Claims Associate Resume Samples

A Claims Associate will evaluate claims and investigate all details related to the insured client. The most common work activities listed on the Claims Associate Resume include – ensuring applicable coverage to individual after investigating and evaluating claims and policy information, performing interviews and gathering all statements, investigating and making reports, evaluating progress for all claims, coordinating with team leader and attorneys; maintaining records of all benefits, resolving issues, managing and distributing all incoming mails, performing research on all claims; and informing claimants about denial on claims.

The most common qualifications needed for the job include – researching skills, investigation skills, negotiation skills, attention to details, knowledge of insurance claims, procedures and policies; ability to conduct and investigate claims, and proficiency in meeting targets. A high school diploma or a college degree in insurance studies is underlined on successful resumes.

Claims Associate Resume

Headline : To obtain a position with a company where I can exercise my work ethics and experience for an employer who provides challenging career opportunities and professional growth.

Skills : Microsoft Office, Microsoft Excel, Microsoft Outlook, Typing, 10-Key.

Description :

    1. Record and submit auto, property damage, and bodily injury loss reports for both insureds and claimants.
    2. Navigate through multiple systems to assist with auto repairs, rental reservations and contacting tow vendors.
    3. Move potential total loss vehicles to salvage and assign staff estimater to access damages.
    4. Effectively collaborate with other departments to assuring proper claim routing and handling.
    5. Maintain and frequently exceed production metrics, while delivering remarkable service to customers.
    6. Recieved awards for maintaining over 90% of service expectations.
    7. Provide emails of process changes and updates to my team members on an as needed basis causing an overall increase of performance metrics and decrease in call handle time.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Consultant
Education
Education
Business Studies


Group Claims Associate Resume

Summary : Highly qualified Claims Associate with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and I would excel in the collaborative environment on which your company prides itself.

Skills : Strong Computer Skills, Strong Analytical Skills, Strong Organizational.

Description :

    1. Completes processing of salvage claims for vehicle owners in accordance to authority provided by the claim handlers.
    2. Facilitates all necessary paperwork to properly brand the vehicle title.
    3. Secures necessary information and documentation to process titlework to conclude salvage handling.
    4. Initiates payments to the vehicle owners at the direction of the claim handler/adjuster.
    5. Take calls from clients and provide answers and solutions to their questions regarding their automotive claim and assist in directing them how to complete the necessary paperwork to transfer their title to State Farm as a salvage vehicle.
    6. Completing legal documents specific to each state to transfer car title legally over into State Farm's possession.
    7. Finding solutions to move cars off the salvage vendors' lots that have incomplete documentation to be sold.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Master's In Instructional Design & Technology


Claims Associate II Resume

Summary : 4.0 graduate of Everest College Medical Insurance Billing and Coding program who is a very dedicated, team player with excellent attendance. Extensive customer service and office experience as well as able to multi-task in a fast paced environment.

Skills : Property and Casualty Adjuster experienced in handling.

Description :

    1. Interacted with policyholders, claimants, attorneys, medical insurers, body shops and other interested parties associated with the claim.
    2. Assisted with being the first point of contact for parties involved in accidents.
    3. Verified accident facts, determine policy coverage and review insurance contracts.
    4. Settled claims where there are no injuries and all parties agreed to the accident details.
    5. Determined disputes for further investigation Detailed and referred possible fraudulent activity during conversation with all interested parties for investigation.
    6. Managed claim dairies that needed further handling and conducted follow-ups in order to expedite closure.
    7. Denied claims based on shared negligence evaluations.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
M.A.

Claims Associate III Resume

Objective : To obtain a position that will enable me to use my strong organizational skills, researching experience, and ability to work well with people.

Skills : CPR and First Aid Certified, Blood Draws, Preforming Lab test, EKG's, Taking Vitals, Assisting Doctors, and giving injections.

Description :

    1. Analyzes and manages complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
    2. Assesses liability and resolves claims within evaluation.
    3. Negotiates settlement of claims within designated authority.
    4. Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
    5. Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles clams within designated authority level.
    6. Prepares necessary state fillings within statutory limits.
    7. Manages the litigation process; ensures timely and cost effective claims resolution.
    8. Coordinates vendor referrals for additional investigation and/or litigation management.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Associate In Paralegal


Express Claims Associate Resume

Summary : To secure a position utilizing my experience in customer service, communication aptitude and sales and information gathering skill incorporated with my knowledge in Banking Industry and Retail Industry.

Skills : Microsoft Office.

Description :

    1. Responsible in processing product damages from customers and in-store which are sent out to the return center after box audit is done.
    2. Responsible for issuance of Purchase Order to vendors.
    3. Responsible for processing of overstock merchandise of local vendors.
    4. Responsible for processing markdowns and ensuring the completeness of items against report before verification of Management.
    5. Knowledgeable in processing of HAZMAT, ensures that other store associates are practicing proper procedures on damages that are HAZMAT.
    6. Ensures claims area is in compliance with the company's policy on HAZMAT.
    7. Helps and assists Receiving Department as needed.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Bachelor Of Science In Commerce

Claims Associate/Claims Manager Resume

Summary : Motivated Claims Associate specializing in personal injury protection and property damage loss claims. My job entails labeling mail, data processing, issuing payments, sending correspondence to explain claim processes and procedures. I also answer phones and assist medical providers, rental companies, attorneys, insureds, claimants and others. My main focus is to give excellent customer service in a positive and easy to understand manner.

Skills : Excel, Word.

Description :

    1. Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
    2. Evaluated all evidence with the ultimate goal of creating positive outcomes for client's claims.
    3. Reviewed new files to determine current status of injury claim and to develop a plan of action.
    4. Answered questions posed by insured and attorneys.
    5. Followed up with the insured individuals regarding premium and deductibles payments.
    6. Reconciled data in direct collection system with the accounting system to address discrepancies.
    7. Answered customer questions regarding deductibles.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor Of Arts

Recieving/Claims Associate Resume

Summary : Experienced Insurance Customer Service Representative and Patient Reimbursement Specialist/Team Leader, with over ten years experience in the medical billing industry. Strengths include: Administrative medical office tasks. Experienced with IDX Bar and EPIC Systems, processing and reviewing medical claims, problem solving and communication, retrieving information, medical terminology, 10-key functions, maintaining payroll accounts, multi-tasking with customer service skills within small and large office environments.

Skills : Word, Customer Service, Data Entry, Documentation, Database Management, Excel, Editing, Filing, Kronos, Medical Terminology, Office Management, Powerpoint, Research, Sharepoint, Typing, Windows.

Description :

    1. Third Party Claims associate, responsible for reviewing coverage determination of claims and providing customer service to clients and providers within the TPA team.
    2. Resolving clients queries regarding claim status and payment status.
    3. Developed thorough knowledge of TPA contracts and assistance products.
    4. Ability to interpret plan provisions from a plan booklet.
    5. Preauthorized medical treatment in accordance with client policies.
    6. Provided benefit and coverage information to clients.
    7. Opened cases for new medical conditions being added to treatment history.
    8. Assisted customers in determining need and eligibility of services available.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Health Service Management

Grocery Reciever/Claims Associate Resume

Headline : To obtain a position in a company in which I will be able to utilize my skills to benefit the company and create growth opportunities for myself.

Skills : Microsoft Office.

Description :

    1. Adjusts PTD claims only Supports other claims representatives, examiners and leads with larger or more complex claims as necessary.
    2. Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy and files necessary documentation with state agency.
    3. Processes assigned claims and determines benefits due pursuant to the client contract; makes timely claims payments and adjustments.
    4. Communicates claim action/processing with claimant, client and appropriate medical contact.
    5. Ensures claim files are properly documented and claims coding is correct.
    6. Process routine claimant payments and prescriptions and status reports for lifetime award claims.
    7. Maintains professional client relationships.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Diploma

Reinsurance Claims Associate Resume

Summary : To secure a position utilizing my experience in customer service, communication aptitude and sales and information gathering skill incorporated with my knowledge in Banking Industry and Retail Industry.

Skills : Quick leaner on any computer system.

Description :

    1. Responsible for taking incoming calls on both new and existing auto and home claims.
    2. Assisted clients by following call processes and procedures.
    3. Accurately documented the appropriate system with information discussed in each conversation and adhere to all applicable state compliance requirements.
    4. Reviewed audits and provided feedback in a timely manner.
    5. Managed projects to ensure accurate and timely completion.
    6. Utilized all resources to answer client questions which avoided long hold times.
    7. Supported expense management by assisting in the mitigation of cost.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Marketing

Sr. Claims Associate Resume

Objective : To work in an organization dedicated to improving the delivery of health care to all individuals, using my experience in a hospital setting, my academic background in psychology and business, to contribute to the success of the organization.

Skills : Public Relations, Marketing, Mentoring, Advising, Teaching, Communications.

Description :

    1. Investigated minor to moderate auto claims in a call center environment.
    2. Evaluated all the facts from both sides to make determination of liability.
    3. Responsible for claims in multiple states and complying with each states jurisdictional requirements.
    4. Processed new and existing claims during a period of company migration from a zone claim process to an enterprise process.
    5. Demonstrated the ability to adapt in an environment that is constantly changing and evolving.
    6. Generated and implemented a team template to promote teamwork, raise morale and effectively communication with team.
    7. Continuously looks for efficiencies to improve processes and activities.
    8. Innovative idea submitted to save time and implemented as a company wide process.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Diploma

Claims Associate/Sales Resume

Headline : Licensed Claims Professional with demonstrated success managing FMLA, short term disability, and liability claims. Earned awards for superior customer service skills, which has led to business retention and revenue. A proactive team player dedicated to quality results and exceeding business and client expectations.

Skills : Business Office Administration Filing, Organization Report Preparation Computer Savvy Written Correspondence Customer Service General Office Skills Detail Oriented Supply & Materials Management Oral & Written Communications.

Description :

    1. Reviewed medical claims and determined eligibility for payment.
    2. Determined responsibility of payment for military medical facilities when civilian care was rendered outside of area of responsibility.
    3. Accurately processed and completed medical claims upon first receipt and within turnaround standards.
    4. Typed correspondence to patients and providers and requested medical records and documents.
    5. Forwarded medical records and hospitalization documents for patients whose health records were maintained in other medical treatment facilities.
    6. Denied and changed medical authorizations for same day voids and reconsiderations.
    7. Processed complex claims to include UHG/Office specific product knowledge while including standard plan components applicable to the service center.
    8. Reviewed claims for eligibility discrepancies and coding discrepancies (pend, remark, diagnosis, service, cause, override, place of service, attachment, and denial/closure codes).
Years of Experience
Experience
5-7 Years
Experience Level
Level
Consultant
Education
Education
Electronics

Claims Associate/Adjuster Resume

Summary : Dedicated worker with two years of experience combining management and customer service expertise in retail call centers. Looking for a full time position in a fast growth company.

Skills : UNMATCHED Work Ethic, Positive & Enthusiastic Attitude, Team Player, Excellent Written, Verbal, and Interpersonal Communication Skills, Computer Savvy, Excellent Time Management, Dependable & Flexible, Willingness to Learn and Expand.

Description :

    1. Processing damaged goods, such as customer returns, by deciding whether or not an item was suitable to ship to the Return Center for full or partial credit for the company.
    2. Managing hazardous waste (leaking products, aerosol waste, flammable products) Making phone calls to vendors to receive a return authorization code to receive full credit on damaged vendor products.
    3. Receiving packages and logging them into the system to notify the customers of the package's arrival.
    4. Monitor sales activities to ensure that customers receive satisfactory service and quality goods.
    5. Enforce safety, health, and security rules.
    6. Report vendor issues,poor claims practices,and problems with merchandise processing.
    7. Tracks goods, maintain in-stock levels, and controls shrinkage in a timely mannner.
    8. Examine merchandise to ensure that it is correctly priced and displayed and that it functions as advertised.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Diploma

Recieving/Claims Associate Resume

Objective : My overall goal is to work for a reputable company where I can utilize the skills and knowledge acquired from past work experience and put them to work. Growing up in a family business has taught me a variety of working skills, customer relations and a strong work ethic. I have had many years of office experience which has allowed me to learn a variety of skills i.e. computer programs, developing customer service and interpersonal skills, the ability to work independently or within a team.

Skills : Autocad, Accounts Payable, Customer Service, Computer.

Description :

    1. Setting up of fixtures/merchandise in the store.
    2. Scan stolen, damaged, returned and overstock merchandise that needs to be returned to the vendor for reimbursement.
    3. Package the above merchandise to be sent back to main returns center.
    4. Assist merchandise supervisors with modular setups, putting merchandise away and assisting their customers.
    5. Assist customers in various departments with merchandise selection/location.
    6. Collection of food donations for the food shelves' distribution three times a week.
    7. Prepare hazardous materials and non-hazardous materials and liquids for disposition , Instruct employees on proper disposition of hazardous/non-hazardous materials and liquids.
    8. Lock up claims area before leaving for the day.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Certification

Audit/Claims Associate Resume

Objective : My goal is to continuously find new ways to increase customer satisfaction. I strive daily to implement new strategies to simplify and make current procedures more effectively appropriate to business needs. My personal objective is to utilize my current skills, progressively learn more, succeed in all business endeavors, build productive relationships and positive experiences that I can't later reflect on.

Skills : Spanish.

Description :

    1. Responsible for recovery of subrogation monies for damages to foreclosed properties.
    2. Handle property damage claims for mortgagees, lenders, etc.
    3. Responsible for review of damages, policy limitations and understanding what is a covered loss.
    4. Filed police reports and completed proof of loss forms on behalf of the lender.
    5. Pursue damage claim after determination of carrier, whether retail or force-placed.
    6. Monitor file to determine whether additional information is necessary.
    7. Rebut denials to recover insurable losses according to the language of the particular policy in force.
Years of Experience
Experience
0-2 Years
Experience Level
Level
Entry Level
Education
Education
Diploma

Claims Associate Resume

Headline : To provide superior customer service to Farmers Insurance customers while broadening my skills in the insurance industry.

Skills : Microsoft office, Microsoft Excel, Telephone Skills, Customer Service, Leadership Development, Microsoft Outlook, Problem Resolution, Insurance.

Description :

    1. Assists Large Property by maintaining expense workbooks and paying vendor invoices for various services.
    2. Creates professional correspondence updating customers with claim status and indemnity payments.
    3. Ensures records are accurate so customers can monitor their use of policy limitations and benefits.
    4. Responsible for assisting various departments with administrative tasks such as check reissuing and payment journals.
    5. Responsibility extends into ordering various reports required by other departments to accurately and efficiently process claims.
    6. Quality control is practiced daily to ensure any invoicing mistakes are corrected; when found they are escalated appropriately to minimize claim inaccuracies.
    7. Daily activities require diligent use of diary management system, accurate record keeping and strong communication skills.
    8. Occasional responsibility for compiling and presenting information in various forms as well as direct communication with customers.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Consultant
Education
Education
Research