The Claim Specialist also referred to as Insurance Claims Specialist or Claims Investigator is accountable for reviewing the client’s claims for determining coverage and non-coverage of claims. The job duties mentioned on the Claims Specialist Resume include – processing claims and negotiating settlements, managing client account during and after the claim is filed, verifying coverage and determining allowable benefits and compensations, following up with clients and insurers to resolve discrepancies, compiling reports, communicating to supervisors and managers regarding claim status, and executing all other duties as assigned.
Claims Specialists must perform their duties accurately, they should treat all clients fairly and equally; they should also ensure that the claims are reasonable and legitimate, and demonstrate a high level of accuracy. To make this happen, the candidates must be aware of the company’s claim policies and processes inside-out and be proficient in payment processing. The ability to handle clients in a diplomatic and tactful way is as well crucial for this post. With a high school diploma or a GED, candidates can step in as an entry-level specialist.
Headline : Seeking a position with a company that will allow to use current talents and skills. Driven to increase skill set and grow within a company.
Skills : Typing 65 Wpm, Microsoft Office Applications.
Description :
Applied knowledge of state and federal laws, statutes, and insurance regulations in claim handling.
Interpreted and applied insurance contract provisions. Uses various electronic resources for claim handling.
Utilized appropriate job aids, knowledge, and tools to process the initial reception of claims.
Completed the phone scope of damages with the assistance of the policyholder including a detailed description of property damage.
Identified of building items, measurements to complete building estimates.
Reconciled submitted estimates with State Farm estimate on non-complex property damage losses and issues replacement cost benefits payments.
Secured inventory of damaged personal property and issues claim settlement payment.
Experience
5-7 Years
Level
Executive
Education
Medical Billing
Sr. Claim Specialist Resume
Summary : Analytical thinker and innovative problem solver. Motivated to succeed in a fast-paced and deadline-driven professional environment. Highly proficient in customer service and implementing objective decision making.
Conducted interviews with involved claims parties and witnesses, gather detailed information, and arrange scene investigations.
Identified and collected evidence and determine its value to a specific claim.
Analyzed first reports of loss and underlying file material to determine if a claim is suspect.
Completed required investigations on referred files in a timely manner. Recommend settlement offers and negotiate payment arrangements.
Drafted statement of loss to summarize damages, payments, and underlying policy coverages.
Contacted injured parties and legal representatives to negotiate final settlements for claims.
Produced quality work product while prioritizing work in a file ownership environment.
Experience
10+ Years
Level
Senior
Education
Diploma
Claim Specialist/Analyst Resume
Summary : Customer service professional experience working in a dynamic environment of specialized groups with direct and indirect relationships, while learning and incorporating the knowledge of all groups.
Responsible for writing estimates for auto damages from hail, collision, water, and flood damage.
Provided homeowner estimates for interior and exterior repair and negotiated pricing with contract labor.
Resolved Property and Casualty claims for commercial auto, general liability, and personal lines, involving bodily injury evaluation.
Experience
10+ Years
Level
Senior
Education
Public Administration
Claim Specialist/Technician Resume
Summary : Seeking a Full-Time position that will allow to expand knowledge and personal growth in an Office Administrative Atmosphere. Open availability and eager to start as soon as possible.
Skills : Microsoft Office, Technical Skills.
Description :
Licensed insurance adjuster in three states. Establish coverage for first-party policies.
Analyzed case files for clients and determine the level of loss and compensation, over cases in inventory.
Recognized possible complex claims, identifying billing trends, fraud indicators, a recommendation for medical management.
Reviewed suits, assign cases to proper legal channels, analyze information, collect preliminary evidence, propose a course of action for defense.
Able to manage extensive caseload and litigation processes to ensure timely resolution for claims.
Negotiated of claims to an amicable resolution, upon medical evidence, case law, and state statute.
Utilized as an interim manager and team lead for total loss and casualty units.
Experience
10+ Years
Level
Senior
Education
International Business
Claim Specialist/Executive Resume
Headline : An Operations Specialist with experience in data entry, mail processing, and problem resolution in a banking lock box environment. Recognized by management for adaptability, sound judgment.
Determined the appropriate action when claims are missing information needed to process claims.
Verified if billed services are authorized for payment.
Retrieved data from the electronic filing system as needed to perform various job assignments/duties.
Gathered missing information from incomplete billing forms being processed.
Verified local code description and ICD - 9 codes on the bill is related to the authorized services or is eligible for payment consideration.
Determined appropriate correspondence and sends it to the provider requesting any additional information required to complete the processing of a bill.
Maintained files on all completed and return claims.
Experience
5-7 Years
Level
Executive
Education
BS
Claim Specialist/Director Resume
Headline : To obtain a position within a challenging environment that will allow to utilize skills and knowledge to the best of abilities and contribute positively to personal growth as well as growth of the organization.
Handled first-party homeowner claims from an in-office location. Wrote estimates using Xactimate and Xactcontents.
Handled first and third party auto claims Determined liability Coordinated repairs with autobody repair shops Organized rental vehicles.
Led team in claim handling results including the number of closed claims per week.
Worked in the Life Response Center which included assisting agents with the underwriting process.
Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
Evaluated all evidence with the ultimate goal of creating positive outcomes for the client's claims.
Conducted background searches and skip traces. Advocated and conducted fraud awareness and training.
Experience
5-7 Years
Level
Executive
Education
Associate Of Science
Asst. Claim Specialist Resume
Objective : Conduct thorough investigation on cases Make sound decisions on what liability and damages to accept or deny Use critical thinking to evaluate each claim.
Precisely completed appropriate claims paperwork, documentation, and system entry.
Managed collections claims for unpaid bills against the estates of debtors.
Posted and adjusted payments from insurance companies.
Identified and resolved patient billing and payment issues.
Examined patients' insurance coverage, deductibles, possible insurance carrier payments, and remaining balances not covered.
Diligently filed and followed up on third party claims. Responded to correspondence from insurance companies.
Confidently and adeptly handled claim denials and/or appeals.
Experience
2-5 Years
Level
Junior
Education
Culinary Arts
Lead Claim Specialist Resume
Headline : To obtain a challenging position with an organization that offers growth for advancement and stability, as well as a company that will utilize business ethics, computer skills.
Skills : Leadership, Total Loss Claim Handling, Microsoft Word Applications.
Description :
Reduced loss ratios through fair and prompt processing of claims.
Identified and collected evidence and determined its value to a specific claim.
Served as subject matter expert in auto total loss and vehicle titles. Kept up-to-date on changes in regulations for deductibles and collections.
Completed required investigations on referred files in a timely manner.
Managed, directed, and resolved litigated cases to conclusion.
Collaborated and developed defense strategies with staff and outside counsel.
Reported and collaborated with authorities on fraudulent claim activity.
Experience
5-7 Years
Level
Executive
Education
Business Management
Associate Claim Specialist Resume
Headline : Associate Claims Specialist is responsible for providing first-class service to our clients, managing the claims process and resolving issues. This includes handling all aspects of the claims process, from initial contact to resolution and beyond.
Skills : Claims Processing, Call Center, Microsoft Office, Customer Service.
Description :
Processed claims that are pending for various holds reasons.
Assisted in the final determination on claim disposition. Inbound /Outbound calls to various insurance companies Director / Owner.
Investigated difficulties claims and correctly processed for payment in full correctly.
Researched and processed, Case Logs, Analyzers, Manuals, Hospital Audits, and Appeals.
Assisted with special projects as assigned or directed.
Explained premiums owed to policyholders, agents, and underwriters.
Recommended settlement offers and negotiated payment arrangements.
Experience
5-7 Years
Level
Executive
Education
BS
Claim Specialist Resume
Headline : To obtain a valuable position, with a reputable company, whereby, can apply skills to become a valuable asset to the employer.
Skills : Microsoft Office, Customer Service, Collections.
Description :
Reduced loss ratios through fair and prompt processing of claims.
Identified and collected evidence and determined its value to a specific claim.
Served as subject matter expert in auto total loss and vehicle titles.
Explained premiums owed to policyholders, agents, and underwriters.
Recommended settlement offers and negotiated payment arrangements.
Changed in regulations for deductibles and collections.
Completed required investigations on referred files in a timely manner.
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