Insurance Claims Representative Resume Samples

An Insurance Claims Representative investigates claims for casualty, personal or property loss and damage, and determine the extent of liability and settlement amount to be paid to the client. While the duties are not common all over, the following are certain core duties that are outlined on the Insurance Claims Representative Resumeinvestigating claims quickly and effectively; negotiating equitable settlements and authorizing prompt payment to policyholders; reviewing insurance forms for accuracy and completeness, calling and writing to the insured parties, reviewing the claim file and the insurance policy to determine coverage; transmitting routine claims for payment, and attending court hearings in case of litigation.

Strong reasoning, time management skills, and organizational abilities are required to solve a wide range of business problems. The ability to understand and utilize insurance and financial reports and legal documents are also crucial. Good manual dexterity and the ability to use all types of office equipment is vital. Formal education beyond a high school diploma is not a must.

 

Insurance Claims Representative Resume example

Insurance Claims Representative Resume

Objective : Seeks to secure a position in a fast-paced organization that offers challenges and opportunities for career development by gaining new skills within a positive team environment.

Skills : Testing, Account Management.

Description :

    1. Managed customers' accounts, keeping records of customer interactions and transactions.
    2. Recorded details of inquiries, comments, and complaints, recorded details of actions taken.
    3. Ensured that claims payments are issued in a timely and accurate manner.
    4. Ensured that claims handling is conducted in compliance with applicable statutes, regulations, and other legal requirements and that all applicable company procedures and policies are followed.
    5. Maintained journal of claims processed and matched all open and closed mail to ensure proper tracking and processing of claims consistent with company guidelines and supervisory expectations.
    6. Used good organizational skills to manage competing demands while performing administrative tasks associated with processing claims such as establishing and maintaining files and folders and generating required correspondences.
    7. Alerted Team Manager to the possibility of fraud potential for claims being processed.
                Years of Experience
                Experience
                2-5 Years
                Experience Level
                Level
                Junior
                Education
                Education
                HS Diploma


                Insurance Claims Representative Resume

                Headline : An experienced and dynamic Health Care professional with an extensive social work service and family preservation background. Seeks to obtain a Customer Service position to further skills and experience and become a great asset to the company.

                Skills : MS Office, Data Entry, Customer Service

                Description :

                  1. Communicated professionally, over the phone, and in-person, with policyholders, claimants, and their representatives.
                  2. Investigated and settled collision, property damage, and homeowner claims.
                  3. Provided quality customer service to members in need of reporting insurance claims.
                  4. Provided updates to members regarding current and previous claims.
                  5. Collected customer information to process insurance claims on lost, stolen, and or physically damage wireless phones.
                  6. Enrolled customers in the insurance program by explaining the terms and conditions of the insurance program.
                  7. Educated the customers on the policy of the insurance program and the benefits of maintaining insurance.
                  8. Transferred customer to the appropriate department to assist in phone replacement.
                Years of Experience
                Experience
                5-7 Years
                Experience Level
                Level
                Executive
                Education
                Education
                Associates in Science


                Insurance Claims Representative Resume

                Summary : Goal-oriented management Insurance Claims Representative professional with excellent organizational and interpersonal skills seeks opportunities to contribute expertise while working for a reputable organization.

                Skills : Typing 70+ wpm, 10-key proficient, Excellent Customer Service and Computer.

                Description :

                  1. Dealt directly with customers either by telephone or electronically.
                  2. Performed daily data entry of incoming insurance claims to be processed by underwriting.
                  3. Performed initial telephone interviews with applicants to obtain any additional information underwriting required.
                  4. Responded promptly to customer inquiries, handle and resolve customer complaints.
                  5. Obtained and evaluated all relevant information to handle inquiries and complaints.
                  6. Performed customer verifications, process orders, forms, applications, and requests.
                  7. Directed requests and unresolved issues to the designated resource.
                Years of Experience
                Experience
                7-10 Years
                Experience Level
                Level
                Management
                Education
                Education
                N/A` in Sociology

                Insurance Claims Representative Resume

                Headline : Looking to obtain an Insurance Claims Representative position in a field wherein one can use skills to the full extent at the same time be an excellent asset to the company.

                Skills : CPR Certified, MS Office.

                Description :

                  1. Investigated and maintained claims.
                  2. Reviewed and evaluated coverage and/or liability.
                  3. Secured and analyzed necessary information.
                  4. Reviewed and researched incoming claims by navigating multiple computer systems and platforms and accurately captures the data/information necessary for processing.
                  5. Completed on a daily basis all data entry required to document and communicate the status of claims as needed adhering to all.
                  6. Obtained information and maintains accurate records.
                  7. Maintained professional client relationships.
                Years of Experience
                Experience
                5-7 Years
                Experience Level
                Level
                Executive
                Education
                Education
                EMT in Emergency Medical Technician

                Insurance Claims Representative Resume

                Headline : Background includes installing/working with various fiber optic, data, telephone, and security systems, have also supervised and maintained confidential employee records, invoices, and payroll.

                Skills : Active Directory, Ticketing Systems, Lotus Notes, Remote Desktop, Java, HTML, Javascript, CSS.

                Description :

                  1. Reviewed and handled simple and straightforward claims (i.e., small theft or minor automobile property damage).
                  2. Wrote or revised a brief description of loss to ensure that it accurately reflects the actual circumstances of the incident in question.
                  3. Determined and establishes liability, enters claim reserve requirements, and made adjustments as necessary, during the processing of the claims.
                  4. Communicated with policyholders, witnesses, and claimants in order to gather information regarding claims.
                  5. Responded to various written and telephone inquiries including status reports.
                  6. Explained the facts and logic behind decisions in a way that the customers were able to understand, even if they did not agree with the findings.
                  7. Documented actual damages associated with claims and processed settlements within assigned authority limits.
                Years of Experience
                Experience
                5-7 Years
                Experience Level
                Level
                Executive
                Education
                Education
                Certifications in Telecom/ Fiber Optics/Security Systems

                Insurance Claims Representative Resume

                Objective : Seeks to become affiliated with a progressive organization where achievements and skills will provide opportunities for advancement.

                Skills : Administrative Support, Customer Service.

                Description :

                  1. Attracted potential customers by answering product and service questions; suggesting information about other products and services.
                  2. Openned customer accounts by recording account information.
                  3. Maintained customer records by updating account information.
                  4. Resolved product or service problems by clarifying the customer's complaint; determining the cause of the problem; selecting and explaining the best solution to solve the problem; expediting correction or adjustment; following up to ensure resolution.
                  5. Maintained financial accounts by processing customer adjustments.
                  6. Recommended potential products or services to management by collecting customer information and analyzing customer needs.
                  7. Prepared product or service reports by collecting and analyzing customer information.
                Years of Experience
                Experience
                2-5 Years
                Experience Level
                Level
                Junior
                Education
                Education
                Diploma

                Insurance Claims Representative Resume

                Headline : A detail-oriented professional employs a strong aptitude for decision making. Excel at troubleshooting. Ability to learn new software in a short amount of time with high retention.

                Skills : CPR Certified, MS Office, Data Entry, Oracle.

                Description :

                  1. Responsible for taking calls regarding claims for medical and dental insurance.
                  2. Took inbound and outbound calls from customers who were filing for vehicle accident claims.
                  3. Resolved problems with upset customers and claims troubleshoot claims, filed while creating folders for the claims, did an inventory of claims numbers.
                  4. Interpreted English and Spanish between the insurance adjuster and customers with language barriers.
                  5. Called up the interpreter's 1-800 line for other foreign language barriers.
                  6. Dealt with customer complaints and assisted customers with financial questions.
                  7. Verified Mortgages to other creditors, updated customer accounts, performed general data entry, and handled payoff balances.
                Years of Experience
                Experience
                5-7 Years
                Experience Level
                Level
                Executive
                Education
                Education
                EMT in Emergency Medical Technician

                Insurance Claims Representative Resume

                Headline : Goal-oriented, responsible professional dedicated to high levels of customer satisfaction and meeting aggressive business goals. Passionate and motivated, with a drive for excellence. Able to offer specialized knowledge in front & back office Medical Assistant and customer service. Handles tasks with accuracy and efficiency.

                Skills : Computer Literate, Typing, Inventory, Customer service, Sales, and Manufacturing.

                Description :

                  1. Used computers for various applications, such as database management or word processing.
                  2. Answered telephones and give information to callers, take messages, or transfer calls to appropriate individuals.
                  3. Created, maintained, and entered information into databases.
                  4. Operated office equipment, such as fax machines, copiers, or phone systems, and arrange for repairs when equipment malfunctions.
                  5. Completed forms in accordance with company procedures.
                  6. Managed projects or contribute to committees or teamwork.
                  7. Supervised other clerical staff and training to new staff.
                Years of Experience
                Experience
                5-7 Years
                Experience Level
                Level
                Executive
                Education
                Education
                Medical Assistant

                Insurance Claims Representative Resume

                Headline : Looking to obtain a fulfilling position at a fitness center, focusing on client goals, customer relations, and team leadership while providing excellent service and client satisfaction.

                Skills : Computer, Communications, Telemarketing, Filing Documenting.

                Description :

                  1. Filled all glass claims while remaining pleasant and professional at all times.
                  2. Answered all inbound calls and handling customer requests in a timely manner.
                  3. Made outbound calls to preferred service shops to repair damaged vehicles.
                  4. Noted accounts with detailed information for every caller.
                  5. Followed detailed scripts for every account and providing the caller with necessary information.
                  6. Worked with Microsoft windows programs to locate different repair shops and customer information.
                  7. Provided a high level of customer service by being courteous, friendly, empathetic, and knowledgeable.
                Years of Experience
                Experience
                5-7 Years
                Experience Level
                Level
                Executive
                Education
                Education
                Biomedical Informatics

                Insurance Claims Representative Resume

                Headline : Contributing to team effort by accomplishing related results as needed, and also completing Appeals for all Insurance carriers and have sent with Medical Records to ensure timely payments.

                Skills : Communication Skills, Planning Skills, Claims.

                Description :

                  1. Specialized in insurance follow-up for all commercial, contracted, and non-government payers.
                  2. Responsible to perform timely insurance follow up on billing submissions.
                  3. Made calls to Insurance companies to find out if claims are paid, and/or paid correctly to contracts.
                  4. Made decisions from calls as to what avenue to take 
                  5. Required to meet the daily/monthly averages per the productivity reports established by the Insurance Claim Supervisor.
                  6. Emails to the Hospital Financial Counselors to ensure correct adjustments and patient responsibilities are correct.
                  7. Emails to the Hospital Billing Department to ensure correct coding and corrected claims are sent to the correct address.
                Years of Experience
                Experience
                5-7 Years
                Experience Level
                Level
                Executive
                Education
                Education
                HS Diploma