Quality Assurance.
- Introduced the Personal Choice product for processing within the team as a new assignment.
- Assigned team members for training with achieving 70% turnaround time.
- Managed and coordinated benefits with Medicare and other insurances.
- Managed facility and durable medical equipment DME Governmental claims.
- Delegated governmental assignments to the team.
- Followed up to insure meeting the objectives in a timely manner.
- Monitored and identified problems with new system Reported findings to the assigned departments in order to enhance system functions.
MA In Psychology