Claims Specialist Resume
Headline : Investigating and reporting discrepancies, Communicating persistent discrepancies to appropriate leadership, and also Documenting medical claims actions by completing forms, reports, logs, and records.
Skills : Lotus Notes, Linx, Microsoft, Multitasking.
Description :
- Responsible for performing customer support functions for patients to include problem-solving accounts discrepancies and research financial activity within the accounting systems.
- Maintained knowledge of policy and procedures and insurance coverage benefit levels, eligibility systems, and verification processes.
- Demonstrated timely customer service and cross-functional coordination of account information to promote and maintain positive customer service.
- Performed patient billing and collection activity as a result of patient contact in person or via telephone.
- Received and processed payments received directly from patient or patient's family, in person or over the telephone.
- Maintained organized and accurate backup of completed transactions.
- Maintained strict compliance with related Policies and Procedures in all transactions, ensuring the protection of patient's Protected Health Information.
Experience
5-7 Years
Level
Consultant
Education
Bachelor of Science
Claims Specialist Resume
Summary : Motivated, personable professional with a talent for quickly learning new technology. Diplomatic and tactful with professionals and non-professionals at all levels. Accustomed to handling sensitive, confidential records. Flexible and versatile; able to maintain a sense of humor under pressure. Poised and competent with demonstrated ability to easily transcend cultural differences. Thrive in deadline-driven environments. Good team-building skills.
Skills : Medicare and Medicaid laws and practices.
Description :
- Balancing daily claims upload report for Accounting, Management, and Investor.
- Receiving daily claims upload communications from outside vendors and reconciling with an internal database.
- Researching and correcting upload occurrences by using excel formulas between three different daily reports.
- Performing a variety of claims upload resets to correct system upload errors.
- Work task planning, flexibility, and strong communication skills with team members to enable completing 2 people / 2 step Claims Update process, ensure all holds have been cleared and all steps have been processed by end of the day.
- Working as part of the Aged Advances Reporting Team.
- Receiving monthly loan batches from investors that require extensive foreclosure timeline history research and reconciling to prepare report rebuttals and action items to investors.
Experience
7-10 Years
Level
Executive
Education
Associate Of Applied Science
Claims Specialist Resume
Objective : Highly detail-oriented individual with excellent customer service and leadership skills seeking a position where I can further my career and knowledge, Earning Employee of the Month honors four times.
Skills : Microsoft Office, Excel, Administrative Assistant, Microsoft Outlook, Legal Terminology, Legal Research.
Description :
- Investigated and coordinated no-fault benefits for accident claims from auto, home, or other liability insurance policies.
- Resolved accounts as quickly and accurately as possible, through communicating with patients, attorneys, and adjusters.
- Reviewed and Researched accident claims to investigate possible leads.
- Billed no-fault and third-party liability carriers when appropriate.
- Requested proper documentation from insurance representatives when no no-fault insurance existed.
- Closed and returned claims to client upon resolution using correct procedures regarding the denial process.
- Used MRA's case management system, Acclaim, to maintain proper account documentation.
Experience
2-5 Years
Level
Junior
Education
Associate's In Marketing
Claims Specialist Resume
Objective : Experienced Customer Service professional with more than 10 years working with a diverse group of people; seeking to work in or out of the home with a company that can use my skills and experience as a loyal team player that can adjust to any circumstance for the need for the company.
Skills : Microsoft Office.
Description :
- Investigate coverage on specialist only claims, which include: thefts, fires, trailers, motorcycles, coverage disputes, and recreational vehicles.
- Responsible for investigating complex liability claims involving losses of three or more vehicles.
- Mentor and train new hire employees in resolving complex liability disputes and policy analysis.
- Review and correct 14 day, 28 day, and 30 day ISO Claim Errors for LNI personal auto team.
- Led liability off-set meetings for the Liability Non Injury Auto Claims Team.
- Cross-trained to assist and handle status calls in the call center.
- Finished the first year of my employment with a top 10% end of year review of all employees across the company nationwide.
Experience
2-5 Years
Level
Junior
Education
BS In Business Management
Claims Specialist Resume
Summary : To obtain a challenging claims or customer service position that will utilize my business and interpersonal skills and will provide an opportunity for growth and advancement.
Skills : Claims Processing, Insurance.
Description :
- Responsible for disability, medical, and death claims processing, as well as compliance functions pertaining to health insurance.
- Analyzed claims to determine extent of company's liability and make approval or denial decisions in accordance with policy provisions.
- Ensured claim investigations are timely and appropriate, and that decisions are correct.
- Obtained routine requirements and determine if additional information is necessary to evaluate the degree of impairment.
- Provided customer service for plan benefits and resolve claim issues for members and providers.
- Processed policy changes on individual health policies.
- Responsible for health insurance compliance reporting, including responding to State Insurance Department inquiries, regularly reporting to states their mandated statistics and claim related information, monitoring new regulations as they pertain, and maintaining claim practice guidelines.
Experience
10+ Years
Level
Senior
Education
Associate of Science
Claims Specialist Resume
Summary : Motivated Claims Specialist with over 4 years of customer service in a face past environment. Dedicated customer service representative with the motivation to maintain customer satisfaction and contribute to company success. Excellent communicator with 2+ years experiences working in a demanding call center environment as a customer service representative. Enthusiastic customer service/telesales representative with over 3 years experience in sales, account management and training.
Skills : Front desk, Switchboard, Insurance, Data Entry, Microsoft Office, Pelco Monitoring Systems.
Description :
- Collected customer feedback and made process changes to exceed customer satisfaction goals.
- Made reasonable procedure exceptions to accommodate unusual customer requests.
- Demonstrated mastery of customer service call script within specified timeframes.
- Addressed customer service inquiries in a timely and accurate fashion.
- Maintained up-to-date records at all times Developed effective relationships with all call center departments through clear communication.
- Worked with upper management to ensure appropriate changes were made to improve customer satisfaction.
- Built customer loyalty by placing follow-up calls for customers who reported product issues.
Experience
7-10 Years
Level
Management
Education
B.A. In Communications Candidate
Claims Specialist Resume
Objective : Experienced Claims Specialist professional with a career in mortgage, banking, accounting, customer service and collections. A highly motivated professional with more than twenty years of combined experience. A creative, results-oriented and solution-focused individual. Excellent interpersonal analytical, and organizational skills. Competitive and flexible with great leadership skills. A diverse individual and enjoy teamwork.
Skills : Microsoft Office,
Description :
- Investigated, evaluated and settled claims, applied technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- Conferred with legal counsel on claims requiring litigation.
- Resolved complex, severe exposure claims, using high service oriented file handling.
- Paid and processed claims within designated authority level.
- Entered claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Presented cases and participate in their discussion at claim committee meetings.
- Verified and analyzed data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
Experience
2-5 Years
Level
Executive
Education
Associate
Claims Specialist Resume
Summary : Claims Specialistprofessional is to provide outstanding customer and employer satisfaction using the necessary work habits acquired through previous work experiences. Leading my team by not only meeting expectations but setting the bar higher and leaving a positive impact on fellow business associates.
Skills : Strong Technical And Functional Skills With Computers And Claim Applications. Excellent Organizational Skills, Verbal Skills And Customer Focus Skills.
Description :
- Contacted policyholders, claimants, and witnesses to determine liability in auto accidents.
- Discussed coverages and exclusions with the policyholder under their policy.
- Secured statements from parties involved in auto accidents to determine liability.
- Obtained and reviewed vehicle photos and accident scene photos to aid in determining liability.
- Utilized outside vendors if necessary to aid in reaching a final liability decision.
- Discussed and explained the final liability decision with involved parties.
- Recognized, investigated, and concluded coverage questions.
Experience
10+ Years
Level
Senior
Education
BS In Criminal Justice
Disability Claims Specialist Resume
Summary : Auditing payment records of providers that are utilizing E-commerce alternatives to ensure complete and accurate information is received by the department to justify claims being paid, and also Working with both State and Federal auditors as well as with independent auditors in conducting research into payments made based on a contract with providers.
Skills : Excel, Customer Service, Data Entry, Filing, Powerpoint, Photoshop, Word, Adobe.
Description :
- Maintained files with the correct correspondence and payments Tackle questions that pertain to all aspects of the claim with the insured Confirm what coverage's that insured has and explain them in detail.
- Handled calls that come in and return messages in a timely manner.
- Helped insured's with getting their vehicle back to where it was prior to the accident.
- Scheduled appointments for insured when they need an Independent Medical Exam.
- Copied files, faxing, and ten key calculators.
- Managed the majority of the non-complex claims such as glass and towing.
- Directed customers to the various departments of operations.
Experience
10+ Years
Level
Senior
Education
Bachelor Of Science
Claims Specialist Resume
Headline : High-energy Claims Specialist professional offering 10 years of outstanding customer service while upholding company standards. Passionate about lasting relationships being creative, and the savvy that is critical to financial and operational success.
Skills : Microsoft Packages, CRM.
Description :
- Completed more than 500+ claims throughout my tenure.
- Provided optimum service to policy holders, negotiated fair settlements and identified fraudulent claims.
- Acted as a single point of contact to assist with file closures; resolve complex claims-processing issues.
- Participated in quality-control audits.
- Monitored claim status updates.
- Responsible for accurately communicating the claims warranty process to the customer.
- Outlined any warranty claims documents, procedures or financial payment processing.
Experience
5-7 Years
Level
Consultant
Education
Bachelor's In Computer Science
Claims Specialist Resume
Objective : Claims Specialist with 15 years background in a Central Business Office. core competencies included PC Literate, Microsoft Office Products, ability to work in a team environment and strong work ethic as well as excellent communication and time management skills. handles tasks with accuracy and efficiency.
Skills : Customer Service, Knowledge Management.
Description :
- Investigated, evaluated, and se le claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
- Supervised claims adjusters to ensure that adjusters have followed proper methods.
- Resolved complex, severed exposure claims, using high service oriented file handling.
- Paied and processed claims within designated authority level.
- Examined claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
- Verified and analyzed data used in se ling claims to ensure that claims are valid and that se lements are made according to company practices and procedures.
- Entered claim payments, reserves and new claims on computer system, inpu ing concise yet sufficient file documentation.
Experience
2-5 Years
Level
Executive
Education
High School Diploma
Billing Claims Specialist Resume
Headline : Focused and meticulous Medical Billing and Collections/Patient Accounts with an extraordinary eye for detail and a strong customer service ethic. Able to work as an independent or as part of a medical office team. Able to handle high volumes of paperwork quickly and accurately. Highly experienced in reconciling insurance and patient payments and resolving account disputes. Dedicated to maintaining strict patient/client confidentiality.
Skills : Sales, Customer Service, Multitasking.
Description :
- Adjusted reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
- Worked with 3rd party module providers to provide equivalent replacement modules when necessary.
- Uncovered fraudulent claims scheme; provided evidence leading to the recovery of thousands of dollars in insurance overpayments.
- Researched environmental guidelines and processing laws and regulations at both the state and federal level.
- Reviewed and processed medical bills for the policyholder under their injury coverages.
- Formulated and enforced Service Center policies, procedures, and quality assurance measures.
- Combining various Access database reports in Excel to prepare monthly Corporate Reporting Investor Audit of batches of loans.
Experience
5-7 Years
Level
Consultant
Education
Associate
Claims Specialist Manager Resume
Objective : Conducting income verification for contracted providers with financial institutions that require income information before determining that the provider is eligible for a loan, also with City, County, and State-administered programs or other services.
Skills : Vehicle Estimator, Vehicle Knowledge.
Description :
- Handled claims filed via office visits and telephone calls on behalf of insureds and claimants.
- Handled various claims involving damage to insured and claimant vehicles.
- Investigated basic liability claims for insured policyholders.
- Resolved claims coverage questions for pending claims.
- Handled subrogation for insured claims and prepared claim files for arbitration.
- Set up appointments for insured and claimant vehicle inspections at body shops.
- Evaluated various medical claims to determine their validity, and issued payment to providers for valid claims.
Experience
2-5 Years
Level
Executive
Education
BS In Management
Recovery & Claims Specialist Resume
Headline : Identifying repetitious or suspicious claims of a lost warrant and initiate OSI inquiry, and also Researching claims on-line information, printed computer reports, and documentation submitted by providers.
Skills : SAP, Microsoft Office, Customer Service, Training & Development, Troubleshooting, Billing, Data Entry, Written Communication, Coaching.
Description :
- Determined appropriate coverage and limits for items reported from the loss based on policy language.
- Explained partial and full denials for items not covered under the policy.
- Asked questions specific to the reported loss to determine if further investigation for fraud was needed.
- Determined value of items involved in loss with current market value based on like kind and quality.
- Negotiated current replacement cost and actual cash value for items, and explained depreciation and price for items.
- Assisted coworkers with high claim volume by following up with their customers in regards to their claim status or making necessary contact for investigative purposes.
- Received above office average of 8.6 out of 10 from customer surveys for the complete satisfaction of the handling of their claim.
Experience
5-7 Years
Level
Consultant
Education
B.A. In Psychology
Claims Specialist Resume
Summary : Over ten years of experience providing administrative support, event planning, logistical coordination, and data processing in a corporate environment. Skill in written and oral communication, technology, planning, problem-solving, and organization.
Skills : Windows, Multitasking, Claims.
Description :
- Created accounts for members by scanning documents of the claims submitted and attaching all documents to appropriate accounts.
- Reviewed supporting claims documents and transfer the information in specific data into the designated accounts.
- Rejected incomplete documents received for missing information and mail back any unknown document to the sender.
- Updated job knowledge by participating in educational opportunities; reading professional publications.
- Maintained personal networks.
- Confirmed that members benefit plans cover intended policy coverage.
- Established proof of loss by studying medical documentation.
- Assembled additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting an investigation of questionable claims.
Experience
10+ Years
Level
Senior
Education
Bachelors In Psychology
