The main duty of a Senior Claims Adjuster is to investigate the insurance claims and ascertain the liability on behalf of the insurance company. The job duties commonly seen on the Senior Claims Adjuster Resume include the following – investigating personal injury and property damage; gathering information from sources, preparing reports for use by the claims examiners; investigating questionable claims; consulting with specialists such as engineers, architects, and physicians; compiling reports on findings; assisting the attorneys during the times of defending the company against any contestation; and guiding the junior claims adjusters.
The best candidate for this role will have a degree and good math skills. Besides, the following skills are also needed – analytic mindset, competency with spreadsheet software; good interpersonal skills; and excellent verbal and written communication skills. While formal education is not a must, possessing a degree will be useful.
Summary : Claims professional with 15 years of Multi-Line claims experience providing fair, detailed, and thorough service to Insureds and Claimants from initial notice to the final resolution. Demonstrated strengths in; organizing and prioritizing time-sensitive claims, establishing collaborative and successful working relationships with colleagues.
Worked on a dedicated team handling claims for United Airlines Handle Workers' Compensation claims to conclusion in Illinois, Indiana, Kansas, Missouri, and Minnesota jurisdictions and follow all jurisdictional laws and requirements.
Filed required state forms and EDI per jurisdictional requirements.
Completed thorough investigations by obtaining recorded statements from the claimant and any witnesses, obtain all necessary medical documentation, setting up IME appointments, assign and work with surveillance for questionable and potentially fraudulent claims.
Evaluated and set appropriate reserves for high exposure and complex claims and monitor them for adequacy, making timely reserve changes as event changes occur.
Reviewed medical bills for accuracy and work will the bill review department to ensure payments are made timely and accurately.
Set clear action plans for claim resolution on each file every 30 days.
Requested update medical within 5 days of every appointment on each claim Maintain contact with the claimant, claimant's attorney or defense counsel at least every 30 days Determine fraud and subrogation potential and handle accordingly.
Experience
10+ Years
Level
Senior
Education
Diploma
Senior Claims Adjuster III Resume
Summary : Talented and professional multi line Claims Adjuster with comprehensive years of experience adjusting all forms of claims. Skilled in all aspects of Claims management and claims resolution for Property and Casualty, Bodily Injury, General Liability, Personal/Commercial Auto and Livery vehicle claims.
Investigated and resolved complex personal auto and liability claims.
Evaluated and settled bodily injury claims.
Investigated claims for fraud prior to referring to internal SIU team.
Monitored 350+ client's files every 30 days based on complex contracts and compliance with minimum supervision Adjudicated and verified eligibility .
Investigated claims against insurance for personal, casualty, property loss and damages.
Examined claim form and other records to determine insurance coverage.
Interviewed, telephoned, and corresponded with claimant and witnesses.
Experience
7-10 Years
Level
Management
Education
Diploma
Senior Claims Adjuster II Resume
Objective : Career Claims Adjuster/Supervisor with emphasis on casualty liability investigations and settlements in both personal and commercial lines. Recently the victim of a company downsize through no fault of my own. Anxious to resume career asap with a reputable company. CPCU/AIC/ARM + college graduate with a BA. Mature, knowledgeable and dependable. Are you ready for a cut above Let's talk. Can relocate to western NC, east TN, or SW VA with the proper incentives. Many excellent references available.
Responsible for the investigation and resolution of complex liability claims and property insurance claims.
Used the Colossus System for bodily injury claims and settled most claims within the targeted figures.
Carried a field case file load in the 150 range.
Resolved complex claims.
Required little supervision.
Settled first and third party casualty as well as property claims in both personal and commercial lines.
Utilized staff and independent adjusters to assist outside the office in remote areas.
Experience
2-5 Years
Level
Executive
Education
Bachelor Of Arts In Social Science
Senior Claims Adjuster I Resume
Objective : Claim Assignment - Verifies policy information for accuracy to determine if coverage is applicable on new claims. Develops an investigative action plan to include resolution of coverage issues as required.
Responsible for the investigation and resolution of complex liability claims in both personal and commercial lines.
Consistently settled claims below target value in roughly 90% of all bodily injury cases.
Carried case load of approximately 150 files on average per month.
Interfaced with policyholders and claimants to resolve complex liability claims in auto and commercial accounts, as well as slip and fall claims and dog bite cases.
Developed well-defined policy interpretations, requiring little supervision.
Finalized property damage and collision losses with first and third parties.
Attained the Chartered Property Casualty Underwriter (CPCU) professional designation, which is the most highly respected professional designation in the insurance industry.
Experience
2-5 Years
Level
Executive
Education
Bachelor Of Arts In Social Science
Assistant Senior Claims Adjuster Resume
Summary : Educated, driven, and results-oriented healthcare professional seeking a career to further skills and talents with a dedicated medical coding/testing. Specific experience in health care insurance processes, provider relations, and health information technology, along with excellent communication skills and attention to detail, allow for superior work in a variety of settings.
Skills : Time Management, As400.
Description :
Selected for membership in a newly litigation team working with attorneys.
Researched and investigated claims to make sure claims were actual insurers of the company.
Conducted special research on projects as requested by the legal team.
Compiled a report to give to the Lawyers to help with presenting factual data in favor of the company.
Contributed to successful defense in research on internal processors with claim payment accuracy.
Reviewed and processed Indemnity claims in accordance with all state regulations on corporate policies and procedures.
Met and exceeded standards for timeless and quality accuracy results with claims and handling phone calls.
Experience
7-10 Years
Level
Management
Education
BA In Political Science
Associate Senior Claims Adjuster Resume
Summary : Highly qualified Senior Claims Adjuster with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and would excel in the collaborative environment on which your company prides itself.
Skills : Microsoft Office, Microsoft Excel, Microsoft Outlook.
Description :
Managed claims involving medical only and lost time.
Communicated with employer representatives on claim statuses and overall South Carolina workers compensation process.
Negotiated settlements with claims involving attorney representation.
Requested settlement hearings for claims involving litigation.
Assigned claims to defense counsel when motions or hearings filed.
Attended meetings and training classes when requested by employer representatives.
Prepared workers compensation presentation and training manuals for employer representatives.
Experience
7-10 Years
Level
Management
Education
Mass Communication
Assistant Senior Claims Adjuster I Resume
Summary : A highly accomplished, goal oriented, multi-jurisdictional claims professional. A proven track record in investigations, communications, liability determinations, and efficient cost effective claim settlements. Passionate about job and in exceeding the goals set by department and the company.
Skills : FL 520 All Lines Adjusters License, Communication skills.
Description :
Successfully utilized prior medical knowledge and management expertise.
Coordinated with field management and HR in the determination of transitional duties for light duty assignments within the medical restrictions.
Analyzed claim trends, involving safety, products, and cyber liability with recommendations to appropriate departments to reduce exposure of loss and liability.
Researched product, vendor and premises exposures.
Tendered claims to Landlord or Vendor when appropriate for indemnification and defense.
Completed the Quarterly WC Nurse line utilization report for presentation at meetings and for company distribution.
Used auto dialer system, computer skills, negotiation, detailed oriented, customer service skills, messages and call backs.
Experience
10+ Years
Level
Senior
Education
B.S. In Business Administration
Senior Claims Adjuster/Manager Resume
Objective : To accept a new and challenging position that will utilize and broaden leadership and technical skills in the insurance, risk management and business industry.
Skills : Texas Department Of Insurance Multi-Lines Adjuster.
Description :
Gathered information and investigated the entire claim to determine liability.
Responsible for settling both first party and third party property damage and bodily injury claims.
Property Damaged Claims Assistant Assisted the management team by making extensive phone contact with policyholders, claimants, and attorneys.
Responsible for taking recorded interviews of insured drivers, claimants, and witnesses.
Responsible for entering all accident information into the claims database for future reference.
Responsible for adjusting worker's compensation claims for pharmacies and manufacturing companies in Kansas, Missouri and Oklahoma.
Responsible for the investigation, evaluation and settlement of the most complex claims and highest exposure (construction and manufacturing.
Experience
2-5 Years
Level
Executive
Education
BS
Senior Claims Adjuster/Representative Resume
Headline : Highly-motivated Claims Adjuster seeking a position that will benefit from my investigation and social service experience, as well as provide a challenging environment that will enable me to utilize my strong analytical, organizational, and problem solving skills. Highlights Licensed Adjuster in SC and NC Team player Insurance fraud expertise Critical thinker Strong interpersonal and Interviewing techniques communication skills Decisive Report writing.
Skills : Avaya, XACT Analysis, ISO.
Description :
Interpreted and analyzed automobile policies for coverage, when initial claim is filed.
Investigated auto accidents, theft claims, fire claims, fraud claims, property damage claims, bodily injury claims, and high dollar claims.
Interviewed and secured statements of all involved parties, secure photos of the accident scene, assess damage involved, review policy and report, and apply correct state statutes.
Analyzed the damage and stated cause to determine the extent of the company's liability.
Effectively and efficiently handled approximately 80 cases at a time.
Assisted customers to resolve their issues in a timely manner, while maintaining rapport.
Gathered necessary medical bills and records for review and evaluate injury claims for settlement.
Negotiated payment solutions for property damage and bodily injuries with insurers, claimants and attorneys.
Experience
5-7 Years
Level
Executive
Education
Associate In Society Claims Law
Senior Claims Adjuster Resume
Summary : Highly competent, versatile and adaptable professional with wide-ranging career and educational experience 15+ years working in sales and customer service roles Excellent communication skills with emphasis on writing Proven ability to work in high-stress environment while meeting challenges and deadlines Experienced in managing relationships; strong team player.
Skills : Microsoft Office, Xactimate Level II, Symbility, Simsol.
Description :
Independently inspected and documented claims, evaluated all relevant data, determined coverage and compensability settlement and negotiate automotive property damage.
Provided resolution on complex exotic car claims.
Documented files with necessary reports, investigative notes, and other data as required by the Department of Insurance.
Provided superior service to policyholders, agents and the claims public.
Complied with standards for service and prompt contact.
Managed personal caseload effectively.
Responsible for adjusting worker's compensation claims for pharmacies and manufacturing companies in Kansas, Missouri and Oklahoma.
Responsible for the investigation, evaluation and settlement of the most complex claims and highest exposure (construction and manufacturing .
Management and direction of assigned counsel and nurse case managers.
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