A Claim Representative working for an insurance company will initiate, investigate and process claims of customers. The major roles and responsibilities listed on the Claim Representative Resume falls nothing short of these tasks – investigating claims and other facts, determining the amount of coverage, loss, and liabilities; assisting supervisors in planning and analysing activities; overseeing medical and legal aspects of claims, resolving claims issues, communicating about claim status with supervisors, recommending claim and expense reserves, performing claim assignments received from higher authorities, managing claim settlements, and attending educational workshops.
First and foremost, candidates applying for this role will need extraordinary customer service skills, they should be able to communicate and negotiate well with customer and vendors, and they should be able to gather all necessary information to complete the investigation process and they must also maintain a high level of professionalism. The minimum education expected by employers include a high school diploma or a GED.
Summary : Accomplished professional with diverse experience as a Claim Representative poised for transition to excel in a Manager position Offer outstanding team leadership, management and coordination.
Skills : Insurance, Communication Skills.
Revised, developed, organized and updated reports and forms for the claims environmental department.
Managed and helped to negotiate timely claims payments and settlements in accordance with jurisdictional and fair claim practice requirements.
Developed, managed and organized various projects to benefits the department where claims are recognized quickly by claim date.
Organized and reviewed claims files in preparation for in arbitration, dispute liabilities, and investigated/evaluated claims.
Assisted in training staff on new technologies and software that linked data to projects.
Serviced the claims need of customers, including, insured, claimants, broker, etc.
Investigated, evaluated and assessed property damage, personal injury, and personal loss.
Claim Representative II Resume
Headline : Seeking a challenging and rewarding career in a diverse environment where strong work ethic, education, and expertise can be used to help promote the mission and exceed team goals.
Assumed Complex Team Manager Role handling file notes, calendars, employee staffing needs, claims decisions.
Reviewed, analyzed, and handled all complex injury claims to the conclusion.
Interpreted the applicable auto policy and apply it to claims where appropriate.
Determined and recognized coverage questions and seek an appropriate resolution by gathering the necessary information.
Negotiated and settled claims when appropriate. Utilize external vendors for claims investigations.
Referred and review reports regarding independent medical examinations and determine the future and appropriate course of action.
Attended Examinations under Oath and determine coverage when appropriate.
Claim Representative/Representative Resume
Summary : Seeking position where can utilize consumer service skills Core Strengths Flexibility and Adaptability, Positive Attitude Team Work Skills . Goal Oriented Communicating Skills with Listening Quick Learner, Computer Skills.
Reviewed and processed medical provider bills according to the Worker's Compensation fee schedule.
Reviewed claims to determine the need for examination under oath.
Prepared claims for arbitration and settlement agreements. Assisted with payroll, tax, and account processing.
Conducted data entry of medical bills, insurance information, and client information into company databases.
Managed administrative and clerical tasks, including filing, faxing, scanning, photocopying, draft correspondence, receiving, and sorting mail.
Analyzed data, coordinated reports, and identified solutions in order to resolve administrative problems.
Scheduled and assigned administrative projects; expedited team projects.
Claim Representative/Analyst Resume
Headline : Functional with Business Lines Underwriting, high volume Inbound Sales, Human Services and Relief Unit Managing with a consistent record of profit increase.
Skills : Claims Adjusting.
Investigated and processed insurance claims filed by policyholders.
Interviewed claimant and witnesses to gather pertinent information.
Handled and process a variety of claims, including automobile, and home insurance claims.
Handled property claims involving damage to buildings and structures, liability claims involving personal injuries.
Verified that coverage applies through an insurance policy.
Evaluated damages to ascertain compensation amount.
Consulted with accountants, architects, construction workers, engineers, lawyers, and physicians to get expert evaluation.
Claim Representative I Resume
Objective : Handling cash, checks and charge transactions, answering telephones with the proper greeting and keeping store neat and clean greeting customers with eyes, and had a goal to reach a day.
Skills : Guide Wire, MS-Excel.
Handled personal line property and bodily injury claims to an appropriate resolution.
Provided quality voice-to-voice contact with all involved parties within the notice of loss.
Conducted factual investigations to determine coverage and nature and extent of damages.
Managed a file inventory to ensure timely resolution of all assigned claims.
Efficiently handled file inventory of an average of 55 notices per month. Bodily settlement authority, without consent from a direct supervisor.
Responsible for handling claims for insureds in several states.
Designated to resolve third party non-attorney represented claims.
Claim Representative III Resume
Summary : Experienced professional with demonstrated leadership and team-building skills, recognized for excellent integrity and personal initiative. Strong ability to motivate others utilizing communication.
Skills : Claims Adjuster, Receptionist, Clerical.
Adjusted claims for Auto, Personal Injury, and small Homeowner losses Taking first notice of loss.
Reviewed and analyzed information to determine the company's liability under a policy contract.
Negotiated to settle liability according to comparative negligence rule.
Claimed bases on sound claims judgment. Making initial contact via phone or letter to all involved parties.
Reviewed medical bills and reports to determine the relation to losing.
Reviewed and reduced per Pa Act 6 law and make payments within the 30-day guideline.
Ordered peer review and or insurance medical exams to determine reasonable/necessary treatment.
Jr. Claim Representative Resume
Objective : Dependable sales leader bringing management experience and a willingness to take on added responsibility to meet tight deadlines. Enthusiastic team player with a strong work ethic and advanced complex problem solving skills.
Skills : Management Experience, Team Leadership, Customer Service.
Implemented improvements in manual and electronic billing procedures.
Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
Evaluated all evidence with the ultimate goal of creating positive outcomes for the client's claims.
Drafted investigative reports covering all phases of the investigation in each case.
Reviewed new files to determine the current status of injury claim and to develop a plan of action.
Answered questions posed by the insured and attorneys. Maintained contact with claimants and attorneys to determine treatment status.
Reported to management on customer problems, field conditions, safety issues, and policy problems.
Bachelor Of Music
Asst. Claim Representative Resume
Objective : Throughout academic and professional endeavors, have utilized high aptitude for efficiency, precision and flexibility along with outstanding communication skills to accomplish tasks at the highest level.
Skills : Microsoft Office, Juris, SIR.
Managed extensive telephone contact with insurance carriers for claim payment or adjustment.
Reviewed insurance policies to determine coverage.
Prepared insurance claim forms and related documents and reviewed for completeness.
Organized and worked with detailed office records using computers to enter, access, search, and retrieve data.
Transmitted claims for payment or further investigation.
Contacted insured or other involved persons to obtain missing information.
Served as a benefits analyst on behalf of patients, and verified and validated information from employers and insurance companies.
Certificate In Medical
Associate Claim Representative Resume
Objective : Qualified Claims Representative with experience in a fast-paced customer service and call center environment. Personable and professional under pressure. Claim Representative excelling at customer satisfaction.
Skills : Microsoft Office, Technical Skills.
Investigated new claims by reviewing the first reports of loss and supporting materials.
Determined the best first point of contact and gather information regarding injuries and loss.
Updated files and provide comprehensive reports as required.
Provided an elevated customer experience to generate a loyal clientele.
Developed reputation as an efficient service provider with high levels of accuracy.
Scored in the top 10% of employees in successfully helping meet service level goals.
Investigated and resolved customer inquiries and complaints in a timely and empathetic manner.
Lead Claim Representative Resume
Headline : Self-motivated, hard working individual who demonstrates quality verbal, written, and organizational skills. Able to work in high demanding environment as well as remain calm in stressful situations.