Claims Service Specialist Resume Samples

The major duty of a Claims Services Specialist is to take responsibility for reviewing the claims of the client and determine if they are covered under the insurance policy or not. Some of the work activities relevant to this post are depicted on the Claims Service Specialist Resume as follows – reviewing the insurance claims, ensuring that it is properly filed, assisting insurance adjusters with unusual or complicated claims, approving or denying the claim after making a thorough research, interviewing and gathering data to determine the authenticity of the incident, conducting investigations, ensuring timely disbursement of claim amount to clients; and consulting with attorneys in case of disposition of complex claims.

While the actual duties vary based areas, the needed skills are common and include – significant experience in the insurance industry, excellent knowledge of the latest state, local and federal insurance-related policies; and a good understanding of insurance claims negotiation and settlement techniques. A high school diploma and work experience are needed.

Claims Service Specialist Resume example

Claims Service Specialist Resume

Summary : Become a valuable asset to your company and provide the best service possible.

Skills : Data Entry, Customer Service.

Description :

  • Analyzed complex medical claims and properly adjudicated for final payment Researched and reviewed original claims Performed online research related .
  • Answered Phones, file accident reports for customer, fully handle claims by issuing any necessary payment, setting up rentals and inspections of .
  • Able to handle more complex claims.
  • Customized claims service to our insureds by appropriately assigning preferred contractors and/or independent adjusters to assist with field work.
  • Assisted Allstate customers with questions regarding property and auto claims.
  • Demonstrated a sense of ownership for all work with the goal of positively driving business results.
  • Handled high stress calls with professionalism.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Diploma


Sr. Claims Service Specialist Resume

Summary : To obtain a challenging career-oriented position that will enable opportunities toward advancement in reaching organizational and personal goals.

Skills : Microsoft Office, Microsoft Word, Microsoft Outlook, Microsoft Powerpoint, Microsoft Powerpoint.

Description :

    1. Created and tested new Processes and systems for increasing customer service Satisfaction.
    2. Trained and provided back-up for other customer service representatives when needed.
    3. Managed quality communication, customer support and product representation for each client.
    4. Worked under strict deadlines and responded to service requests and emergencies.
    5. Responded to general inquiries from members, staff, and clients via mail, email and fax.
    6. Served as one of the company's bilingual Spanish/English customer Service representative.
    7. Guaranteed positive customer Experiences and resolved all customer complaints.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Criminal Justice


Jr. Claims Service Specialist Resume

Objective : Seeking to obtain a with Allstate Insurance Company in which experience, skill, and work ethic will add value to the company.

Skills : Microsoft Office, Microsoft Word, Microsoft Outlook, Microsoft Powerpoint, Microsoft Powerpoint.

Description :

  • Collected customer feedback and made process changes to exceed customer satisfaction goals.
  • Made reasonable procedure exceptions to accommodate unusual customer requests.
  • Created and tested new Processes and systems for increasing customer service Satisfaction.
  • Assigned independent adjusters and preferred contractors for quality and timely service.
  • Assisted resolution specialists with tasks assigned, such as assisting with contents valuation and depreciation holdback.
  • Maintained open lines of communication with agents, sales representatives, marketing and underwriting personnel who are serviced by the resolution center.
  • Established and maintained effective working relationships with co-workers.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Criminal Justice

Claims Service Specialist Resume

Objective : To obtain a position, that will utilize my work experience and provide a challenging career with potential for advancement.

Skills : Microsoft Office, Healthcare, Customer Service, Research, Leadership Development.

Description :

    1. Achieved customer satisfaction through the ability to identify and solve customer needs.
    2. Clarifed customer requirements; probe for and confirm understanding of requirements or problems.
    3. Confirmed customer understanding of the solution and provide additional customer education as needed, effectively transfer misdirected customer requests to an appropriate party.
    4. Handled investigational claims involving sensitive Inquiries and correspondence under heavy volumes and tight deadlines.
    5. Joined another specialised team that was created to handle only unemployment determinations, discussing appeals with clients, and drafting.
    6. Worked a full service desk as an unemployment insurance consultant communicating with clients in order to gather information and formulate protest .
    7. Collaborated and worked with colleague mentors to develop knowledge to set claim handling, reserve and resolution strategies.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
BS

Claims Service Specialist III Resume

Summary : Immediate career goal is to work with reputable organization having congenial working environment and where challenging opportunities are available to contribute towards the development of organization. Also, strive to ensure that a high degree of relationship is maintained between staff and colleagues.

Skills : Customer Service, Data Entry, Clerical.

Description :

    1. Investigated and evaluated claims, applying technical knowledge and human relations skills to effect fair and prompt resolution of claims.
    2. Claimed payments and new claims on computer system, inputting concise yet sufficient file documentation.
    3. Maintained claim files such as records of settled claims and an inventory of claims requiring detailed analysis.
    4. Reported overpayments and process overpayments.
    5. Reviewed policy to determine coverage.
    6. Prepared correspondence or related documents and review them for completeness.
    7. Assisted customers filing claims Assisted customers with basic claims process Recognition Committee: collaborate with colleagues to create an.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Medical Assisting

Claims Service Specialist II Resume

Headline : A highly-seasoned professional with years of broad-based and diversified hands on experience in Recruiting, customer Service, Sales, Human Resource Management, operations, account management and PR. Strong experience in multi-location recruiting and placement of Software Engineers/Architects (Distributed and Mainframe), Database Architects/Developers/ Administrators, Network/System/Security, Engineers/Unix/Solaris Administrators, Infrastructure Architects/Engineers, Web Developers, CRM consultants, Technical Program/Project Managers and Business Analysts.

Skills : MS Office, Word, Excel, Outlook, ATS, Ruby, Sabre, Goldmine, NexGen.

Description :

    1. Developed relationships with customers over the phone to answer questions.
    2. Obtained information and provide support throughout the claims process Investigate, analyze and document claims and log all calls file notes into NextGen ATS.
    3. Ensured that appropriate changes were made to resolve caller's issues.
    4. Referd unresolved caller's grievances to designated departments for further investigation.
    5. Received and processed First Notice of Loss (FNOL) into NextGen Allstate proprietary system.
    6. Handled special assignments as requested including back up of other MCO core support pep ensure ongoing work flow and a positive work.
    7. Included Mitchell input of CPT Codes/medical codes, take inquiry calls, pay expense bills, back up to run the DMV plates in a private room.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Bachelor

Claims Service Specialist I Resume

Headline : Creative, resourceful, and flexible. Able to adapt to changing priorities and maintain a positive attitude and strong work ethic.

Skills : Word, Training & Development, Public Speaking, Blogging, Administrative Support, Administrative Assistant.

Description :

  • Supported team of six adjusters Responded to subpoenas & prepared files for litigation Took first notice of loss calls from insured and claimant .
  • Responsible for answering incoming calls from Agents, policyholders, employers and providers by using on-line records of Policyholders Service, .
  • Worked for Allstate as a Claim Service Specialist in Cheyenne, where I'd take claims from people who have been in accidents, set up inspections for .
  • Allowed me to learn how to diffuse bad situations, establish rapport, develop phone skills, and keep personal information confidential.
  • Handled customer complaints and escalated calls or complaints.
  • Provided technical and administrative support to Claims/Underwriting as needed.
  • Structured call center environment Answering routine insurance questions including billing and status inquiries position.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
GED

Assistant Claims Service Specialist Resume

Objective : Over 5 years progressive work experience as a Claims Adjuster and Coordinator in the insurance industry. 1 year work experience in purchasing and order administration in the distribution industry. Skilled in customer service and experience, project management, process improvement and team leadership. Intermediate project management skills with experience completing diverse projects while achieving performance targets.

Skills : Microsoft Office, Fluent In English And Spanish.

Description :

    1. Assigned to assist adjusters in their roles.
    2. Compiled estimates to replace personal property damaged in a loss.
    3. Received increased responsibilities to project manage special projects in addition to daily claims processing.
    4. Recognized as a team leader assigned to coach and train colleagues.
    5. Monitored the completion of claim processing cycle time goals by coordinating deliveries with the claim adjusters.
    6. Reduced the backlog for overdue temporary housing invoices; identified root cause of payment issues and took corrective actions.
    7. Performed clerical duties (including data entry, filing paper documents, email, calendar management, and word processing) Handled Claims Retrieved.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Bachelors Of Science

Associate Claims Service Specialist Resume

Summary : Responsible for intake and set up of new claims files in iVOS Research policy and client information in Salesforce & Starr360 Scanning claims mail and documents and importing into the claims system.

Skills : Legal Research,excel, Powerpoint, Word.

Description :

    1. Handled claim files locates/requests files,moves misfiled documents, sends files to other offices upon request etc.
    2. Retrieved, prints, faxes, or emails supporting documentation to vendors or others as directed.
    3. Investigated prior losses and other information on file and orders reports as needed at the direction of adjusters and management.
    4. Recieved,screens and routes incoming calls and other electronic correspondence.
    5. Contacted or recieved contact from customers or other claim related third parties to obtain and or provide necessary file information to comply with quality and process standards.
    6. Completed all necessary forms,logs documents into the system, and routes them to the appropriate parties.
    7. Coordinated claims in order to meet customer needs.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
BA In Criminal Justice

Claims Service Specialist Resume

Summary : To be employed with a company that can contribute skills and experience to enhance the company's overall objective. To obtain employment with a company that will provide stability and growth.

Skills : Receptionist, Office Administration.

Description :

    1. Investigated, researched, analyzed, verified and recommended solutions, using independent judgment on claims against auto insurance.
    2. Established excellent and courteous working relationship with other employees and the public.
    3. Confirmed coverage for first and third party auto claims Ensured accuracy of information collected and reported and guarded against fraudulent claims.
    4. Performed data entry, filing, typing, word processing, record-keeping and letter writing.
    5. Reviewed processed claims appealed by provider to determine accuracy.
    6. Researched plan details and applied adjustments as needed.
    7. Investigated claims to determine legitimacy.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
HRM