A Claims Officer evaluates insurance claims and determines if the claims have to be paid or not. Working for a variety of insurance companies, these officers complete the following tasks as described on the Claims Officer Resume – advising on making a claim and the processes involved, processing new insurance claims notifications, collecting accurate information and documents to proceed with a claim, analyzing a claim made by the policymaker, guiding policyholders on how to proceed with the claim, identifying the reason why a full payment may not be made, investigating potentially fraudulent claims, preparing an initial estimate of costs, and keeping a record of costs.
The nature of the job demands the following skills – knowledge of what claims are covered through various policies; the ability to assess the situation correctly, sound report writing skills, analytical and decision-making skills, and customer service orientation. A degree is a common requirement.
Summary : Have worked as Associate Researcher and a team leader for a national health research institute over the last eight years. I have masters of Science in Biostatistics and Health Informatics. Highly ambitious and energetic Biostatistician with rich experience in field of health care research & data analyses.
Skills : Qualitative And Quantitative Data Database Management & SQL Analysis Advanced Excel Spreadsheet Writing Grant Proposal Functions Statistical Software.
Description :
Worked with a team to develop the medical record review process for application of the settlement criteria to the medical records.
Reviewed and analyzed medical records in support of disease claims.
Composed letters to claimants and attorneys reflecting deficiencies in claims.
We achieved consistent review results over the 15 year term of the Settlement.
Developed and maintained the quality control review process which fulfilled the Court's mandate to ensure reliability of claims.
Liaised who explained the provisions and application of the settlement agreement to claimants and attorneys in an effort to render understanding of the deficiencies and the documentation necessary to cure.
Worked with clients to determine if they were eligible for disability.
Experience
10+ Years
Level
Senior
Education
Associate Degree
Claims Officer Resume
Objective : A highly motivated individual with over ten years experience of working within the financial services industry. This is supplemented with five years experience of working for the country's leading Financial Regulator and four years experience within Professional Indemnity Insurance. I am versatile and an extremely effective communicator with outstanding analytical, quantitative, multi-tasking and interpersonal skill.
Skills : Microsoft Office, LegalPlus Software.
Description :
Identified, evaluated and enhancement of claims handling on products i.e. endowments, mortgages, insurance, investments and deposits.
Researched background information of firms to respond to outstanding queries.
Identified the IFAs' current solvency position and verifying their ability to deal with claims.
Liaised with in-house to obtain relevant information regarding technical issues from external experts (Insolvency Practitioner & Run-Off Agents).
Contacted product providers and other relevant parties to confirm dates and figures for valuation purposes to determine whether an investor has suffered a loss.
Ensured an accurate calculation on settlements for the investor in an event of a claim.
Monitored and updated investors and their representatives on the status of their claim by providing key day-to-day operational support in accordance with FSCS operating standards.
Experience
2-5 Years
Level
Junior
Education
GED
Claims Officer Resume
Headline : Three-year mission serving in Bolivia as a lay missioner. Coordinating with Sales Manager(s) the placement of new business with carriers to maximize commission and contingency income while providing for clients protection, security, and suitability. Collaborating with heads of other division and department leadership and other senior leadership at First Mid.
Skills : Planning, Officer Assistant, Law Assistant.
Description :
Represented veterans/dependents in presenting claims before the US Department of Veterans Affairs for all benefits to which they might be entitled, or become entitled, by virtue of their military service, under the laws administered by the USDVA to include pension, education, disability and death compensation.
Responsible for claims worked through the Muskogee Oklahoma Claims Office, claimants obtain compensation and pension benefits.
Assisted Veterans in the appeals process.
Provided advocacy, counseling, referral and follow-up services to veterans / dependents needing assistance to help stabilize their life's quality.
Made professionally sound decisions on behalf of veterans/dependents concerning claim issues; and, assists with obtaining claim awards.
Know ledged of public and federal laws, regulations, and directives for all eligibility/entitlement that is required.
Represented veterans/dependents in presenting claims before the US Department of Veterans Affairs for all benefits to which they might be entitled, or become entitled, by virtue of their military service, under the laws administered by the USDVA to include pension, education, disability and death compensation.
Experience
5-7 Years
Level
Executive
Education
B.S. In Science
Claims Officer Resume
Summary : Claims Officer is providing inspiration, objectives, operational oversight, and other managerial services. To helping prioritize objectives and provide guidance toward achieving the overall corporate vision. To guiding individuals and departments successfully through organizational challenges and changes with a people centric approach for effective organizational growth and development.
Skills : Desktop Specially, Microsoft Office And HTML.
Description :
Responsible for claims worked through the Muskogee Oklahoma Claims Office, claimants obtain compensation and pension benefits.
Assisted Veterans in the appeals process.
Prepared a complaint investigation report when dealing with complaints and queries received from Members of Parliaments (MPs) on behalf of the investor.
Aligned with Sales, Underwriting and Product leadership teams to develop strategic plans for Nationwide's western expansion.
In partnership with local claims leadership, developed strategic plans around staffing, CAT response and training.
Responsible for agency training and the development of agency claims scorecards.
Developed regional strategy for Nationwide's Brand awareness in western regions.
Experience
7-10 Years
Level
Management
Education
B.S. In Science
Claims Officer Resume
Headline : A forward and strategic thinking executive leader with more than 26 years of success in creating value for both the insurance and financial services industry. Within each of my three executive roles, I have demonstrated the ability to increase capability, value and mitigate risk for each organization while seeking new opportunities to increase profit while also driving increased customer service and brand loyalty.
Skills : Fluent In Arabic, Microsoft Office, Excellent Analytical.
Description :
Accountable for all reserved development and loss trends in both Personal and Commercial Lines.
Received and processed credit card, savings account, claims from costumers.
Filed and documented claims reports and follow ups.
Reviewed and sent claims reports every three months to the national banking superintendence.
Worked with medical personnel at Disability Determination Services.
Performed quality control review on all Claims Files and Collections Activities before submission to guarantor for payment Create ad hoc reports for .
Served as a key resource for the department, providing assistance with coordinating administrative hearings regarding child support obligations.
Experience
5-7 Years
Level
Executive
Education
GED
Claims Officer Resume
Objective : Claims Officer is fully employing with efficiency, quality and responsibility in a company where I can fulfill my functions as a professional business administrator. Cooperating to the growth of a company to which I aspire to manifest my knowledge and passion for work. Managing digital distribution strategies and teams as assigned. Acting as primary liaison with internal First Mid marketing department and leads advertising, marketing, and promotional activities for FMIG as assigned.
Skills : Marketing, Customer Relations, Microsoft Office.
Description :
Prepared and processed documents for distribution to all appropriate parties, while ensuring compliance with confidentiality standards.
Successfully achieved zero overturned cases during tenure.
Provided precision support to claims operations with a focus on supporting the consistent execution of claims functions and maintenance of .
Managed, prepared and assessed claims.
Ensured claims are settled in accordance with policy and company guidelines.
Promptly advised clients of decisions .
Improved overall claims performance including reducing ANCP's, expenses, file quality and Loss Ratios in a 5-state operation.
Experience
2-5 Years
Level
Executive
Education
Bachelor's
Claims Officer Resume
Objective : Claims Officer with 4 years of experience in Supervising and managing various other operations functions and teams, Providing direction to team members engaged in production and leadership to other administrative personnel in various divisions, May managing various aspects of a large book of business or key accounts, Developing and maintaining existing customer base and builds customer satisfaction.
Skills : Planning, Developing, Claim Assistant.
Description :
Responsible for leading Casualty, Material Damage and Property Teams for 5 states.
Increased our overall Customer and Employee Satisfaction ratings.
Assisted in reducing our Trade Combined Ratio by 28 points in 2 years.
Analyzed, investigated, and evaluated complex losses to determine both coverage position and claim disposition.
Utilized Global Claims Center (internal Guidewire product) to document claims and to diary future events or follow-up.
Outside authority level, made recommendations to management to set reserves at appropriate level for claims, make settlements and pay claims.
Managed vendors involved to achieve best outcomes on all claims.
Experience
2-5 Years
Level
Executive
Education
GED
Claims Officer Resume
Headline : Claims Officer is sharing responsibility with division heads for all lines account profitability, retention rates, and organic growth. Serving in a senior management role and may be responsible for other management responsibilities including personnel decisions, budgeting, P&L responsibility, decisions with regards to talent recruitment/termination, strategic planning, employee engagement initiatives and other high-level management projects and initiatives.
Identified and communicated specific claim trends and account and/or policy issues to management and underwriting.
Managed the coverage and/or litigation process through the retention and monitoring of counsel.
Participated in Claims audit process.
May provided claims marketing services by participating in meetings with brokers, risk managers and reinsurers.
Functionally know ledged of maritime law and insurance regulations in various jurisdictions.
Collaborated with the Leadership Team in loss trend, coverage and exposure analysis for existing and new business opportunities.
Experience
5-7 Years
Level
Executive
Education
MS
Claims Officer Resume
Objective : Claims Officer with 2 years of experience in Serving in various other capacities as assigned. Representing FMIG and the holding co. and provides leadership in key community activities and committees. Enterprising application integration (EAI)-the task of uniting the databases and workflows associated with business applications to ensure that the business uses the information consistently and that changes to core business data made by one application are correctly reflected in others.
Skills : Community Assistant, Database Management, Business Data.
Description :
Overseeing internal claims personnel to manage and achieve high standards of productivity, efficiency and alignment of organizational goals.
Ensured compliance with all local, federal and state regulations related to claims while minimizing risk/exposure to the organization.
Exercised independent judgment, effectively make sound business decisions, and resolve unique and challenging business problems.
Managed complex Workers' Compensation claims, including investigating, taking statements, calculating time loss payments, reserving, and reviewing medical records to ensure County compliance with relevant laws, administrative orders, and policies and procedures.
Communicated with employees in a timely, positive manner to explain benefits and decisions.
Initiated and coordinated early return to work, light duty, and alternative work assignments.
Assisted in coordinating compliance of County offices with Americans with Disabilities Act (ADA) requirements.
Experience
2-5 Years
Level
Executive
Education
GED
Claims Officer Resume
Objective : To obtain a Claims Officer is Reviewing draft contract agreements, and modifications to such agreements, to ensure adherence to NIROs regulations and that programmatic, compliance and financial interests are considered and represented in such agreements. Developing and maintaining operational, procurement and record-keeping systems for efficient performance and audit records of client contracts and agreements.
Interacted with physicians, vocational rehabilitation counselors, attorneys, supervisors, administrators, and employees with issues related to Workers' Compensation.
Interact and direct the work of external nurse case managers and vocational rehabilitation counselors, including selection and case assignment.
Communicated and negotiated with the Washington State Department of Labor and Industries on determinations, allowances, denials, closures, re-openings, and permanent disability awards.
Prepared claims for litigation and participate in subrogation matters.
Maintained professional knowledge and remain current on all applicable federal, state, and local statutes, codes, and ordinances governing the administration and management of Workers' Compensation.
Led marketing, loss mitigation and claims administration and teams.
Delegated operational and client-facing duties. Coordinates activities with members of the executive, marketing, claims, loss, operational, production, and administrative/support areas.
Creating an account is free and takes five seconds.
You'll get access to the PDF version of this resume template.
Choose an option.
Sign up with Google
Sign up with Facebook
Sign up with Linkedin
This helps us make sure you're human and prevents spammers from abusing our services.
By continuing, you agree to our Privacy Policy and Terms.
Unlock the Power of Over 10,000 Resume Samples.
Take your job search to the next level with our extensive collection of 10,000+ resume samples. Find inspiration for your own resume and gain a competitive edge in your job search.
Get Hired Faster with Resume Assistant.
Make your resume shine with our Resume Assistant. You'll receive a real-time score as you edit, helping you to optimize your skills, experience, and achievements for the role you want.
Get Noticed with Resume Templates that Beat the ATS.
Get past the resume screeners with ease using our optimized templates. Our professional designs are tailored to beat the ATS and help you land your dream job.
