A Claims Representative will work for insurance companies and take charge of investigating claims by customers. The associated tasks listed on the Claims Representative Resume include the following – evaluating the damage amount, calculating the compensation amount due to customers, ensuring claims are genuine and there are no fraudulent actions, reviewing insurance forms for completeness and accuracy, investigating claims if necessary, promptly negotiating settlements, attending court hearing in case of litigations, securing testimony from relevant parties, examining reports, transmitting routine claims for payment, and informing claims supervisor about claims that need investigation.
The most sought-after qualifications for the post include – claims handling experience, good communication skills, and proficiency with claims processing software, good manual dexterity and the ability to understand and use insurance and financial reports to conduct business. A Bachelor’s degree in business administration or a suitable field of study is expected on resumes.
Objective : Dynamic Claims Representative with 5 years of experience adept at managing the complete claims lifecycle. Skilled in analyzing complex claims, negotiating settlements, and ensuring adherence to regulatory standards. Committed to providing exceptional client service and fostering positive relationships. Excited to leverage expertise in a collaborative environment to drive organizational success.
Skills : Data Analysis Tools, Research Skills, Claims Investigation, Documentation Skills, Claims Reporting, Claim Documentation
Description :
Managed workers' compensation claims, ensuring timely and accurate adjustments to indemnity and medical payments.
Conducted thorough analysis of job descriptions, wages, and medical records to determine claim validity.
Assigned appropriate reserves and monitored their adequacy throughout the claim lifecycle.
Processed claim payments and adjustments, ensuring compliance with company policies and state regulations.
Coordinated with medical vendors for treatment referrals and additional investigations as needed.
Oversaw subrogation and recovery efforts, optimizing claim recoveries and reducing costs.
Maintained professional communication with claimants and clients, fostering trust and effective relationships.
Experience
2-5 Years
Level
Junior
Education
B.A.
Claims Representative Resume
Summary : Accomplished Claims Representative with 10 years of extensive experience in managing and resolving complex claims efficiently. Adept at analyzing claims, negotiating settlements, and ensuring compliance with industry standards. Strong advocate for client satisfaction with a proven ability to communicate effectively and build lasting relationships. Committed to driving operational excellence and enhancing team performance.
Skills : Time Management, Expertise In Hmo Regulations, Proficient In Microsoft Office Suite, Advanced Excel Skills, Conflict Resolution, Policy Knowledge
Description :
Processed and evaluated insurance claims for accuracy and compliance with policy guidelines.
Analyze claims for accuracy and completeness, ensuring compliance with regulatory standards.
Coordinate with clients and stakeholders to gather necessary documentation and resolve claim issues.
Manage patient accounts and oversee billing processes to ensure timely payments.
Utilize the Epic hospital system to evaluate patient records and facilitate claims processing.
Perform clerical duties while exercising independent judgment in accordance with company policies.
Maintain confidentiality regarding all claims and sensitive information.
Experience
7-10 Years
Level
Management
Education
B.S. in BA
Claims Representative Resume
Objective : Accomplished Claims Representative with 5 years of expertise in managing the claims lifecycle. Demonstrated proficiency in analyzing claims, negotiating settlements, and ensuring compliance with industry regulations. Adept at fostering client relationships and delivering outstanding service. Eager to leverage my skills to enhance operational efficiency and contribute to a collaborative team environment.
Skills : Product Knowledge, Time Tracking, Claims Adjustment Applications, Insurance Regulations Compliance, Ms Office Suite For Reporting, Quality Assurance
Description :
Managed the complete claims process for radiologic billing, ensuring accurate coding for optimal compensation.
Handled patient inquiries and provided clear explanations of benefits, enhancing customer understanding.
Conducted end-of-month collections, successfully reducing delinquent accounts through proactive outreach.
Analyzed coverage issues, recommended liability positions, and negotiated settlements for property and bodily injury claims.
Maintained knowledge of state regulations, including Medicare and Medicaid, to ensure compliance.
Identified potential fraudulent claims and collaborated with the special investigative unit for resolution.
Completed training on policy handling and closure, applying knowledge to improve claims outcomes.
Experience
2-5 Years
Level
Junior
Education
B.S. in BA
Call Center Claims Representative Resume
Objective : Enthusiastic Claims Representative with 2 years of hands-on experience in processing insurance claims and delivering superior customer service. Skilled in investigating claims, negotiating settlements, and ensuring regulatory compliance. Adept at building rapport with clients and streamlining processes to enhance operational efficiency. Ready to contribute to a high-performing team and drive client satisfaction.
Skills : Insurance Regulations, Empathy, Attention To Detail, Problem Solving, Team Collaboration, Report Writing
Description :
Investigate and evaluate auto and general liability claims to ensure fair and prompt resolution, contributing to a reduced loss ratio.
Contact and interview claimants, medical professionals, and employers to gather necessary information for thorough investigations.
Adjust and provide reserve recommendations consistent with corporate policies, ensuring accurate financial assessments.
Verify and analyze data used in settling claims, confirming validity and adherence to company practices.
Collaborate with legal counsel on claims requiring litigation, effectively managing a caseload of 120-140 claims.
Provide accurate information to customers regarding claims status through effective communication channels.
Process complex medical claims, including state filings and treatment decision assessments.
Experience
0-2 Years
Level
Entry Level
Education
AAS
Claims Representative Resume
Objective : Proficient Claims Representative with 5 years of extensive experience in the claims process. Skilled in evaluating claims, negotiating fair settlements, and ensuring compliance with industry regulations. Known for exceptional client communication and problem-solving abilities. Eager to utilize analytical expertise and dedication to enhance operational efficiency and contribute positively to a team.
Skills : Claims Analysis Software, Data Interpretation, Fraud Detection, Collaborative Teamwork, Microsoft Office Suite, Customer Relationship
Description :
Analyzed claims for accuracy and compliance with relevant policies and regulations.
Provided guidance to team members on complex claims issues, ensuring adherence to procedures.
Managed a high volume of claims, demonstrating strong organizational skills and attention to detail.
Communicated effectively with clients, providing updates and resolving inquiries regarding their claims.
Utilized specialized software for claims documentation, tracking, and reporting.
Investigated claims thoroughly to determine validity and appropriate resolutions.
Collaborated with legal and compliance teams to ensure proper handling of claims and settlements.
Experience
2-5 Years
Level
Junior
Education
B.S. in BA
Claims Representative Resume
Objective : Enthusiastic Claims Representative with 2 years of experience in efficiently managing claims processes and delivering high-quality customer service. Skilled in analyzing claims, negotiating settlements, and ensuring compliance with industry standards. Dedicated to fostering strong client relationships and contributing to team success while driving operational efficiency.
Efficiently manage workers' compensation claims, determining compensability and benefits while ensuring compliance with state regulations.
Develop and implement action plans for claims resolution, coordinating return-to-work efforts and overseeing payment approvals.
Process assigned disability claims, evaluating benefits and managing action plans per client contracts.
Ensure meticulous documentation and accurate coding for all claim files.
Communicate effectively about rejected claims, submitting necessary adjustments and following up on coding errors.
Handle claims invoices for payment processing, reviewing contractor proposals, and training new team members.
Conduct thorough investigations into homeowners' claims, verifying coverage and assessing property damage through direct customer interactions.
Experience
0-2 Years
Level
Entry Level
Education
B.S. Business Admin.
Claim Representative/Representative Resume
Objective : Driven Claims Representative with 2 years of experience in effectively managing insurance claims and enhancing customer satisfaction. Proficient in evaluating claims, negotiating settlements, and ensuring compliance with industry regulations. Known for strong communication skills and a commitment to fostering positive relationships with clients and stakeholders. Eager to contribute to a results-oriented team.
Reviewed and processed medical provider bills in accordance with the Workers Compensation fee schedule.
Evaluated claims to determine the necessity for examination under oath.
Analyzed claim data to identify trends and potential fraud indicators.
Maintained detailed records of claims and correspondence for audit purposes.
Managed administrative tasks including filing, scanning, and drafting correspondence.
Analyzed data to identify solutions for administrative challenges.
Coordinated reports and scheduled administrative projects to expedite team tasks.
Experience
0-2 Years
Level
Entry Level
Education
AAS
Claim Representative Resume
Objective : Accomplished Claims Representative with 5 years of extensive experience managing the claims process. Adept at investigating claims, negotiating settlements, and ensuring adherence to regulatory standards. Recognized for exceptional client service and effective communication skills. Ready to leverage my expertise to enhance operational efficiency and contribute positively to a high-performing team.
Consistently received positive feedback for outstanding customer service.
Experience
2-5 Years
Level
Junior
Education
B.S. in BA
Jr. Claims Service Representative Resume
Headline : Dedicated insurance professional with 7 years of comprehensive experience in claims management. Skilled in analyzing claims, negotiating settlements, and ensuring compliance with industry regulations. A strong communicator known for building relationships and enhancing client satisfaction. Seeking to leverage proven expertise to contribute positively to a dynamic team environment.
Skills : Critical Thinking, Process Improvement, Financial Acumen, Case Management, Stress Management, Policy Interpretation
Description :
Handled all claims processes, including comparative negligence and complex liability issues.
Engaged in ongoing education through NICB, focusing on insurance fraud prevention tactics.
Drafted comprehensive statements of loss detailing damages and policy coverage.
Analyzed first reports of loss to assess liability accurately.
Conducted thorough reviews of claims data to verify validity and compliance.
Mentored over 30 new claims staff members, enhancing team effectiveness.
Maintained vigilance for potential fraud in all assigned claims, contributing to risk management efforts.
Experience
5-7 Years
Level
Management
Education
B.S.B.A.
Associate Claims Service Representative Resume
Objective : Proactive Claims Service Representative with 2 years of experience in processing and managing insurance claims. Skilled at investigating claims, ensuring compliance, and effectively communicating with clients. Passionate about fostering strong relationships and enhancing customer satisfaction while contributing to team goals.
Investigated claims for insurance fraud, collaborating with Special Investigative Units for thorough reviews.
Processed customer orders and entered client information into the POS system to facilitate accurate quotes and estimates.
Assisted in securing loans for customers purchasing vehicles, ensuring proper documentation and compliance.
Provided exceptional customer service by addressing concerns and resolving issues promptly.
Reported auto accidents, guiding clients through the claim process with empathy and professionalism.
Scheduled auto appraisals and coordinated communication between body shops and rental agencies.
Handled an average of 30 customer calls daily, effectively addressing inquiries and providing product information.
Experience
0-2 Years
Level
Entry Level
Education
AAS
Telephone Claims Representative Resume
Objective : Driven Claims Representative with 2 years of experience in managing telephone claims processes and ensuring compliance with industry standards. Adept at analyzing claims, negotiating settlements, and resolving customer inquiries efficiently. Passionate about delivering exceptional service and building strong relationships with clients to enhance overall satisfaction.
Skills : Insurance Terminology, Effective Telephone Communication, Accurate Data Entry, Persuasion Skills, Technical Writing, Client Relationship
Description :
Conducted thorough interviews with claimants to gather necessary information.
Participated in continuing education to stay updated on industry changes.
Addressed customer inquiries and resolved issues through effective communication.
Maintained accurate records of daily tasks and claims processing activities.
Gained proficiency in handling various aspects of auto claims management.
Developed a strong understanding of company policies and industry regulations.
Collaborated with team members to enhance overall claims processing efficiency.
Experience
0-2 Years
Level
Entry Level
Education
A.S. in Bus Admin
Telephone Claims Representative Resume
Objective : With over two years of experience as a Telephone Claims Representative, I excel in managing claims processes and delivering outstanding customer service. My expertise lies in evaluating claims, coordinating with stakeholders, and ensuring compliance with industry standards. I am committed to enhancing client satisfaction and eager to contribute my skills to a results-driven team.
Skills : Time-sensitive Tasks, Customer Service Excellence, Negotiation Tactics, Time-sensitive Decision Making, Training And Mentoring, Data Entry
Description :
Investigated auto claims to determine coverages, liability, and damages while maintaining accurate records.
Handled a high volume of inbound calls, providing prompt responses to inquiries from policyholders, claimants, and attorneys.
Collaborated with adjusters and appraisers to coordinate auto inspections, ensuring timely service for customers.
Negotiated with adverse carriers to achieve favorable settlements for clients.
Delivered exceptional customer service in a fast-paced environment, addressing concerns and providing solutions.
Managed GEICO customer claims, ensuring adherence to company policies and regulatory standards.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in BA
Telephone Claims Representative Resume
Objective : Results-driven Claims Representative with extensive experience in handling complex claims and providing timely resolutions. Proficient in utilizing claims management software and maintaining accurate records. Strong problem-solving abilities and a customer-focused approach, ensuring clients receive the best possible service. Excellent interpersonal skills, facilitating effective communication with clients and team members.
Objective : Enthusiastic Auto Claims Representative with 5 years of experience in managing claims processes from initiation to resolution. Proficient in analyzing vehicle damage, negotiating settlements, and ensuring compliance with industry standards. Committed to delivering exceptional client service and fostering strong relationships. Eager to utilize my expertise to enhance team performance and operational efficiency.
Created first notice of loss for initial claims reporting, reviewing policyholder coverage and completing thorough investigations.
Collaborated with customers to assess, appraise, and settle vehicle damage claims effectively.
Conducted field appraisals on damaged vehicles, ensuring accurate estimates and timely settlements.
Communicated clear expectations to customers regarding repair timelines, outcomes, and costs.
Explained repair authorization processes and secured necessary signatures from customers.
Selected as a member of the Ambassador of Employee Mentor program, promoting workplace engagement.
Participated in the Employee Engagement Committee to enhance team morale and collaboration.
Experience
2-5 Years
Level
Junior
Education
B.S. in BA
Auto Claims Representative Resume
Objective : Detail-oriented Auto Claims Representative with 2 years of experience in managing and resolving claims efficiently. Skilled in conducting thorough investigations, assessing damages, and negotiating settlements to ensure compliance with industry standards. Committed to delivering exceptional service and building strong client relationships to enhance overall satisfaction and operational efficiency.
Skills : Auto Claims Management, Claims Processing, Market Awareness, Service Orientation, Policy Review, Compliance Knowledge
Description :
Managed an inventory of approximately 120 auto claims, collaborating with defense counsel to achieve timely settlements.
Handled property damage and injury claims in a fast-paced call center environment, ensuring compliance with industry standards.
Conducted thorough investigative interviews with insureds, claimants, and witnesses to gather essential information for liability assessments.
Reviewed medical records and billing statements to evaluate injuries and lost wages accurately.
Negotiated settlements with insureds and claimants, ensuring fair compensation and compliance with regulations.
Implemented strategies to reduce loss ratios through prompt and effective claims processing.
Developed strong relationships with clients and stakeholders to enhance communication and service delivery.
Experience
0-2 Years
Level
Entry Level
Education
B.S. in BA
Auto Claims Representative Resume
Objective : Dedicated Auto Claims Representative with 5 years of experience in managing the complete claims process. Expert in evaluating vehicle damage, negotiating settlements, and ensuring compliance with all regulatory standards. Passionate about delivering superior client service and building strong relationships to enhance customer satisfaction. Looking forward to leveraging my skills to drive operational success.
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