Claim Specialist II Resume
Headline : Seeking a position with a company that will allow to use current talents and skills. Driven to increase skill set and grow within a company.
Skills : Typing 65 Wpm, Microsoft Office Applications.
Description :
- Applied knowledge of state and federal laws, statutes, and insurance regulations in claim handling.
- Interpreted and applied insurance contract provisions. Uses various electronic resources for claim handling.
- Utilized appropriate job aids, knowledge, and tools to process the initial reception of claims.
- Completed the phone scope of damages with the assistance of the policyholder including a detailed description of property damage.
- Identified of building items, measurements to complete building estimates.
- Reconciled submitted estimates with State Farm estimate on non-complex property damage losses and issues replacement cost benefits payments.
- Secured inventory of damaged personal property and issues claim settlement payment.
Experience
5-7 Years
Level
Executive
Education
Medical Billing
Sr. Claim Specialist Resume
Summary : Analytical thinker and innovative problem solver. Motivated to succeed in a fast-paced and deadline-driven professional environment. Highly proficient in customer service and implementing objective decision making.
Skills : Private Investor LSAMS, LPS, Remedy, Assurant Portal.
Description :
- Conducted interviews with involved claims parties and witnesses, gather detailed information, and arrange scene investigations.
- Identified and collected evidence and determine its value to a specific claim.
- Analyzed first reports of loss and underlying file material to determine if a claim is suspect.
- Completed required investigations on referred files in a timely manner. Recommend settlement offers and negotiate payment arrangements.
- Drafted statement of loss to summarize damages, payments, and underlying policy coverages.
- Contacted injured parties and legal representatives to negotiate final settlements for claims.
- Produced quality work product while prioritizing work in a file ownership environment.
Experience
10+ Years
Level
Senior
Education
Diploma
Claim Specialist/Analyst Resume
Summary : Customer service professional experience working in a dynamic environment of specialized groups with direct and indirect relationships, while learning and incorporating the knowledge of all groups.
Skills : Insurance, Inventory management, Communication, Litigation.
Description :
- Assisted in the direction of trainees and new claim adjusters. Met regularly with fire investigators, firefighters, and cause and origin experts.
- Provided direction to policyholders and outlined repair processes.
- Contacted policyholders who had experienced severe weather storm damage to their homes or automobiles.
- Explained insurance policy, photographed & documented damages, and provided emergency advice.
- Responsible for writing estimates for auto damages from hail, collision, water, and flood damage.
- Provided homeowner estimates for interior and exterior repair and negotiated pricing with contract labor.
- Resolved Property and Casualty claims for commercial auto, general liability, and personal lines, involving bodily injury evaluation.
Experience
10+ Years
Level
Senior
Education
Public Administration
Claim Specialist/Technician Resume
Summary : Seeking a Full-Time position that will allow to expand knowledge and personal growth in an Office Administrative Atmosphere. Open availability and eager to start as soon as possible.
Skills : Microsoft Office, Technical Skills.
Description :
- Licensed insurance adjuster in three states. Establish coverage for first-party policies.
- Analyzed case files for clients and determine the level of loss and compensation, over cases in inventory.
- Recognized possible complex claims, identifying billing trends, fraud indicators, a recommendation for medical management.
- Reviewed suits, assign cases to proper legal channels, analyze information, collect preliminary evidence, propose a course of action for defense.
- Able to manage extensive caseload and litigation processes to ensure timely resolution for claims.
- Negotiated of claims to an amicable resolution, upon medical evidence, case law, and state statute.
- Utilized as an interim manager and team lead for total loss and casualty units.
Experience
10+ Years
Level
Senior
Education
International Business
Claim Specialist/Executive Resume
Headline : An Operations Specialist with experience in data entry, mail processing, and problem resolution in a banking lock box environment. Recognized by management for adaptability, sound judgment.
Skills : Computer literate: 60-65 WPM, 10-touch key, Windows.
Description :
- Determined the appropriate action when claims are missing information needed to process claims.
- Verified if billed services are authorized for payment.
- Retrieved data from the electronic filing system as needed to perform various job assignments/duties.
- Gathered missing information from incomplete billing forms being processed.
- Verified local code description and ICD - 9 codes on the bill is related to the authorized services or is eligible for payment consideration.
- Determined appropriate correspondence and sends it to the provider requesting any additional information required to complete the processing of a bill.
- Maintained files on all completed and return claims.
Experience
5-7 Years
Level
Executive
Education
BS
Claim Specialist/Director Resume
Headline : To obtain a position within a challenging environment that will allow to utilize skills and knowledge to the best of abilities and contribute positively to personal growth as well as growth of the organization.
Skills : Customer Service, Claim Handling, LexisNexis, Investigations.
Description :
- Handled first-party homeowner claims from an in-office location. Wrote estimates using Xactimate and Xactcontents.
- Handled first and third party auto claims Determined liability Coordinated repairs with autobody repair shops Organized rental vehicles.
- Led team in claim handling results including the number of closed claims per week.
- Worked in the Life Response Center which included assisting agents with the underwriting process.
- 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.
- Conducted background searches and skip traces. Advocated and conducted fraud awareness and training.
Experience
5-7 Years
Level
Executive
Education
Associate Of Science
Asst. Claim Specialist Resume
Objective : Conduct thorough investigation on cases Make sound decisions on what liability and damages to accept or deny Use critical thinking to evaluate each claim.
Skills : Bodily Injury Claims Adjusting, Retail Management.
Description :
- Precisely completed appropriate claims paperwork, documentation, and system entry.
- Managed collections claims for unpaid bills against the estates of debtors.
- Posted and adjusted payments from insurance companies.
- Identified and resolved patient billing and payment issues.
- Examined patients' insurance coverage, deductibles, possible insurance carrier payments, and remaining balances not covered.
- Diligently filed and followed up on third party claims. Responded to correspondence from insurance companies.
- Confidently and adeptly handled claim denials and/or appeals.
Experience
2-5 Years
Level
Junior
Education
Culinary Arts
Lead Claim Specialist Resume
Headline : To obtain a challenging position with an organization that offers growth for advancement and stability, as well as a company that will utilize business ethics, computer skills.
Skills : Leadership, Total Loss Claim Handling, Microsoft Word Applications.
Description :
- Reduced loss ratios through fair and prompt processing of claims.
- Identified and collected evidence and determined its value to a specific claim.
- Served as subject matter expert in auto total loss and vehicle titles. Kept up-to-date on changes in regulations for deductibles and collections.
- Completed required investigations on referred files in a timely manner.
- Managed, directed, and resolved litigated cases to conclusion.
- Collaborated and developed defense strategies with staff and outside counsel.
- Reported and collaborated with authorities on fraudulent claim activity.
Experience
5-7 Years
Level
Executive
Education
Business Management
Associate Claim Specialist Resume
Headline : Associate Claims Specialist is responsible for providing first-class service to our clients, managing the claims process and resolving issues. This includes handling all aspects of the claims process, from initial contact to resolution and beyond.
Skills : Claims Processing, Call Center, Microsoft Office, Customer Service.
Description :
- Processed claims that are pending for various holds reasons.
- Assisted in the final determination on claim disposition. Inbound /Outbound calls to various insurance companies Director / Owner.
- Investigated difficulties claims and correctly processed for payment in full correctly.
- Researched and processed, Case Logs, Analyzers, Manuals, Hospital Audits, and Appeals.
- Assisted with special projects as assigned or directed.
- Explained premiums owed to policyholders, agents, and underwriters.
- Recommended settlement offers and negotiated payment arrangements.
Experience
5-7 Years
Level
Executive
Education
BS
Claim Specialist Resume
Headline : To obtain a valuable position, with a reputable company, whereby, can apply skills to become a valuable asset to the employer.
Skills : Microsoft Office, Customer Service, Collections.
Description :
- Reduced loss ratios through fair and prompt processing of claims.
- Identified and collected evidence and determined its value to a specific claim.
- Served as subject matter expert in auto total loss and vehicle titles.
- Explained premiums owed to policyholders, agents, and underwriters.
- Recommended settlement offers and negotiated payment arrangements.
- Changed in regulations for deductibles and collections.
- Completed required investigations on referred files in a timely manner.
Experience
5-7 Years
Level
Executive
Education
A.S In Education