Senior Claims Representative Resume
Summary : To obtain a Claims Manager position where may utilize experience, provide support to the network operations staff as well as our provider community to ensure accurate payment of claims, ensure updated policies are implemented correctly, and provider education occurs timely.
Skills : Trend Analysis, Risk Management, Risk Control, Loss Prevention, HIPAA, Facility Auditing, Training, Claims Management, Safety Management, Excel, Power Point, Word, Microsoft Outlook,.
- Received and initiated timely reviews of new assignments and then analyze policies, endorsements, and circumstances reported to determine what coverages, if any, apply to a particular claim/accident.
- Immediately issued an appropriate reservation of rights letter for any and all coverage issues.
- Communicated directly with insureds, claimants, witnesses, doctors, attorneys, body shops, and others by telephone, through written correspondence or through their Attorney as required.
- Conducted prompt investigations by securing recorded statements from insureds, claimants, and witnesses and obtaining police reports or any other documentation pertinent to the investigation.
- Obtained and verified damages including, but not limited to obtaining copies of repair estimates; medical bills; medical records, and photographs.
- Reviewed, interpreted, and evaluated all information to ascertain the proper amount of damages for any type of claim/exposure.
- Adjusted, negotiated, and settled claims for proper amounts within authorization or as directed by your manager; secure releases then issue settlement drafts or deny unjustified claims as soon as practical (authorization from manager on all questionable matters, on all settlements exceeding adjuster's authorization, and on all claims prior to denial).
Bachelors Of Arts In Economics
Senior Claims Representative III Resume
Summary : To obtain a position in your organization utilizing acquired knowledge and experience, while offering an opportunity for professional growth and advancement.
Skills : Time Management, As400.
- Assigned Risk claims handling. Knowledge of Regulation 68.
- Determined approximate exposure in order to adequately reserve accordingly.
- Identified coverage and underwriting issues.
- Assessed, assigned and coordinated internal and external resources.
- Obtained information from DMV on claim files.
- Evaluated and Negotiated No-Fault Claims.
- Investigated, evaluated and processed all medical and vendor billing.
A.A.S In Business Administration
Senior Claims Representative II Resume
Summary : Service-oriented Senior Claims Representative who delivers high quality customer service by accurately assessing client needs and recommending the most useful policies and products.
Skills : Healthcare, Home Care, Microsoft Office, Management.
- Investigated claims and make appropriate decisions regarding claim compensability and/or liability of employer/contract holder and general claims management for assigned files.
- Established appropriate case reserves.
- Actively assisted the injured worker to return to work.
- Complied with all performance guidelines.
- Used automated diary system to issue indemnity payments and for claims management.
- Investigated and managed claim subrogation and negotiate settlements.
- Documented claim handling activities; create and document action plans.
Bachelor Of Science
Senior Claims Representative I Resume
Objective : Responsible for the development and administration of the Corporate Risk Management, Compliance and Quality Assurance programs for CHP related health care services to inmates in jails and state prison environments.
Skills : Lexisnexis Westlaw Internet Microsoft Office.
- Handled extensive claims investigations and made liability decisions using multiple software applications.
- Managed time sheets and attendance for 5-8 employees.
- Presented and executed plans for employee recreation as a member of the Employee Advisory Board Fall 2008.
- Served as temporary supervisor for different claims teams on multiple occasions.
- Evaluated details of administrative and management processes.
- Lead a focus group that evaluated effectiveness of programs and operations.
- Developed plans of action to increase productivity and effectiveness of administrative and management functions.
- Used fact-finding and investigative techniques to conduct surveys about employee wellness.
MA In Administrative Leadership
Assistant Senior Claims Representative Resume
Headline : Organized and detail-oriented claims adjuster dedicated to improving efficiency, productivity and profitability through continuous process improvement. Analytical thinker skilled at developing innovative solutions to complex problems.
Skills : Microsoft Office, Siebel On Demand.
- Utilized well developed listening skills, data collection procedures and problem solving techniques.
- Collected procedures including identifying claims with subrogation potential for early referral to recovery.
- Assisted in training of new associates.
- Participated in due diligence of potential company purchase with Bond Department.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Evaluated all evidence with the ultimate goal of creating positive outcomes for client's claims.
- Followed up on potentially fraudulent claims Directed and coordinated various investigations conducted by field investigation team.
Bachelor Of Science
Associate Senior Claims Representative 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.
Skills : Microsoft Word, Excel.
- Investigates and resolves complex coverage and liability claims.
- Completes arbitration files.
- Takes recorded statements from insureds, claimants, agents, witnesses, police officers and passengers.
- Completes investigative research to verify coverage and make coverage decisions.
- Handles claims for all states and interprets policies and state laws to make accurate coverage and liability decisions.
- Reviews coverage verifications and clears level 3 coverage verifications.
- Researches information needed on the internet and searches to obtain information for contacting insureds, claimants and insurance companies.
Bachelors In Bachelors
Assistant Senior Claims Representative I Resume
Headline : To obtain a position in insurance claims that allows to utilize knowledge of material damage and liability claims.
Skills : Vehicle Estimator, Vehicle Knowledge.
- Served as a drive-in estimator for the auto property damage claims department.
- Generated estimates for claimants and insureds.
- Negotiated with body shops to keep costs down for the company while maintaining a high level of customer satisfaction.
- Evaluated vehicles that were deemed total losses using the Pathways estimation and CCC valuation software applications.
- Determined monetary allocations for auto rentals based on estimation guidelines.
- Investigated and resolved liability claims for the liability department.
- Recorded statements from claimants and insureds.
BS In Management
Senior Claims Representative/Director Resume
Summary : Passionate and result driven customer service representative with over 10 years' experience in the art of customer relationship building.
Skills : Proficient in Microsoft Word, Excel, Power Point, Outlook.
- Responsible for developing medical evidence and documenting disability cases leading to representation of the clients with a subsequent award of Social Security disability benefits through written legal brief or oral hearing before an Administrative Law Judge.
- Managed a caseload of 350+ clients analyzing medical evidence and documenting relative details meeting the requirements of the Social Security disability program.
- Represented clients from the 48 contiguous states, Hawaii, Alaska, and Puerto Rico.
- Effectively controled the number of aged client cases without briefs while prioritizing the identified cases ready for hearing.
- Examined medical evidence composing and submitting written legal briefs.
- Communicated with administrative law judge and/or legal assistant to provide requested case documentation.
- Represented clients at oral hearings in multiples states preparing the clients in advance of hearing on procedures, strategies and testimony.
B.S. In Education
Associate Senior Claims Representative I Resume
Summary : Over 7+ years handling medical malpractice claims plus many more years in commercial claims handling.
Skills : Face to face customer service, Microsoft office suites,.
- Completed evaluations, negotiations and resolution of cases including all aspects of claim handling while continuing excellent customer service relations.
- Directed and coordinated litigation strategy and discovery with counsel.
- Presented files at round table with recommendations.
- Participated and attended mediations and trials.
- Monitored exposure, reported to management including case notifications, pre-trial documents and authority request.
- Proactively maintained proper reserving, tracking & control expenses.
- Completed large loss reports.
- Partnered with underwriters, agents, experts, SIU, vendors, defense attorneys to ensure efficient quality and satisfaction and develop effective solution strategies.
AAS In Paralegal Studies
Senior Claims Representative Resume
Objective : Focused, results oriented leader with P&L experience in start-up management and development of profitable sales territories within Fortune 100 companies. Top ranked sales executive with track record of identifying new business and revenue opportunities within wholesale and business-to-business markets.
Skills : I've Completed Various Nationally Recognized Sales Training Programs.
- Ability to investigate and bring cases to a satisfactory resolution earned me the Senior Representative title, sooner than anyone previously.
- Took advantage of a more lucrative job offer with the Railroad and chose to further career in that industry.
- Focused business activities in the areas of residential, new construction, and bank owned properties.
- Identified the cases not meeting the Social Security disability criteria and communicating such results appropriately with the claimants identifying the obstacles to a potential award.
- Resolved liability claims in a timely and efficient manner.
- Conducted on-scene investigations using photos and diagrams to help determine liability.
- Hired and trained personnel to take reports via telephone of first and third party auto collisions.
B.S. In Business Administration