Claim Specialist Resume Samples

Description :

1. Applied knowledge of state and federal laws, statutes, and insurance regulations in claim handling.
2. Interpreted and applied insurance contract provisions. Uses various electronic resources for claim handling.
3. Utilized appropriate job aids, knowledge, and tools to process the initial reception of claims.
4. Completed the phone scope of damages with the assistance of the policyholder including a detailed description of property damage.
5. Identified of building items, measurements to complete building estimates.
6. Reconciled submitted estimates with State Farm estimate on non-complex property damage losses and issues replacement cost benefits payments.
7. Secured inventory of damaged personal property and issues claim settlement payment.

Experience

5-7 Years

Level

Executive

Education

Medical Billing

Description :

1. Conducted interviews with involved claims parties and witnesses, gather detailed information, and arrange scene investigations.
2. Identified and collected evidence and determine its value to a specific claim.
3. Analyzed first reports of loss and underlying file material to determine if a claim is suspect.
4. Completed required investigations on referred files in a timely manner. Recommend settlement offers and negotiate payment arrangements.
5. Drafted statement of loss to summarize damages, payments, and underlying policy coverages.
6. Contacted injured parties and legal representatives to negotiate final settlements for claims.
7. Produced quality work product while prioritizing work in a file ownership environment.

Experience

10+ Years

Level

Senior

Education

Diploma

Description :

1. Assisted in the direction of trainees and new claim adjusters. Met regularly with fire investigators, firefighters, and cause and origin experts.
2. Provided direction to policyholders and outlined repair processes.
3. Contacted policyholders who had experienced severe weather storm damage to their homes or automobiles.
4. Explained insurance policy, photographed & documented damages, and provided emergency advice.
5. Responsible for writing estimates for auto damages from hail, collision, water, and flood damage.
6. Provided homeowner estimates for interior and exterior repair and negotiated pricing with contract labor.
7. 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

Description :

1. Licensed insurance adjuster in three states. Establish coverage for first-party policies.
2. Analyzed case files for clients and determine the level of loss and compensation, over cases in inventory.
3. Recognized possible complex claims, identifying billing trends, fraud indicators, a recommendation for medical management.
4. Reviewed suits, assign cases to proper legal channels, analyze information, collect preliminary evidence, propose a course of action for defense.
5. Able to manage extensive caseload and litigation processes to ensure timely resolution for claims.
6. Negotiated of claims to an amicable resolution, upon medical evidence, case law, and state statute.
7. Utilized as an interim manager and team lead for total loss and casualty units.

Experience

10+ Years

Level

Senior

Education

International Business

Description :

1. Determined the appropriate action when claims are missing information needed to process claims.
2. Verified if billed services are authorized for payment.
3. Retrieved data from the electronic filing system as needed to perform various job assignments/duties.
4. Gathered missing information from incomplete billing forms being processed.
5. Verified local code description and ICD - 9 codes on the bill is related to the authorized services or is eligible for payment consideration.
6. Determined appropriate correspondence and sends it to the provider requesting any additional information required to complete the processing of a bill.
7. Maintained files on all completed and return claims.

Experience

5-7 Years

Level

Executive

Education

BS

Description :

1. Handled first-party homeowner claims from an in-office location. Wrote estimates using Xactimate and Xactcontents.
2. Handled first and third party auto claims Determined liability Coordinated repairs with autobody repair shops Organized rental vehicles.
3. Led team in claim handling results including the number of closed claims per week.
4. Worked in the Life Response Center which included assisting agents with the underwriting process.
5. Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
6. Evaluated all evidence with the ultimate goal of creating positive outcomes for the client's claims.
7. Conducted background searches and skip traces. Advocated and conducted fraud awareness and training.

Experience

5-7 Years

Level

Executive

Education

Associate Of Science

Description :

1. Precisely completed appropriate claims paperwork, documentation, and system entry.
2. Managed collections claims for unpaid bills against the estates of debtors.
3. Posted and adjusted payments from insurance companies.
4. Identified and resolved patient billing and payment issues.
5. Examined patients' insurance coverage, deductibles, possible insurance carrier payments, and remaining balances not covered.
6. Diligently filed and followed up on third party claims. Responded to correspondence from insurance companies.
7. Confidently and adeptly handled claim denials and/or appeals.

Experience

2-5 Years

Level

Junior

Education

Culinary Arts

Description :

1. Reduced loss ratios through fair and prompt processing of claims.
2. Identified and collected evidence and determined its value to a specific claim.
3. Served as subject matter expert in auto total loss and vehicle titles. Kept up-to-date on changes in regulations for deductibles and collections.
4. Completed required investigations on referred files in a timely manner.
5. Managed, directed, and resolved litigated cases to conclusion.
6. Collaborated and developed defense strategies with staff and outside counsel.
7. Reported and collaborated with authorities on fraudulent claim activity.

Experience

5-7 Years

Level

Executive

Education

Business Management

Description :

1. Processed claims that are pending for various holds reasons.
2. Assisted in the final determination on claim disposition. Inbound /Outbound calls to various insurance companies Director / Owner.
3. Investigated difficulties claims and correctly processed for payment in full correctly.
   
4. Researched and processed, Case Logs, Analyzers, Manuals, Hospital Audits, and Appeals.
5. Assisted with special projects as assigned or directed.
6. Explained premiums owed to policyholders, agents, and underwriters.
7. Recommended settlement offers and negotiated payment arrangements.

Experience

5-7 Years

Level

Executive

Education

BS

Description :

1. Reduced loss ratios through fair and prompt processing of claims.
2. Identified and collected evidence and determined its value to a specific claim.
3. Served as subject matter expert in auto total loss and vehicle titles.
4. Explained premiums owed to policyholders, agents, and underwriters.
5. Recommended settlement offers and negotiated payment arrangements.
6. Changed in regulations for deductibles and collections.
7. Completed required investigations on referred files in a timely manner.

Experience

5-7 Years

Level

Executive

Education

A.S In Education