Claims Specialist Resume Samples

A Claims Specialist job role includes examining claims, negotiating and processing settlements, verifying insurance coverage and reviewing insurance cases. Job duties listed on a Claims Specialist Resume include some or all of these – reviewing insurance claims, assisting insurance adjuster with unusual or complicated claims, performing detailed site inspections, reviewing and processing new claims reports or court verdicts; negotiating settlements, resolving claims in a timely manner, determining the validity of the claim, compiling reports and staying up-to-date with state and federal laws.

Even though the job description may vary with the type of insurance, the needed skills are common and include – the ability to treat all clients fairly and equitably; being legitimate and reasonable, knowledge of claims verification, and payment processing; and the potential to deal with customers in a diplomatic manner. For an entry-level position, high school or GED will help. A combination of experience and education may be considered in lieu of a degree.

Claims Specialist Resume

Headline : To obtain a position in Medical Billing/Management that challenges my abilities and gives opportunities for growth and advancement.

Skills : Excel, Lotus Notes, Linx, Microsoft, Outlook.

Description :

    1. Responsible for performing customer support functions for patients to include problem solving accounts discrepancies and research financial activity within the accounting systems.
    2. Maintain knowledge of policy and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
    3. Demonstrate timely customer service and cross-functional coordination of account information to promote and maintain positive customer service.
    4. Performs patient billing and collection activity as a result of patient contact in person or via telephone.
    5. Receive and processes payments received directly from patient or patient's family, in person or over the telephone.
    6. Maintains organized and accurate backup of completed transactions.
    7. Maintains strict compliance with related Policies and Procedures in all transactions, ensuring protection of patient's Protected Health Information.
    8. Investigates and reports discrepancies; communicating persistent discrepancies to appropriate leadership.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Consultant
Education
Education
Bachelor of Science


Glass 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 :

    1. Balancing daily claims upload report for Accounting, Management and Investor.
    2. Receiving daily claims upload communications from outside vendor and reconciling with internal database.
    3. Researching and correcting upload occurrences by using excel formulas between three different daily reports.
    4. Performing a variety of claims upload resets to correct system upload errors.
    5. Work task planning, flexibility and strong communication skills with team members to enable completing 2 person / 2 step Claims Update process, insure all holds have been cleared and all steps have been processed by end of day.
    6. Working as part of the Aged Advances Reporting Team.
    7. Receiving monthly loan batches from investor that require extensive foreclosure timeline history research and reconciling to prepare report rebuttals and action items to investor.
    8. Combining various Access database reports in Excel to prepare monthly Corporate Reporting Investor Audit of batches of loans.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Executive
Education
Education
Associate Of Applied Science


Claims Specialist/Biller Resume

Objective : Highly detail- oriented individual with excellent customer service and leadership skills seeking a position where I can further my career and knowledge.

Skills : Microsoft Office, Excel, Administrative Assistant, Microsoft Outlook, Legal Terminology, Legal Research.

Description :

    1. Investigated and coordinated no-fault benefits for accident claims from auto, home, or other liability insurance policies.
    2. Resolved accounts as quickly and accurately as possible, through communicating with patients, attorneys, and adjusters.
    3. Reviewed and Researched accident claims to investigate possible leads.
    4. Billed no-fault and third-party liability carriers when appropriate.
    5. Requested proper documentation from insurance representatives when no no-fault insurance existed.
    6. Closed and returned claims to client upon resolution using correct procedures regarding the denial process.
    7. Used MRA's case management system, Acclaim, to maintain proper account documentation.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Associate's In Marketing

Litigated 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 :

    1. Investigate coverage on specialist only claims, which include: thefts, fires, trailers, motorcycles, coverage disputes, and recreational vehicles.
    2. Responsible for investigating complex liability claims involving losses of three or more vehicles.
    3. Mentor and train new hire employees in resolving complex liability disputes and policy analysis.
    4. Review and correct 14 day, 28 day, and 30 day ISO Claim Errors for LNI personal auto team.
    5. Led liability off-set meetings for the Liability Non Injury Auto Claims Team.
    6. Cross-trained to assist and handle status calls in the call center.
    7. Finished the first year of my employment with a top 10% end of year review of all employees across the company nationwide.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
BS In Business Management

Medical 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 :

    1. Responsible for disability, medical, and death claims processing, as well as compliance functions pertaining to health insurance.
    2. Disability Premium Waiver Claims Examination - Analyze claims to determine extent of company's liability and make approval or denial decisions in accordance with policy provisions.
    3. Ensure claim investigations are timely and appropriate, and that decisions are correct.
    4. Obtain routine requirements and determine if additional information is necessary to evaluate the degree of impairment.
    5. Medical Claims/Compliance Process medical claims, assuring proper payment according to insurance benefit plan.
    6. Provide customer service for plan benefits and resolve claim issues for members and providers.
    7. Process policy changes on individual health policies.
    8. 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.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Associate of Science

Benefits And Claims Specialist Resume

Summary : Motivated customer service representative 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 experience 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 :

    1. Collected customer feedback and made process changes to exceed customer satisfaction goals.
    2. Made reasonable procedure exceptions to accommodate unusual customer requests.
    3. Demonstrated mastery of customer service call script within specified timeframes.
    4. Addressed customer service inquiries in a timely and accurate fashion.
    5. Maintained up-to-date records at all times Developed effective relationships with all call center departments through clear communication.
    6. Worked with upper management to ensure appropriate changes were made to improve customer satisfaction.
    7. Built customer loyalty by placing follow-up calls for customers who reported product issues.
    8. Formulated and enforced Service Center policies, procedures and quality assurance measures.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
B.A. In Communications Candidate

Senior Claims Specialist Resume

Objective : Experienced 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 :

    1. Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
    2. Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
    3. Confer with legal counsel on claims requiring litigation.
    4. Resolve complex, severe exposure claims, using high service oriented file handling.
    5. Pay and process claims within designated authority level.
    6. Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
    7. Present cases and participate in their discussion at claim committee meetings.
    8. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
Associate

Collections/Claims Specialist Resume

Summary : My goals are a professional are 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 :

    1. Contacting policyholders, claimants and witnesses to determine liability in auto accidents.
    2. Discussing coverages and exclusions with the policyholder under their policy.
    3. Securing statements from parties involved in auto accidents to determine liability.
    4. Obtaining and reviewing vehicle photos and accident scene photos to aid in determining liability.
    5. Utilizing outside vendors if necessary to aid in reaching a final liability decision.
    6. Discussing and explaining the final liability decision with involved parties.
    7. Recognizing, investigating and concluding coverage questions.
    8. Reviewing and processing medical bills for the policyholder under their injury coverages.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
BS In Criminal Justice

Disability Claims Specialist Resume

Summary : Below show cases some of my skills and experience: Ability to work both independently and within a group dynamic Over 20 years of experience with internal and external customer service. Strong organizational skills that ensure proper management of time and resources Multi-functional in customer service, ten key calculator, copy machine, fax machine. Proficient in Excel, quick books, payroll, Microsoft office, Windows.

Skills : Microsoft Office, Excel, Customer Service, Data Entry, Filing, Powerpoint, Photoshop, Word, Adobe.

Description :

    1. Maintaining 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.
    2. Handle calls that come in and return messages in a timely manner.
    3. Help insured's with getting their vehicle back to where it was prior to the accident.
    4. Schedule appointments for insured when they need an Independent Medical Exam.
    5. Copy files, faxing, and ten key calculators.
    6. Managed the majority of the non-complex claims such as glass and towing.
    7. Direct customers to the various departments of operations.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor Of Science

Casualty Claims Specialist Resume

Headline : High-energy 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 :

    1. Completed more than 500+ claims throughout my tenure.
    2. Provided optimum service to policy holders, negotiated fair settlements and identified fraudulent claims.
    3. Acted as a single point of contact to assist with file closures; resolve complex claims-processing issues; participate in quality-control audits; and monitor claim status updates.
    4. Responsible for accurately communicating the claims warranty process to the customer.
    5. Outline any warranty claims documents, procedures or financial payment processing.
    6. Worked with 3rd party module providers to provide equivalent replacement modules when necessary.
    7. Uncovered fraudulent claims scheme; provided evidence leading to the recovery of thousands of dollars in insurance overpayments.
    8. Researched environmental guidelines and processing laws and regulations at both the state and federal level.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Consultant
Education
Education
Bachelor's In Computer Science

Lead Claims Specialist Resume

Objective : Service- oriented Medical collector 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 :

    1. Investigate, evaluate 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.
    2. Supervise claims adjusters to ensure that adjusters have followed proper methods.
    3. Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
    4. Resolve complex, severe exposure claims, using high service oriented file handling.
    5. Pay and process claims within designated authority level.
    6. Examine claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
    7. Verify and analyze data used in se ling claims to ensure that claims are valid and that se lements are made according to company practices and procedures.
    8. Enter claim payments, reserves and new claims on computer system, inpu ing concise yet sufficient file documentation.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
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.

Description :

    1. Investigate, evaluate and settle claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
    2. Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.
    3. Confer with legal counsel on claims requiring litigation.
    4. Resolve complex, severe exposure claims, using high service oriented file handling.
    5. Pay and process claims within designated authority level.
    6. Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
    7. Present cases and participate in their discussion at claim committee meetings.
    8. Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Consultant
Education
Education
Associate

Claims Specialist Manager Resume

Objective : To obtain a position in insurance claims that allows me to utilize my knowledge of material damage and liability claims.

Skills : Vehicle Estimator, Vehicle Knowledge.

Description :

    1. Handled claims filed via office visits and telephone calls on behalf of insureds and claimants.
    2. Handled various claims involving damage to insured and claimant vehicles.
    3. Investigated basic liability claims for insured policyholders.
    4. Resolved claims coverage questions for pending claims.
    5. Handled subrogation for insured claims and prepared claim files for arbitration.
    6. Setup appointments for insured and claimant vehicle inspections at body shops.
    7. Evaluated various medical claims to determine their validity, and issued payment to providers for valid claims.
    8. Earned Employee of the Month honors four times.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
BS In Management

Recovery & Claims Specialist Resume

Headline : To obtain a position that uses skills developed through my career while enhancing other skills and creating new skills through job development and cross training.

Skills : SAP, Microsoft Office, Customer Service, Training & Development, Troubleshooting, Billing, Data Entry, Written Communication, Coaching.

Description :

    1. Determined appropriate coverage and limits for items reported from the loss based on policy language.
    2. Explained partial and full denials for items not covered under policy.
    3. Asked questions specific to the reported loss to determine if further investigation for fraud was needed.
    4. Determined value of items involved in loss with current market value based on like kind and quality.
    5. Negotiated current replacement cost and actual cash value for items, and explained depreciation and price for items.
    6. 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.
    7. Received above office average of 8.6 out of 10 from customer surveys for complete satisfaction of the handling of their claim.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Consultant
Education
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 organizational.

Skills : Windows.

Description :

    1. Create accounts for members by scanning documents of the claims submitted and attaching all documents to appropriate accounts.
    2. Review supporting claims documents and transfer the information in specific data into the designated accounts.
    3. Reject incomplete documents received for missing information and mail back any unknown document to the sender.
    4. Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks.
    5. Confirms that members benefit plans cover intended policy coverage.
    6. Establishes proof of loss by studying medical documentation; assembling additional information as required from outside sources, including claimant, physician, employer, hospital, and other insurance companies; initiating or conducting investigation of questionable claims.
    7. Documents medical claims actions by completing forms, reports, logs, and records.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelors In Psychology