A Claims Investigator will investigate plans and execute investigations for insurance claim purposes. The major roles and responsibilities associated to the post are listed on the Claims Investigator Resume as follows – protecting insurance companies and policyholders against frauds, looking into the background of claimants, and witnesses; reviewing the circumstances of the cases through interviews, surveillance, and research; inspecting sites, vehicles and writing reports of findings; investigating suspicious insurance claims; consulting police and hospital records; examining photographs and statements; and visiting claimants to obtain oral statements.
To work at this level, the following skills are needed to succeed in this job – an enquiring mind, good numeracy and literally skills; the ability to adapt quickly to any situations; good time management skills, negotiation skills, knowledge of insurance laws; and the ability to work under pressure. Employers like to hire graduates who have studied subjects like – Economics, Law, Management, and Mathematics.
Summary : Extensive background in claims, client/customer satisfaction, and project management. Able to take corrective action on projects. Skilled in business technology; Lotus Notes, Microsoft Office including Word, PowerPoint, Excel, Outlook, Visio & Access. Work under minimal direction, under continual change and under tight time constraints in fast-paced environments.
Skills : SAP, Microsoft Office, Driving.
Description :
Analyze & resolve litigated & non litigated, general liability and auto claims.
Manage/resolve multiple projects including slip & falls, electrical contacts, bodily injury and collection claims.
Initiate investigation reports of extremely sensitive materials to be submitted to attorneys & corporate.
Prepare claim summary reports based on management requirements.
Handle claims investigation, discovery, prepare response to lawsuits, assessment of damages, proper storage of evidence Analyze coverage in connection with indemnity provisions.
Attend mediation, settlement conferences, and provide trial analysis.
Responsible for adjustment and investigation of potentially fraudulent insurance automotive claims.
Experience
10+ Years
Level
Senior
Education
General Management
Sr. Claims Investigator Resume
Objective : Aspire to use the skills I've acquired throughout previous positions to gain a full time position with an exciting company with opportunities for advancement.
Skills : Proficient In Windows Technology, Email.
Description :
Assisted Human Resources and Risk Management with investigations of General Liability, Workers Compensation, and Workplace Violations by employees and/or customers.
Assisted the Director of Risk Management with setting up new claims in the data base.
Analyzed the facts, secured pending information, and determined the liability.
Scheduled appointments with claimants, employees, and third party witnesses to obtain their statements per an investigation.
Maintained a great rapport with the insurance carrier and provided pending claim information.
Coordinated with Human Resources and Store Management to implement better store practices on workplace safety, policies, and procedures.
Conducted store audits consisting of warehouse inventory, alarm settings, and risk assessment of store conditions.
Experience
2-5 Years
Level
Junior
Education
Business Management
Jr. Claims Investigator Resume
Summary : Customizes a wide variety of workshops, courses, and programs to optimize the performance of employees, expanding scope, volume and ensuring accurate outcomes.
Received and handled calls daily: Made preliminary assessment of problems.
Ensured each call received an excellent customer experience, while educating them on contracts and procedures.
Identified and resolved customer's concerns and goals relating to their accounts: Handled complex situations and questions to customer's satisfaction while maintaining company's standards and objectives.
Provided a personal experience to each customer by proposing an appropriate solution and ensuring a plan for each concern that provided satisfactory results.
Followed up on a weekly basis until resolved. Resolved service, billing and product concerns.
Combined, separated and transferred billing to various accounts, per customer request.
Processed payments & determined adjustments based on claim issues.
Promoted benefits and value of customer's product: Explained how customer's product retained value and representation.
Experience
10+ Years
Level
Senior
Education
BS
Claims Investigator III Resume
Summary : Experienced business professional and with high-level skills in advising senior leaders on administrative plans, policy, and guideline interpretations. Highly developed expertise in policy implementation, analysis, editing and reporting. Excellent communication skills with proven leadership ability in challenging situations.
Skills : Microsoft Excel, Customer Service , SAS, Sharepoint.
Description :
Exceeded all performance goals and objectives over a tenured career with AIG.
Conducted insurance claims investigations for liability, workers' compensation, private clients, auto liability, and construction liability.
Identified, located, and secured statements from claimants, witnesses, and insureds, in addition to performing background investigations and various activity checks.
Ensured 100% adherence to new technology systems and reporting guidelines, in addition to assisting investigators and employees with the utilization of new technology.
Overcame considerable obstacles, including persons of interest in investigations not being cooperative or providing false and biased information.
Saved considerable costs in terms of claims payouts by ensuring complete factual accuracy in claims investigations.
Planned and executed investigations into insurance claims both in the office as well as in the field, interacting with internal and external claims stakeholders.
Experience
10+ Years
Level
Senior
Education
Bachelor Of Arts
Claims Investigator II Resume
Summary : Dedicated and highly accomplished claim/compliance manager with comprehensive experience in claims handling, vendor management, regulatory compliance, fraud investigation, claims personnel hiring and development, and case management.
Skills : Detail Excellent oral and written communication Quick learner MS Outlook.
Description :
Maintained strong working relationships with insurance adjusters and examiners, swiftly communicating information in suspected cases of insurance fraud.
Utilized a wide range of information to make determinations in an investigation, including background checks, research, interviews, surveillance, and in-person inspections of sites and vehicles.
Conducted insurance claims investigations for liability, workers' compensation, private clients, auto liability, and construction liability.
Identified, located, and secured statements from claimants, witnesses, and insureds, in addition to performing background investigations and various activity checks.
Ensured 100% adherence to new technology systems and reporting guidelines, in addition to assisting investigators and employees with the utilization of new technology.
Saved considerable costs in terms of claims payouts by ensuring complete factual accuracy in claims investigations.
Planned and executed investigations into insurance claims both in the office as well as in the field, interacting with internal and external claims stakeholders.
Experience
10+ Years
Level
Senior
Education
Criminal Justice
Claims Investigator I Resume
Summary : More than 10 years experience in insurance claims handling. Highly skilled in investigating and negotiating liability, workers compensation, and litigated claims. Strong partnerships with attorneys and insurance companies.
Skills : Investigations, Sales.
Description :
Investigate, analyze, and determine the extent of insurance company's liability concerning commercial liability, construction defect, personal loss or damages.
Handled complex litigated claims with sometimes settlement authority of up to $5,000,000.
Handled a case load of 80 claims, receiving 40 new claims per month.
Handled a case load of 80 claims, receiving 40 new claims per month.
Audited samples of work from the team members and coached them on the findings to ensure that our department met the 98% quality expectation.
Designed and developed team documentation instruments that are now standard in the internal reporting process.
Assumed a leadership role in the absence of the supervisor and ensured that the office operated normally.
Experience
7-10 Years
Level
Management
Education
B.A.
Assistant Claims Investigator Resume
Summary : To be working in a job locally that has stability and a professional environment. Dedicated and driven with the ability to serve as a catalyst for successful operations.
Investigated worker's compensation and third party liability claims to determine recovery potential for health care providers.
Worked with automobile, worker's compensation, and third party insurance adjusters to obtain information crucial to the recovery process.
Capable of prioritizing and handling large caseloads.
Evaluated files using various tools to identify potential third party payers.
Possesses problem solving and decision making abilities.
Interviewed involved parties, established facts, and identified paid claims to determine where recovery potential exists.
Managed distribution of over claims per day, comprising of three separate.
Experience
7-10 Years
Level
Management
Education
Bachelor Of Science
Associate Claims Investigator Resume
Summary : To utilize experience and diverse skill set in a challenging position within the insurance claims field, while increasing, sharing and expanding knowledge of the industry.
Skills : Office, Excel. Word, Powerpoint, Outlook, Lotus.
Description :
Conducted investigations related to workers compensation and general liability claims and ensured the timely, accurate, and efficient administration of claims activities including interviews, research, documentation, and reporting.
Maintained full compliance with all states specific regulations and internal and external quality standards.
Leveraged state-of-the-art surveillance equipment including covert cameras, video and communication devices to conduct covert surveillance of persons involved in suspicious claims activity.
Conducted extensive research including thorough interviews with claimants, employers and witnesses to obtain statements.
Inspected and photographed construction sites as well as commercial and motor vehicle accident scenes including those involving serious injuries and/or death.
Identified subrogation opportunities to facilitate monetary recovery from other liable parties.
Served as subject matter expert and guided insured clients on the proper documentation and reporting process of workers compensation claims.
Experience
10+ Years
Level
Senior
Education
Criminal Justice
Claims Investigator I Resume
Summary : Successful Claims Investigator I with at least 11 years' experience in municipality and utilities administration with current experience in claims analysis. Strong customer service relations and operations management background developed through customer service and administrative positions.
Responsible for assisting applications with identified disputes to finalize qualification for unemployment claims.
Responsible for all in bound call from customers and assisted them with starting new claims.
Answered any unresolved issues from taking a claim(s), re-opening claims, fixing any errors the customers may of made, adjusted payments, closed out any disqualification or and ineligibilities.
Handled all case issues were sent correspondence, overall just outstanding customer service for all customers.
Investigated, examined and processed all hospital, major medical and prescription claims, ICD9 coding and DRG maintenance billing.
Investigated and evaluated general liability and first-party property claims.
Identified and analyzed claim damages in relation to policy provisions.
Experience
10+ Years
Level
Senior
Education
High School Diploma
Claims Investigator Resume
Summary : To establish a long-term career in a company where I may utilize my Claims Investigator professional skills and knowledge to be an effective Associate Program Manager and inspiration to those around me.
Skills : Microsoft Office, Management, Problem Solving/Decision Making/Analytical.
Description :
Conducted investigations with a focus of fraud investigations, and ensured the timely, accurate, and efficient administration of claims activities including interviews, research, documentation, and reporting.
Maintained compliance with all state specific protocols and regulations.
Leveraged expertise with investigations, legal knowledge, insurance regulations and compliance rules, to develop and implement an investigative plan of action.
Maintained detailed records and accounts of all claims.
Respond on death cases and successfully investigation each to mitigate damages.
Developed and prepared professional, accurate, and thorough reports.
Maintained a high level of performance and served as subject matter expert, providing training and mentorship for new employees.
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