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Claims Representative Resume Samples
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0-5 years of experience
Held the highest referral rate on team to Premier Service Provider program in first 6 months
- Made over 550 outbound calls in January, 59% greater than team average
- Selected 2013 February Employee of the Month
- Conducted and investigated claims, interpreted laws and regulations, rendered insurance decisions from onset to closing
10+ years of experience
Managed the investigation and adjustment of bodily injury and property damage
insurance claims
- Caseload of up to 227+ files and $2,175,007 in reserves
- Trained in the use of bio-mechanical (low impact), comparative negligence and injury evaluation techniques and software
- Led as a Technical Specialist/Team Lead in staff management and training; Participated in the computer system user group and process improvement projects; duties included risk management, large exposure claims, concurrent coverage investigation and initiating a forms library
0-5 years of experience
Process life claims up to $50,000, provide customer support to clients. Perform numerous administrative tasks, process medical records, perform investigations as needed.
- Recognized for consistency of 98% plus, accuracy in claims processing.
- Took on international claims to relieve the workload of others.
- Maintained exemplary work record completing work to meet goals to compensate for any variance of schedule.
- Provided assistance to others as needed assuring goals of department
- Responded effectively to increased workloads, increasing knowledge and expertise as required while meeting targeted goals.
10+ years of experience
Investigated, evaluated, and negotiated settlement of commercial property and casualty insurance
claims. Settled claims both in the field (with a territory) as well as from the office handling several
states. Hired independent adjusters for field inspections when needed. Settlement authority level
varied from $25,000 to $50,000.
- Conducted agency visits as a territory field adjuster that established rapport and cultivated relationships with agents, resulting in increased business.
- Consistently received “Green Flag” recognition for receiving top ratings on customer
- Analyzed policy coverage accurately including from complex commercial property
- Reported all hazardous and poor property conditions to the risk underwriter who would
- Reduced claim expenses the past two years during a concerted expense reduction effort by making personal inspections when possible to minimize the use of independent
10+ years of experience
Responsible for investigating claims for file recoveries.
- Handled approximately 100-125 inbound and/or outbound calls daily.
- Reviewed 1400 files and notified the responsible party.
- Provided documentation of the damages, costs, and facts.
- Planned, prioritized, and organized files for attorneys.
- Reviewed documents, correspondence, and reports.
- Handled case files and deposition calls.
- Maintained calendars and prepared and filed pleading packages.
0-5 years of experience
Prepare insurance claim forms or related documents and reviewed them for completeness.
- Performed adjustments, invested claims, and provided telephone coverage
- Transmit claims for payment or further investigation
- Processed and adjudicated medical claims according to health plan polices
- Contact insured or other involved persons to obtain missing information
- Closely coordinated with all departments to ensure smooth day to day operation
0-5 years of experience
Handled incoming calls from insured, claimants, attorneys or agents regarding first notice of claims or any other claim related questions.
- Conducted recorded interviews with insured, claimants and witnesses to determine liability.
- Addressed diaries, emails and voicemails within company timeframe.
- Sent correspondence and completed actions to satisfy department of insurance and/ or state specific regulations.
- Provided efficient and courteous service to internal business partners and external customers concerning investigation and resolution of claims.
10+ years of experience
Worked as property and casualty claim representative handling auto liability, commercial, and homeowner general liability claims.
- Evaluated, negotiated and settled bodily injury claims with attorneys or claimants.
- Assisted in the defense of the Insured on litigated files.
- Conducted extensive coverage and liability investigations applying relevant state statues and policy language.
- Responsible for making sound financial decisions that are in the best interest of the company and its clients.
- Conducted scene investigations in the field.
0-5 years of experience
Highly productive commercial claims processor that negotiated and adjusted physician and facility
claims to allow proper benefit determinations.
- Proactively generated solutions to solve complex problems regarding systems issues.
- Isolated coding discrepancies reducing cost containment measures.
- Reduced rework and appeals by effective research and analysis.
- Minimized roadblocks and improved the consumer and provider experience.
- Re-wrote policy provisions in Standard Operations Procedures (SOPs) to ensure proper eligibility
6-10 years of experience
Adjusted auto insurance claims for a high volume regional claims office
- Investigated coverage and liability for non-injury property damage claims, which include multi car accident claims, liability disputes, and commercial vehicle claims
- Resolved claims in a timely manner, including a majority of total loss claims within 7 days of report
- Provided a high level of customer service with multiple customer service awards
- Wrote estimates and negotiated with auto body shops, and monitored vehicle repairs and rental
0-5 years of experience
Provided instructions and education to members, providers and facilities on Connecticare policies and procedures in a call center environment.
- Received and responded to inquiries as well as issues from members and providers regarding benefits, coverage, payment, coding and health service policies and procedures via telephone calls.
- Researched and analyzed recurring trends, problems and complaints to determine the root cause concerning health insurance claims.
- Knowledge of ICD-9/10, CPT-4, UB82/UB92 revenue coding and procedural coding.
0-5 years of experience
Established and managed division productivity goals met by employees
- Conducted quality assurance reports providing employee and departmental checks for the company
- Implemented continuous training programs to maintain quality of production
- Coordinated critical patient/members/providers correspondence with outside agencies
- Key decision-maker providing solutions for case studies and directing issue to the correct department
- Assigned and reconciled medical correspondence to the appropriate department
- Monitored and inventoried medical correspondence developing annual reports
0-5 years of experience
- Review and analyze suspicious and potentially fraudulent insurance claims
- Evaluated all injury and damage claims with the ultimate goal of creating positive outcomes for client’s
- Established productive working relationships with public officials, including law enforcement officers
- Documented all investigation activity, presented reports to management, and collaborated with the all departments
- Administrative and secretarial duties upon request
- Negotiated with attorneys, claimants, insured’s, and body shops in regard to damage and injury claims
- Currently exceeding closing goal of 100% consistently for one year
0-5 years of experience
- Resolved claims for property damage claims within authority.
- Established and maintained accurate reserves on all assigned files.
- Supported agencies with losses coverage evaluation.
- Worked closely with third party vendors in estimating losses.
- Reviewed quotes for structural damages and completed estimates for content losses using Xactimate.
- Identified subrogation potential in an effort to maximize recovery.
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[Claims Representative]
Last edited by: Gabriela Barcenas, CPRW, Content Writer II -
Gabriela Barcenas
CPRW, Content Writer IIGabriela is a Certified Professional Resume Writer (CPRW) and career adviser. With 10 years of digital media experience and five years of resume writing expertise, her publication history includes fashion, education, travel, social justice, equitable design and career advice.
