Claims Consultant Resume Samples

A Claims Consultant plays a key role mainly in the home, health, automobile, and business industry field. The roles and responsibilities listed on the Claims Consultant Resume are – processing claims, negotiating settlements, reviewing insurance cases, verifying insurance coverage; analyzing and investigating complicated insurance claims for preventing frauds; performing detailed site inspections; reviewing and processing new claims reports; upholding relationships and communicating with insurance departments and clients; negotiating settlements; organizing and presenting claim review plans; and staying up to date on local, state and federal law changes in the insurance field.

The chosen candidate for this role should be highly analytical, professional, and possess a strong knowledge of the latest policies and regulations relating to the insurance industry. Other skills include strong analytical and organizational skills; excellent knowledge of the latest local, state, and federal-related policies. While a high school diploma is a minimum requirement, possessing a good understanding of insurance claims negotiation and settlement techniques is mandatory.

Claims Consultant Resume example

Claims Consultant Resume

Objective : Motivated individual seeking to obtain a challenging and rewarding Claims Consultant position in a team-oriented setting. To utilize leadership, billing, customer and provider relations service, CPC certification, and clerical skills to help a company thrive.

Skills : MS Office, Detail Orientation, Good Communication.

Description :

    1. Reviewed and analyzed complex coverage issues and preparation of coverage position letters.
    2. Investigated, analyzed and evaluated liability and damages.
    3. Managed and directed outside counsel.
    4. Prepared case summary reports related to matters of significant reserve and trial activity.
    5. Developed and executed claim strategies as well as resolution strategies.
    6. Negotiated and resolved cases.
    7. Attended trials, mediations and settlement conferences.
                                            Years of Experience
                                            Experience
                                            2-5 Years
                                            Experience Level
                                            Level
                                            Executive
                                            Education
                                            Education
                                            GED


                                            Claims Consultant Resume

                                            Objective : As a Claims Consultant position, responsible for Reviewing all new claims on designated customers and established a plan of action to achieve favorable claims resolution using advanced problem-solving skills.

                                            Skills : Customer Service, Microsoft Office Suite, Planning Skills.

                                            Description :

                                              1. Analyzed BCBS claims for proper coding.
                                              2. Set payment plans for self-pay patients.
                                              3. Properly documented accounts.
                                              4. Educated self and coworkers of changes with carriers.
                                              5. Effectively worked Aging Reports.
                                              6. Provided necessary medical records to assure claim payments.
                                              7. Provided initial case review, accident investigations, and reviewed and established case evaluations.
                                            Years of Experience
                                            Experience
                                            2-5 Years
                                            Experience Level
                                            Level
                                            Executive
                                            Education
                                            Education
                                            Bachelor Degree


                                            Claims Consultant Resume

                                            Objective : Seeking a Claims Consultant profession with an outstanding career opportunity that will offer a rewarding work environment along with a winning team that will fully utilize management skills.

                                            Skills : Customer Service, Team Player, Written And Verbal Communication, Microsoft Office.

                                            Description :

                                              1. Independently verified high-value electronic equipment claims for the insurance industry nationwide.
                                              2. Evaluated documentation with the ultimate goal of creating positive outcomes for the client's claims.
                                              3. Analyzed suspicious and potentially fraudulent insurance claims.
                                              4. Inspected equipment damage to determine the extent of the company's liability; met with insureds, vendors & adjusters.
                                              5. Utilized local & national technical resources to verify loss & damage and minimized loss evaluation expenses.
                                              6. Wrote technical reports; provided recommendations on course of action to claims.
                                              7. Researched RCV & ACV of damaged and replacement equipment.
                                            Years of Experience
                                            Experience
                                            2-5 Years
                                            Experience Level
                                            Level
                                            Executive
                                            Education
                                            Education
                                            BS

                                            Claims Consultant Resume

                                            Objective : Seeking a Claims Consultant position. Over 2 years of experience in Working with underwriters to support policy construction and drafting, and reporting claim trends, data analysis, and risk assessments.

                                            Skills : Compute SKills, Good Communication SKills, Training Skills.

                                            Description :

                                              1. Effectively generated leads and process appointments with potential clients.
                                              2. Guided property owners through all processes for damage repairs so they can have peace of mind.
                                              3. Built personal relationships with new and existing clients.
                                              4. Gained great experience with interpersonal communication and bilingual skills.
                                              5. Assessed salvage potential including exchange options & disposition of damaged equipment to maximize salvage recovery.
                                              6. Trained & managed/supervised team members to expand company presence.
                                              7. Provided oversight management of vendors through process mapping, program development, claims reviews, quality audits, and other projects.
                                            Years of Experience
                                            Experience
                                            2-5 Years
                                            Experience Level
                                            Level
                                            Executive
                                            Education
                                            Education
                                            High School Diploma

                                            Claims Consultant Resume

                                            Objective : Claims Consultant with 5 years of experience in Assisting production teams with account management, renewal negotiations, special projects, resolution of claims, loss issues.

                                            Skills : Administrative Skills, Managing Skills, Negotiating Skills.

                                            Description :

                                              1. Adjusted professional/professional Medicare, Medicaid, and facility claims to reflect the correct payment.
                                              2. Handled manual check requests due to lack of activity with a provider bank account, sub payable, returned due to bad address.
                                              3. Scanned all supporting documentation, submitted a manual check request to the Cash Operations manager.
                                              4. Obtained and provided any additional information required by the accounts payable department.
                                              5. Approved by accounts payable mailed live checks out to provider or sub.
                                              6. Managed and assisted on multiple projects and tasks.
                                              7. Maintained ongoing education of carrier and TPA claims services, programs, capabilities, and trends.
                                            Years of Experience
                                            Experience
                                            2-5 Years
                                            Experience Level
                                            Level
                                            Executive
                                            Education
                                            Education
                                            High School Diploma

                                            Claims Consultant Resume

                                            Headline : Claims Consultant with 6 years of experience in Investigating claims against the oil spill for personal, casualty, or property loss or damages and attempts to effect out-of-court settlement with claimant Examining claim form and other.

                                            Skills : MS Office, Work Under Pressure, Customer Service.

                                            Description :

                                              1. Attended claim reviews with accounts with large deductibles and sirs.
                                              2. Attended to the litigation process, including mediations by phone.
                                              3. Provided assistance to the Dallas MCU when one of the claim consultants was out on leave.
                                              4. Maintained a customer-centered outlook and continuously self-educated on clients businesses, goals, policy coverage, claims practices, case law, and industry claim trends.
                                              5. Responded to requests from clients for help in understanding claims. 
                                              6. Handled requests from claims adjusters for assistance in gathering additional data or documentation around a specific claim.
                                              7. Reviewed and interpreted adjuster reports and provide necessary information to clients.
                                            Years of Experience
                                            Experience
                                            5-7 Years
                                            Experience Level
                                            Level
                                            Executive
                                            Education
                                            Education
                                            G.E.D

                                            Claims Consultant Resume

                                            Objective : As a Claims Consultant position, responsible for assisting production teams with account management, renewal negotiations, special projects, resolution of claims, and loss issues.

                                            Skills : Attention-Detail, Good Communication, Presentation Skills.

                                            Description :

                                              1. Inspected roofs for all major insurance companies across the country.
                                              2. Provided details regarding covered and non-covered issues relating to the insured home and property.
                                              3. Provided detailed information on roof quality and the best course of action to resolve the issues found.
                                              4. Experienced in locating and determining multiple types of covered and non-covered issues.
                                              5. Utilized great people skills to not only relate to different types of customers but also explain in detail what is the meaning of the issues found and the best way to solve them.
                                              6. Interpreted policy coverages and be able to explain policy provision. 
                                              7. Worked with adjusters, clients, and other parties to close and mitigate current losses and prevent future losses.
                                            Years of Experience
                                            Experience
                                            2-5 Years
                                            Experience Level
                                            Level
                                            Executive
                                            Education
                                            Education
                                            GED

                                            Claims Consultant Resume

                                            Summary : Seeking a Claims Consultant position. Over 7 years of experience in Reviewing claims and loss run/reports on a monthly basis and provide a personalized comprehensive report and technical supervision to facilitate action plans in order to control losses and expedite claim resolution, etc.

                                            Skills : Troubleshooting, Coordinating Skills, Claim Adjusting Skills.

                                            Description :

                                              1. Performed claims and reserve audits at client or carrier offices as needed to improve case management protocols.
                                              2. Communicated with several different TPA's and Insurance carriers to establish what is expected for each client.
                                              3. Reviewed workers' compensation experience modification factors, with unit stat management 6 months prior to renewal.
                                              4. Calculated an Ex-Mod projection for each client and compare any contradictions with the WCIRB ex-mod worksheet.
                                              5. Provided Workers' Comp program (policy) and systems reviews (determine more efficient and cost-effective workflows), training and education, and vendor coordination.
                                              6. Participated in loss control service to ensure that each client receives appropriate levels of service.
                                              7. Evaluated damages to ascertain compensation amount.
                                            Years of Experience
                                            Experience
                                            7-10 Years
                                            Experience Level
                                            Level
                                            Management
                                            Education
                                            Education
                                            Bachelor Degree

                                            Claims Consultant Resume

                                            Objective : As a Claims Consultant position, responsible for Identifying solutions and processes for claims technical, procedural, and coverage issues to promote and impact the planned business results in the Claims Organization.

                                            Skills : Computer Skills, Claim Processing Skills, Presentation SKills.

                                            Description :

                                              1. Provided expert-level knowledge of policy interpretation, claims coverage, and procedures for purposes of establishing and documenting organizational standards for Claims.
                                              2. Guided and supported Claims, in a consultant capacity, across a broad spectrum of property and liability claims issues and estimating practices.
                                              3. Created, distributed, monitored, and maintained formal Claims' organizational directives to assure consistent claims handling throughout the organization.
                                              4. Assured handling standards are clearly and consistently communicated and followed throughout the Claims organization.
                                              5. Acted as a liaison for Claims representing Claims' positions and interest cross-functionally, and maintained strong working relationships with Citizens' Legal, Public Affairs and Product Development Departments.
                                              6. Analyzed and Monitored statutory and regulatory legislation and changes that will impact Claims.
                                              7. Prepared reports on claims and loss statistics and other information as required.
                                            Years of Experience
                                            Experience
                                            2-5 Years
                                            Experience Level
                                            Level
                                            Executive
                                            Education
                                            Education
                                            G.E.D

                                            Claims Consultant Resume

                                            Summary : Over 8 years of experience in Claims Consultant Managing claim functions of commercial clients and served as an extension of their claims and risk management team.

                                            Skills : Attention to Detail, Accuracy, Clerical Support, Customer Service Skills.

                                            Description :

                                              1. Served as one of a team of Consultants who provided services ranging from process testing to claim adjudication to companies such as Anthem/Wellpoint BCBS.
                                              2. Responsible for correcting system-generated provider errors and manually pricing professionals.
                                              3. Worked with team members to improve processes, increase accuracy, create efficiencies, resolve related issues, and achieve the overall goals of the project.
                                              4. Provided customer service support for plan members and providers in a call center environment.
                                              5. Assisted providers with collections and insurance follow-up functions for healthcare providers around.
                                              6. Experienced knowledge of the quality of the roof along with issues found and the best solutions to resolve.
                                              7. Drove the sales process to procure SSDI claimants based on medical criteria, work history, restrictions, and earnings data.
                                              Years of Experience
                                              Experience
                                              7-10 Years
                                              Experience Level
                                              Level
                                              Management
                                              Education
                                              Education
                                              Bachelor Degree