Insurance Claims Representative Resume Samples

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.

Experience

2-5 Years

Level

Junior

Education

HS Diploma

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.

Experience

5-7 Years

Level

Executive

Education

Associates in Science

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.

Experience

7-10 Years

Level

Management

Education

N/A` in Sociology

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.

Experience

5-7 Years

Level

Executive

Education

EMT in Emergency Medical Technician

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.

Experience

5-7 Years

Level

Executive

Education

Certifications in Telecom/ Fiber Optics/Security Systems

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.

Experience

2-5 Years

Level

Junior

Education

Diploma

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.

Experience

5-7 Years

Level

Executive

Education

EMT in Emergency Medical Technician

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.

Experience

5-7 Years

Level

Executive

Education

Medical Assistant

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.

Experience

5-7 Years

Level

Executive

Education

Biomedical Informatics

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.

Experience

5-7 Years

Level

Executive

Education

HS Diploma