Claims Service Representative Resume Samples

A Claims Service Representative acts as a bridge between the customer and insurance company when it comes to assessing the amount of claim and compensation to be paid. The job description involves performing a lot of research work. A well-drafted Claims Service Representative Resume gives a list of the following core tasks and duties – gathering information from third parties and determining if the claims can be accepted or not; authorizing payments, denying the claims, investigating customer background and assessing the level and amount of damage.

The most sought-after skills for the post include the following – researching skills, investigating skills, the ability to communicate with diverse kinds of people, negotiation capabilities and a solid understanding of insurance and claims processes and procedures. While there are no pre-set requirements to enter this occupation, a high school diploma or GED is mandatory, higher studies or education in the field of insurance studies or business showcased on the resumes will be useful.

 

Claims Service Representative Resume example

Claims Service Representative Resume

Headline : Seeking a position where can provide a memorable customer experience while persuing a Masters Degree in Human Services: Health and Wellness.

Skills : Research, Training & Development, Analysis, Communication.

Description :

    1. Provided caring customer service to insureds and claimants who have suffered recent auto accidents.
    2. Communicated with insureds and claimants regarding accident details, repair updates and settlement amounts.
    3. Coordinated with police forces, body shops, appraisers and tow yards to provide seamless service to insureds and claimants.
    4. Analyzed policy language to make determinations on coverage.
    5. Conducted interviews to investigate liability on claims between insureds and claimants.
    6. Created letters to process claims handling such as contact letters, free form letters, subrogation letters, and denial letters.
    7. Completed state-mandated forms or letters timely and accurately to ensure compliance with regulatory requirements.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
BS


Sr. Claims Service Representative Resume

Summary : Seeking a position as a part time Certified Nursing Assistant. Offering compassion, CNA certifications and training and exceptional communication skills to provide the highest level of care.

Skills : Microsoft Office, Management.

Description :

    1. Monitored and scored Claim Service Representative calls on a daily basis.
    2. Compiled and arranged call-monitoring scores on a monthly basis for the QA Report.
    3. Compiled and rearranged claim audits on a monthly basis for the QA report.
    4. Assisted the training department in developing CSR training in order to set expectations.
    5. Assisted Claim supervisors with call monitoring program.
    6. Improved monitoring methods for the QA department.
    7. Assisted subscribers in processing insurance claims for mobile phones.
    8. Provided product information to subscribers.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Merchandising


Jr. Claims Service Representative Resume

Objective : Energetic and enthusiastic insurance professional motivated to succeed in a fast-paced and deadline-driven professional environment. Comprehensive knowledge of claims adjustments with special knowledge of automobile claims.

Skills : HR, Human Resources, Recruiting, Interviewing, HRIS.

Description :

    1. Trained to handle all claims including comparative negligence.
    2. Participated in continuing education efforts through NICB and extensive training regarding insurance fraud prevention.
    3. Drafted statements of loss to summarize damages, payments and underlying policy coverage.
    4. Analyzed first reports of loss and underlying file material to determine claim liability.
    5. Reviewed data to verify the validity of claims.
    6. Mentored over thirty new members of the claim staff.
    7. Maintained a constant awareness for potential fraud in all assigned claims.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Business

Claims Service Representative III Resume

Summary : To obtain a challenging position that will utilize the technical and professional business experiences currently posses, as well as, furthering and expanding skills.

Skills : MS Word, Excel, MS4.

Description :

    1. Explained policy coverage and limits. Determined fault.
    2. Settled bodily injury claims. Handled subrogation with other insurance companies.
    3. Assisted in the investigation of fraudulent claims.
    4. Handled arbitrary claims.
    5. Recorded statements from policyholders, claimants, and witnesses.
    6. Handled customer questions and complaints in a tactful and prompt manner while issuing payments on property damage claims.
    7. Tracked developing problem trends, suggested and advised management of possible solutions.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Sociology Master's

Claims Service Representative II Resume

Headline : Over 10 years' of providing exceptional performance in client service delivery. Demonstrated expertise in diverse areas, including data entry, account maintenance, telephone support, and client service. Four years of successful experience as an Administrative Assistant and Receptionist with the ability to handle simultaneous projects and meet deadlines effectively.

Skills : Customer Service Conflict resolution Front line, property.

Description :

    1. Provided claims assistance and advice to customers, verified necessary accident facts and determines policy coverage.
    2. Reviewed information and verify the company's loss payment exposure under policy contracts, and determine possible payment recovery.
    3. Received inquiries from policyholders, claimants, or repair shops, and resolve questions and complaints.
    4. Settled first and third party non-questionable, non-injury claims, and make vehicle assignments to Auto Damage.
    5. Evaluated the claim, and reviewed details with the claimant to determine the best course of action Plans acquisitions for standard.
    6. Specialized services, commodities and/or construction contracts where specifications.
    7. Standardized within established competitive markets Reviews requisition package for adequacy and completeness of description, consistency, and compliance with administrative, regulatory, and procedural requirements.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Business Administration

Claims Service Representative I Resume

Summary : To obtain employment as a claims service representative either in call center or work from home environment.

Skills : Microsoft Office, Coaching, Leadership Development.

Description :

  • Provided a high level of customer service while maintaining all performance metrics Took inbound calls from customers to capture and service claims .
  • Worked diligently and independently to ensure claims handled to completion.
  • Stayed available to take incoming calls in order to establish claims and handle customer inquiries in reference to their claim(s) while multitasking .
  • Deescalated customer concerns by offering empathy and addressing the customer's needs.
  • Reprocessed claims in MS4 according to subscribers benefits for payment and denial Adjustments to claims based on group benefits and matched .
  • Respond to approximately 650 weekly customer phone calls to set auto damage claims and discuss coverage options with next steps for both the policy .
  • Responsible for a desk assigned all single car losses for the last two years of employment.
  • Identified trends and worked closely with providers and internal resources to resolve issues.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Child Development

Claims Service Representative/Specialist Resume

Summary : Ability to identify and deliver substantial revenue growth, customer satisfaction and cost saving efficiencies. Strong expertise in proactively hunting and tactfully closing insurance claims. Highly accomplished in consultative selling and ability to build and maintain relationships.

Skills : Microsoft Office, Microsoft Outlook, Excel, Customer.

Description :

    1. Investigated, estimated and resolved motor vehicle claims, determined company liability and payout of claim.
    2. Interacted with policyholders, claimants, medical insurers and body shops during investigation period.
    3. Provided insurance information and initiated auto repair process.
    4. Utilized internal claims system to record, tracked and monitored insurance claims.
    5. Utilized exceptional operation and relationship building skills to exceed company expectations by 10%.
    6. Maintained high ethical and quality standards, professional demeanor and a cooperative attitude.
    7. Sustained 85% customer registration rate for GEICO 's Auto Repair Xpress (ARX), surpassing company standards by 21%.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Business Management

Claims Service Representative Resume

Objective : Highly motivated individual seeking a full time position where experience, skill set, and proficiency will contribute and allow the opportunity to build a longterm career while including opportunities for career growth. It is important that Able to utilize all of strengths and knowledge on all tasksPerforming. Driven to keep commitments, further ambition, continue efficiency, and to always take initiative in professional job performance.

Skills : Organizational/Management, Proficient In Microsoft.

Description :

    1. Dedicated to a specific Client, the Client was a parent company to many hospitals around the states.
    2. Responsible for conducting interviews of customer's involved in automotive accidents.
    3. Investigated and reconstructed accidents; entered into the electronic filing database which required good analytical and writing skills.
    4. Handled in excess 100 hospital accounts per week.
    5. Managed up to 60 assigned claims at any given time to support expedient closure for each claim.
    6. Provided customer service for auto liability and property damage; handling 30-50 calls per day.
    7. Responsible for resolution of provider issues from beginning to end, including appeals, queues, emails, phone calls, retractions, adjustments, and partnership meetings.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Bachelor's

Assistant Claims Service Representative Resume

Objective : Provide leadership and developmental skills to teams, educate and assist customers in a fast paced work environment using strong problem solving and computer skills in a professional manner. Help teams exceed company revenue goals and provide number one service with accurate information and timeliness to external and internal customers.

Skills : Customer Service, Training, Sales, Management.

Description :

    1. Corresponded with policyholders, claimants, witnesses and attorneys to gather important information to support contested claims in court; prepares .
    2. Handled the initial investigation of Worker's Compensations claims.
    3. Verified coverage and determined eligibility.
    4. Handled in excess 100 hospital accounts per week.
    5. Responsible for adjudicating medical only and lost time files according to applicable law.
    6. Denied, settled, or authorized payments to routine claims based on coverage.
    7. Provided prompt accurate responses to customers' and provider inquires regarding eligibility of covered benefits, policies & procedures, complaints claims and enrollment issues.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Certificate

Associate Claims Service Representative Resume

Summary : Customer Service Representative you will guide members through their healthcare questions via customer calls and e-mails or help providers with answering questions about member plans.

Skills : Insurance Terminology, VOIP, Data Entry, Several PC Programs.

Description :

    1. Investigated claims for insurance fraud and assigned Special Investigative Units for further Review.
    2. Conducted Phone orders and sale for customers Entered client information into POS database to process quotes, estimates, measurements and filled orders for pick-up.
    3. Assisted dealers in getting loans approved for their customers for ATV's, Automobiles and Motorcycles End of the day batch work, loan applications and payments agreements.
    4. Ensured superior customer experience by addressing customer concerns, demonstrating empathy and resolving problems on the spot.
    5. Provided excellent customer service and assistance with the reporting of auto accidents from clients or complainants.
    6. Scheduled auto appraisals and acted as liaison between body shop and car rental agency.
    7. Answered an average of 30 calls per day by addressing customer inquiries, solving problems and providing new product information.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Associates