Senior Claims Specialist Resume Samples

Working for a variety of industries such as home, health, business insurance, and automobile, a Senior Claims Specialist will undertake the task of processing claims, verifying insurance coverage, reviewing insurance cases; and negotiating settlements. A well-written Senior Claims Specialist Resume mentions the following core duties and responsibilities – analyzing and investigating complicated insurance claims; performing detailed site inspections; reviewing and processing new claims reports; negotiating settlements; resolving claims, and presenting claims review plans.

The most sought-after skills for the post include the following – staying up to date with the latest changes and regulations made in the insurance field; strong analytical skills; good understanding of insurance claims negotiation and settlement techniques; familiarity with workers’ compensation, property, and liability claims legislation; and mediation skills. As this is a higher-level position, a bachelor’s degree in any insurance-related discipline and prior work experience is required.

Senior Claims Specialist Resume example

Senior Claims Specialist Resume

Summary : To obtain long term employment with a well established organization where may fully utilize education, training, skills and abilities.

Skills : Claims Processing, Customer service.

Description :

    1. Interpreted claims edits responses and system edits, made logical benefit and coding decisions for complex pended and reopened claims to adjudicate in a timely manner.
    2. Ensured claim accuracy and efficiency for all lines of business according to subscriber terms and provider contractual agreements, utilizing ICD-9, CPT-4, and HCPCS coding.
    3. Researched and updated system records, finalized customer service, medical review, subrogation, COB and appeals inquires.
    4. Adjudicated health plan claims payment for professional and institutional that includes home health, home infusion, Medicare crossover, Medicaid, durable medical equipment.
    5. Audited, approved and finalized large dollar claims over $20,000.
    6. Pended claims accurately to medical review, provider contracting, system interface and department supervisor for direction for claims adjudication.
    7. Researched and finalized non-investigative pended claims.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Certificate In Medical Coding


Senior Claims Specialist III Resume

Headline : Senior Claims Specialist is accountable for meeting customers delivery needs at an optimal cost. This person will have the experience and knowledge to create and manage Purchase Orders leading to customer satisfaction and profitability.

Skills : Claims Processing, Customer Service, Data Entry, Data Analysis, Client Relations, Excellent Communication, Microsoft Office Suite, Management, Adobe Acrobat.

Description :

  • Handled automobile liability and bodily injury claims Conducted investigations and determined negligence Issued car rentals Negotiate settlements and .
  • Investigated and evaluated multi-line insurance claims through personal contact to ensure accurate settlements.
  • Completed estimates of damages for commercial lines property/auto, personal auto and homeowners.
  • Reviewed and investigated claims.
  • Confirmed and evaluated coverage; Determined liability and exposured; obtained statements, fire and police reported.
  • Investigated and evaluated multi-line insurance claims through personal contact to ensure accurate settlements.
  • Completed estimates of damages for commercial lines property/auto, personal auto and homeowners.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Certificate In Medical Coding


Senior Claims Specialist II Resume

Summary : To acquire a position that provides mentally challenging and stimulating duties. To be afforded the opportunity to demonstrate excellent planning, organizational and logistic skills in delegating various duties and responsibilities.

Skills : Microsoft Office, Medical Terminology, Billing And Coding, Records Management, Basic Accounting.

Description :

    1. Expertised in analyzing complex primary and excess casualty litigation involving Fortune 500 Companies.
    2. Handled Coverages included professional liability, Excess and General Liability including Environmental and Toxic claims and its application to insurance contracts involving multi-district jurisdictions.
    3. Drafted sidetrack indemnity agreements for SIR accounts.
    4. Extensived experience in determining insurance and reinsurance coverages.
    5. Developed, implemented and carried out organizational policy.
    6. Managed the Home Office staff responsible for vice regional offices (Chicago, Dallas, Los Angeles, New York and Toronto).
    7. Directed and managed substantial caseload.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Post Graduate

Senior Claims Specialist I Resume

Summary : A highly analytical and results-driven senior claims management professional with demonstrated experience in managing third-party administrator (TPA), product claims, litigation management, attended mediation, cost reduction analysis and risk reporting, . A resourceful and enthusiastic top-performer who possesses a strong ability to visualize, plan, and implement solutions as well as cross-collaborate to drive for results in a logical and systematic approach.

Skills : Word, Excel, Outlook.

Description :

    1. Audited and tracked TPA claims handling procedures and resolutions.
    2. Analyzed and initiated litigation strategy on all lawsuits and assign panel counsels, as well as manage litigated claims, including nationwide salon claims.
    3. Supervised and resolved claims involving products liability, premises liability, auto liability, discrimination, contract and construction matters, as well as media threats.
    4. Issued and maintained legal retention holds.
    5. Managed all stages of insurance defense litigation between panel counsel and store personnel.
    6. Mitigated loss through early claims resolution.
    7. Collaborated closely with loss prevention on safety training and manual and policy revisions.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor Of Arts

Assistant Senior Claims Specialist Resume

Summary : In search of an analytical position that will allow to utilize 11 years of healthcare claims knowledge, or 4 years of member and provider configuration.

Skills : Proficient In Word And Excel, Customer Service.

Description :

    1. Investigated, evaluated and resolved high exposure and high risk claims including general liability, products liability, liquor liability, commercial automobile / trucking and commercial property.
    2. Highlighted responsibilities and accomplishments Data Collection & Document Analysis: Gathered and analyzed investigative reports and legal documents to determine facts of incidents.
    3. Confirmed coverage by reviewing policies and documents submitted in support of claims.
    4. Evaluated information on coverage, liability, and damages to determine the extent of insured's exposure.
    5. Documented analysis which included identifying exposures, evaluation, review of financial data and developing resolution strategy.
    6. Interpreted lease and service agreements to determine potential risk transfer to a third-party.
    7. Ensured that documents are properly maintained and kept up to date in accordance with company policy.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor Of Science

Associate Senior Claims Specialist Resume

Summary : Accomplished Leader/Team Player with over 15 years of Interpretation of Policy, Contract Language and Negotiation expertise in Claims Handling, Administration and Resource Allocation. Heavy emphasis on Commercial General Liability and Bodily Injury Claims. Recognized for Negotiation of Contracting Language for both General and Federal Agreements for 4 years in the Office of Contracts Management at Vanderbilt University.

Skills : superior written and verbal , settlement negotiations, conflict resolution, wide range of labor code interpretation.

Description :

    1. Ensured bill is processed correctly, including pricing.
    2. Performed quality checks on all claims over $25,000.
    3. Sent feedback to fellow processor.
    4. Reviewed and processed Professional, Facility, RX, DME, Home Health claims within timely filing deadlines.
    5. Communicated with State Analyst directly via company email, conference call.
    6. Created workflows to help process claims.
    7. Prepared and presented loss reports to senior executives addressing potential exposures.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
High School Diploma

Associate Senior Claims Specialist I Resume

Summary : A highly motivated and skilled negotiator, investigator and team player, who is seeking an opportunity to work in a claims representation, team leader or management position. Major Accomplishments was awarded top closer of the year at Progressive Insurance. Have consistently meet or exceeded personal and company objectives through out career.

Skills : Mircrosoft Word, Excel, PowerPoint, Paint, Outlook; Siebel; LIS; Facets; Avaya; SPSS.

Description :

    1. Evaluated first and third party, personal and commercial, property damage, total loss, collision, rental and bodily injury claims.
    2. Applied policy provisions to the facts of loss to determine coverage.
    3. Investigated all relevant aspects of coverage, cause and origin, liability compensation, injury, damages and recovery potential.
    4. Secured oral and written statements, diagrams and scene photos determine a position regarding liability.
    5. Monitored the injuries and treatment of the injured parties initiating claims.
    6. Wrote vehicle estimates for first and third party property damage claims.
    7. Monitored the property damage process including repairs, storage and rental issues, to ensure a timely resolution.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor Of Science

Lead Senior Claims Specialist Resume

Summary : Over 10 years in the mortgage and finance industry, seeking a long term position in an organization to contribute to the success and growth of an organization while leveraging technical skills and professional experience.

Skills : Microsoft Office, Management, Accident Investigation, Forensic Investigations.

Description :

    1. Managed the recovery of advances, principal balances and interest for the bank and its investors.
    2. Responsible for ensuring timely and accurate filing of investor claims, timely follow up for funds and reconciliation of funds received.
    3. Responsible for ensuring servicing documents are provided to the carrier in timely manner.
    4. Prepared additional anaylsis for data included month end reporting.
    5. Interpreted contacts and evaluated information from documentation obtained.
    6. Discussed common legal concepts fluently with plaintiff attorneys.
    7. Made claim recommendations to enable company to set aside appropriate reserves and settle cases efficiently and cost effectively.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
BS

Senior Claims Specialist/Officer Resume

Summary : Driven business development professional who effectively builds loyalty and long-term relationships with customers while consistently exceeding sales targets.

Skills : Type approximately 80 wpm Fast learner Impressive technical writing Avid hockey player, swimmer.

Description :

    1. Evaluated all evidence with the ultimate goal of creating positive outcomes for client's claims.
    2. Drafted investigative reports covering all phases of the investigation in each case.
    3. Established productive working relationships with public officials and law enforcement officers.
    4. Reviewed new files to determine current status of injury claim and to develop a plan of action.
    5. Answered questions posed by insured and attorneys.
    6. Followed up with the insured individuals regarding premium and deductibles payments.
    7. Answered customer questions regarding deductibles.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor Of Arts

Senior Claims Specialist Resume

Summary : Seeks a position within an insurance company where skills and qualifications handling Property Damage & Personal Injury Protection claims may provide for opportunity and security.

Skills : Configuration, Auditing, Claims Processing, Data Entry, Research, Implementation, Procedural Writing.

Description :

    1. Included all of the below involving injuries that were catastrophic in nature/death.
    2. Confirmed and denied coverage to policyholders.
    3. Communicated with customers, doctors, hospitals, health insurance carriers and attorneys.
    4. Involved in the precertification process.
    5. Maintained contact with claimants and attorneys to determine treatment status.
    6. Trained other claims staff members on proper handling and evaluation of injury claims.
    7. Provided liability analysis and recommendation Drafted policies Wrote denial letters and processed payments Captured recorded statements from all .
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Medical