Claims Consultant Resume Samples
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Claims Consultant Resume Samples
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A Davis
Alan
Davis
817 Garett Garden
San Francisco
CA
+1 (555) 851 7812
817 Garett Garden
San Francisco
CA
Phone
p
+1 (555) 851 7812
Experience
Experience
New York, NY
Claims Consultant
New York, NY
Larkin and Sons
New York, NY
Claims Consultant
- Consulting with clients on complex losses, providing guidance and assistance with emphasis on claims preparation, submission, and resolution
- Analyzing claims and coverage issues while guiding the claims process
- Managing claim in accordance with Lloyds reporting version 4 compliance
- Building and developing external business relationships with loss adjusters, brokers, Underwriters and Coverholders
- Coordinating and attending claims settlement meetings with clients and insurers
- Maintaining accurate time management records for billing purposes
- Leading by example by demonstrating and sharing with all lines of business the importance of best practices; and
San Francisco, CA
Specialty Claims Consultant, LPL
San Francisco, CA
Heller-Weimann
San Francisco, CA
Specialty Claims Consultant, LPL
- Recognized as the company consultant in a field providing technical guidance, assistance and training to lower level associates
- Responsible to provide consultation and participation in the development of large claim strategies handled by both independent and staff adjusters
- Makes decisions in an informed confident and timely manner
- Cultivates an environment of teamwork and collaboration
- Thinks critically and anticipates, recognizes, identifies and develops solutions to problems in a timely manner
- Maintains constructive working relationships despite differing perspectives
- Maintain a high level of communication with leadership
present
Chicago, IL
Senior Claims Consultant
Chicago, IL
Wilkinson-Auer
present
Chicago, IL
Senior Claims Consultant
present
- Developing and maintaining working relationships with other claims professionals
- Manage return to work with internal and external partners
- Participate and manage quarterly claims reviews with the TPA for managed claims
- Communicate and go on-site as necessary to locations to assist with all internal claims management activities
- Working knowledge of Workers’ Compensation coverage and cost containment practices
- Advise clients of their claim related obligations under the policy and establish client-specific claims management procedures and protocols
- Consulting with clients on major losses, providing guidance and assistance with emphasis on claims preparation, submission, and resolution
Education
Education
Bachelor’s Degree in Technical Complexity
Bachelor’s Degree in Technical Complexity
University of Georgia
Bachelor’s Degree in Technical Complexity
Skills
Skills
- Strong technical and analytical skills, proficient with Excel
- Strong communication, negotiation and presentation skills. Ability to effectively interact with all levels of CNA's internal and external business partners
- Ability to conduct single and multi-party negotiations and espouse coverage/liability positions
- Advanced technical and product expertise, claims resolution and knowledge of insurance, and claims principles, practices and procedures
- Lodging new claims for assessment and record details throughout the process including information gathering, treatment requests and obtaining incident reports
- Make liability assessments and recommendations to management which impact results
- Ability to work effectively with insured's, defense counsel, other carriers, and agents and brokers in the management of accounts
- Ability to work on a project team; flexible to adjust to changing deadlines
- Ability to implement strategies with a proactive long-term view of business goals and objectives
- Senior level knowledge of claims and insurance industry theory and practices
15 Claims Consultant resume templates
Read our complete resume writing guides
1
Claims Consultant Resume Examples & Samples
- Consulting with clients on complex losses, providing guidance and assistance with emphasis on claims preparation, submission, and resolution
- Preparing reports on claims disputes for management review and guidance
- Taking the lead position with Account Managers and Brokers to resolve coverage disputes with insurers
- Providing general guidance and support to the Claims Management Team as required and approved by the Regional Claims Manager/Leader
- Developing and maintaining working relationships with other claims professionals
- Maintaining accurate time management records for billing purposes
- Minimum 5 to 7 years of claims handling or adjusting experience in the property/casualty sector is required
- General insurance experience is an asset
- Strong organization skills and the ability to prioritize under pressure of competing deadlines
2
Senior Claims Consultant Resume Examples & Samples
- Supervising the claims team in Winnipeg
- Analyzing claims and coverage issues while guiding the claims process
- Researching legal decisions and judgments on insurance contracts and claims as required
- Making recommendations to clients as appropriate for alternative dispute resolution
- Developing and coordinating a claims resolution team working with legal counsel or others as may be appropriate
- Coordinating and attending claims settlement meetings with clients and insurers
- Assisting in the development and maintenance of quality control standards
- Providing general guidance and supporting to the Claims Management Team as required and approved by the Regional Claims Manager
- Leading by example by demonstrating and sharing with all lines of business the importance of best practices; and
- Minimum 7 – 10 years of claims handling experience in the property/casualty sector is preferred
- People management experience is an asset
3
Senior Claims Consultant Resume Examples & Samples
- Reports into Claims Director and serves as subject matter expert on advanced disability and risk principles
- Primary resource to coordinate reviews and responses to Market Conduct Examinations (MCE) and Department of Insurance inquiries
- Partner with Sr. Process Consultants in enhancing policy & procedures stemming from analyses of complaints, appeals, litigation, MCE or other external governing requirements
- Partner with Performance Measures in analyzing trending / outcomes through Appeals, Complaints & Litigation
- Participate in development of applicable policy & procedures
- Partner with key business partners, i.e. training, compliance, Law, etc. to jointly develop and implement solutions
- Acts as Subject Matter Expert to Appeal, Litigation & Complaints
- Resource for complex contractual, legal and policy issues
- Key project coordinator for claim operation initiatives requiring detailed product knowledge
- Coordinates process changes stemming from SIFI requirements
- Incumbents typically have eight to ten years of progressive experience in disability claims
4
Senior Claims Consultant Resume Examples & Samples
- Assume responsibility for consultative claim services on a robust book of Casualty accounts
- Confer with client and broker to tailor the policy language and program design to meet the client’s needs
- Advise clients of their claim related obligations under the policy and establish client-specific claims management procedures and protocols
- Provide claims advocacy on behalf of the client by providing written responses to carrier coverage positions and by negotiating favorable claim resolutions in face to face meetings
- Support new business efforts by participating in sales presentations and RFPs
- Identify new business opportunities that promote and offer Willis claim consulting services
- Monitor the performance of clients’ insurer/TPA claim services
- Participate in stewardship and strategic client meetings as required
- Maintain direct relationships with key clients, markets, and key carrier claim liaisons
- Review and provide insightful commentary on new policy forms when requested
- Manage account profitability by managing service levels appropriate to account revenue levels
5
MRA Data Claims Consultant Resume Examples & Samples
- Basic understanding of Claims
- Computer literate (MS Word, Power Point, Excel)
- Proven analytical skills,
- Proven intermediate Excel skills
- Prior SQL database development; MSSQL or PLSQL experience, Intermediate,
- Experience in SF data (PPNOSQL)
- Medicare Risk Adjustment Knowledge
- EDW Claims experience
- Experience with Macro’s and VBA
6
Claims Consultant, Albany Auckland Resume Examples & Samples
- Minimum 12-24 months experience in disability and lump sum medical claims
- Tertiary qualification in a related discipline highly regarded and Certificate in Medical Terminology preferable
- Leadership qualities and or experience
- Proven ethic of “exceeding customer expectations” and strong people skills
- Excellent oral and written communications and proficient in the use of Microsoft office applications
- Strong problem solving and negotiation skills and ability to work under pressure
7
Claims Consultant Resume Examples & Samples
- Provide advocacy on behalf of assigned clients relating to services rendered by carriers and/or TPAs to include the review and revision of account instructions and addressing client service concerns
- Participate in telephone or in-person claim reviews and audits designed to result in file resolution, inclusive of documenting claim specific outcomes, reserve analysis and action plans
- Attend and participate in periodic on-site client meetings regarding service delivery and/or stewardship
- Analyze loss data for trends inherent to a client's operations and be able to provide solutions to minimize the exposure to that organization
- Communicates with senior management/risk management groups and articulates strategies to resolve claim related issues
- Presents to potential prospects in order showcase our capabilities
- Up to 30% travel, this includes local and out of state. Driving is also a requirement of this position
- Manage time spent in the delivery of agreed client services to ensure content quality, timely delivery, and profitability
- Adhere to established Best Practices and make recommendations for improvement, when appropriate
- Maintain knowledge/skills as an insurance professional and possess excellent written and verbal communication skills
8
Claims Consultant Resume Examples & Samples
- Consulting with clients on major losses, providing guidance and assistance with emphasis on claims preparation, submission, and resolution
- Taking the lead position with Account Executives and Brokers to resolve coverage disputes with insurers
- Providing general guidance and support to the Claims Management Team as required and approved by the Regional Claims Manager
- Other related duties and responsibilities as assigned
- Minimum of five (5) to seven (7) years of progressive claims handling experience in the property & casualty sector
- General insurance experience required
- Ability to work collaboratively as a key member of a team and independently with minimum supervision
- Seven (7) to ten (10) years of progressive claims handling experience in the property & casualty sector preferred
9
Senior Claims Consultant Resume Examples & Samples
- Technical expertise in General Liability
- 10 years of experience working in a commercial claims environment
- Insurer or Broker experienced
- Completion of/ working towards CIP/FCIP designation
- RIBO licenced (must obtain within 1 year of employment)
- Demonstrated leadership abilities an asset
- Strong negotiation and relationship managements skills
- Ability to influence audience and act with diplomacy
- Strong presentation skills, highly organized and can effectively manage competing demands
10
Senior Claims Consultant Resume Examples & Samples
- Lead a team in the analysis or preparation of a complex construction claims, being responsible for the deliverable to the client, whether it be a report, presentation, or expert testimony
- Management experience, along with extensive experience in Project Controls, CPM scheduling, delay analysis, productivity analysis, claims, and dispute resolution
- Experience with Heavy Highway, transit or building construction, and a strong construction background on large, complex projects is highly preferred
- An intuitive knowledge and ability to quickly understand principals of construction and contractor means and methods is necessary
- Earned Value analysis and trending, construction contracting, planning, staffing, budget management, and resource allocation required
- Exceptional written and verbal communications and organizational skills are a must
- The successful candidate must interface effectively with clients, coworkers, and others
- Market and promote construction claims services, management of projects, financial planning, and control
- Establish and maintain professional business relations with clients
11
Field Claims Consultant Resume Examples & Samples
- Identification, investigation and rejection of unwarranted and/or fraudulent claims
- Contribution to a favorable corporate image through effective communication
- Effective investigation of disability income claims through thorough and timely contact with policyholders, insureds, physicians, employees and other parties
- Preparation of timely and thorough written reports of investigative activities on claims to assist managers and claim consultants in their ongoing administration of disability claims
- Preservation of Berkshire Life Insurance Company of America, a Guardian company’s image and reputation in the obtaining of necessary facts so as to permit approval, denial or compromise of claims consistent with Berkshire Life Insurance Company of America's claim philosophy, despite difficult and delicate circumstances
- Provision of assistance to the Law department and outside counsel when litigating cases through gathering and preparing required evidence
- Performs additional responsibilities as requested
12
Associate Claims Consultant Resume Examples & Samples
- Critical thinking and analytical skills
- Demonstrated accountability and initiative for providing excellent customer service
- Meets expectations for accuracy and quality of work
- Must exhibit a positive attitude and remain in control during stressful situations
- Demonstrated ability to organize, prioritize and manage multiple tasks within time expectations
- Demonstrated ability to remain adaptable and contribute to a work environment that seeks and recognizes continuous improvement
- Demonstrated ability to interact with confidence while engaging in open discussions in an effort to build rapport with others
- Demonstrated knowledge of disability products and services
- Sound knowledge of Berkshire’s products, administration and claims procedures a plus
- Strong knowledge of PC Applications (including Microsoft Office, Cypress, etc.)
- ALHC preferred
- Financial, medical, occupational and investigative experience
- Minimum of 1 year of experience in a disability claims environment or equivalent work experience required
13
Senior Claims Consultant Resume Examples & Samples
- Manage litigation caseload in partnership with the Law Department with a view to having cases resolved in a timely and effective manner. Speak for and represent the interests of Sun Life Financial at discoveries, mediations, trials and other judicial or quasi-judicial proceedings in a professional manner
- Review, investigate and assess complex or appealed claims and inquiries from Life Claims Specialists, within required deadlines
- Deliver exceptional proactive customer service to clients, advisors and internal staff who consult with you
- Handle inquiries and escalated cases
- Coach and mentor team members as opportunities arise
- Provide training to new employees or existing team members when needed
- Assist other members of the claims teams to attain objectives
- Conduct quality reviews on team members assessments
- Participate in projects aimed at improving customer service and experience
- Continuously identify and deliver service improvements that deliver value to our customers
14
Technical Claims Consultant Resume Examples & Samples
- Extensive Life Claims experience assessing Retail and or Group claims
- Exposure to litigation matters or involvement in claims mediation processes. Including FOS & SCT matters
- Claims investigations expertise including previous experience in the identification of valid and non-legitimate claims
- Strong financial acumen and previous specialist experience in a dispute resolution claims environment
- Outstanding written and verbal communication skills including the ability to write complex case notes
15
Claims Consultant Resume Examples & Samples
- Effectively manage claims stemming from multiple lines of business
- Monitor performance, reviewing open, reopened and closed claims to ensure that claims are handled according to company policies and procedures, resulting in an equitable resolution within the company's contractual and legal liability
- Perform claims reviews in connection with market conduct examinations when not needed for receivership work
- Ensure salvage and subrogation opportunities are identified and coordinate third party recovery with the asset recovery team
- Direct and control the establishment of appropriate claim case reserves to ensure that future costs are accurately assessed and the company can determine its financial position
- Manage all types of investigative activity on major claims. Coordinate discovery and litigation strategy with defense counsel or panel attorneys
- Negotiate highly complex settlement packages, set reserves and authorize payment within scope of authority, settling claims in most cost effective manner and ensuring timely issuance of disbursements
- Make recommendations on claims policy and processes to management
- Analyze claims activities; prepare and present reports to management
- Work with attorneys, account representatives, agents, doctors and insured's regarding the handling and/or disposition of highly complex claims
- Properly utilize claims systems to document losses to minimize the possibility of erroneous payments
- Participate and lead tactical and strategic projects both within claims and within the larger company structure
- Based on effective investigative efforts, ensure all resolution and negotiation strategies are considered including the pursuit of all appropriate third parties/collateral sources
- Present cases and share expertise through the claim committee process
- Adhere to all statutory regulations and Unfair Claims Practices Acts
- Timely and appropriately communicate with internal and external customers relative to account trends, service issues and claim losses
- Ensure the establishment, documentation, and execution of appropriate strategies to bring early resolution to assigned claims
- Contribute to a collaborative environment by consistently demonstrating teamwork, high motivation, positive behavior and effort to achieve goals and objectives
- Make decisions regarding payment amounts and claim settlements
- Provide direction and development to staff to ensure that they have sufficient knowledge and skills to resolve claims timely and equitably
- Ensure that staff provides prompt and courteous service
- Adhere to all Information Security policies/practices including reporting any security breaches, and comply with Company password management and PC locking policies
- Manage the responses to complaints; communicate complaint trends and create action plans to solve claims adjusting problems. Provides input to Best Practices process for long-term solution to problems. Ensure customer satisfaction
16
Claims Consultant Resume Examples & Samples
- This position has the option to telecommute.**
- Develops and maintains effective working relationships with internal and external customers, assigned accounts and brokers. May provide day-to-day work direction to non-sales associates. May attend or conduct meetings with Policyholders, Brokers, and Group Office Associates
- Provides excellent service recovery, to include turning complaint/error situations into an advantage, delivering service from a total need level and using every contact as an opportunity to provide a positive customer experience. Consults with clients regarding insurance coverage needs and assists in plan design. Services and/or assists in servicing complex client issues and requests
- Responds to assigned customer inquiries regarding a wide variety of topics including implementation and disability claims management. Inquiries may require detailed investigation or may require coordination with other areas throughout the company. Establishes effective claim administration guidelines/procedures. Exchanges information with assigned customers for the purpose of anticipating and identifying potential customer needs; communicates customer needs and recommends solutions to management
- Investigates service complaints, coordinates responses to customer questions and concerns, creates customer specific action plans and develops specific recommendations to improve customer satisfaction
- Initiate's and leads cross-functional teams to ensure satisfaction of customer needs. Manages projects associated with product and client service enhancements
- Assist management with developing a collaborative and cohesive work team that is motivated, productive, and committed to achieving superior results to include, influencing others effectively, using appropriate interpersonal styles and techniques to build consensus, win support, and encourage others to take action. Assists in developing and maintaining a fair and equitable working environment
- Thorough knowledge of Group Insurance products, including systems and distribution channels
- Demonstrated ability to provide quality and thorough customer service
- Demonstrated ability to think and conceptualize beyond existing barriers, methods, and practices and utilize sound and independent
17
Senior Claims Consultant Resume Examples & Samples
- 4 year college degree required; a Business related field is highly preferred. Additional level(s) of education are a plus
- Minimum of 6 years’ experience in a Claim and/or Risk Control related position with some prior experience working at an insurance carrier or third party administrator preferred
- CPCU, or AIC, or ARM within 3 years of obtaining this position or 6 years or more insurance industry experience exempt
- WC and Liability experience required
- Must have appropriate licenses in their resident state
- Knowledge of Claim Handling & Claim processes and procedures
- Understand medical case management and cost containment programs
- Knowledge of laws, legal codes, procedures and processes involving insurance
- Analyze data and provide concise conclusions; communicate orally and in writing, and display versatility in working with different personalities
- Evaluate information against a set of standards to verify compliance; handle complaints, arbitrate disputes and negotiate settlements, and handle multiple tasks simultaneously
- Obtain relevant information; analyze and report financial data, and communicate technical information orally and in writing
- Effectively communicate with senior management; evaluate information against a set of standards to verify correctness, and handle complaints, arbitrate disputes, and negotiate alternative solutions
- Handle multiple tasks simultaneously; obtain relevant technical information to support decision making or selling risk improvement programs, and work independently
- Computer skills relevant to Microsoft Office, Outlook, and web-based applications
- Interpersonal relationship skills with internal and external executives
- Understand the process and value of basic data analytics and benchmarking
18
Claims Consultant Resume Examples & Samples
- Good communications skills
- Strong technical and analytical skills, proficient with Excel
- Ability to work on a project team; flexible to adjust to changing deadlines
19
Claims Consultant Resume Examples & Samples
- Ability to review multiple policies and coverage parts, write and articulate clear coverage positions
- Conduct investigations regarding the claims and/or lawsuits
- Make liability assessments and recommendations to management which impact results
- Ability to work effectively with insured's, defense counsel, other carriers, and agents and brokers in the management of accounts
- Ability to conduct single and multi-party negotiations and espouse coverage/liability positions
- Executing financial transactions
- Strong planning and organization skills
- Strong analytical and critical thinking ability
- Strong negotiation and conflict resolution skills
- Experience handling claims or its functional equivalent
- Minimum of 3 years claims experience
20
Claims Consultant Hartford Financial Products Resume Examples & Samples
- Conducting investigations and analyzing and evaluating the information learned
- Appropriately and accurately analyzing and determining coverage, liability and damages based upon the facts of each claim
- Communicating written position(s) to insured’s and other required parties on coverage, liability damages and other issues
- Within prescribed authority levels, setting appropriate expense and indemnity reserves and monitoring on a regular basis for any needed adjustment
- Presenting cases to management for expense or indemnity reserve authority above established authority levels
- Developing and implementing resolution strategies through negotiations to achieve high quality outcomes
- Proactively managing litigation and counsel, inclusive of litigation planning and execution, budgeting and bill review
- Understanding and analyzing potential extra-contractual liability as needed
- Attending trials and mediations as necessary
- Contributing to broader claim and enterprise goals by participating in audits, projects, training and product development initiatives
- Preparing comprehensive reports and delivering presentations to senior claim leadership on case developments, policy issues, industry trends, etc
- Providing support and working collaboratively with business partners to evaluate and address claim trends and developments
- Address inquiries from agents and policyholders, providing superior customer service
- Bachelor’s degree required; law degree a plus
- Minimum of seven years handling complex litigated coverage and liability matters
- Candidate should be disciplined, results-oriented and able to focus on bottom line results
- Strong preference for candidates with knowledge and experience handling complex Financial Services/ D&O liability claims
- Excellent strategic thinking ability and execution skills
- Excellent negotiation and advanced technical claim handling skills, including knowledge of insurance coverage issues
- An ability to communicate thoughts clearly and concisely, and to influence and persuade others
- Superior interpersonal skills
21
Reinsurance Accounting / Claims Consultant Resume Examples & Samples
- Management of assigned client portfolio. Duties to support client base will include all transactional processing, follow up and securing of reinsurance premiums, claims, and collateral transactions with timely/accurate system entry of all assigned client activity
- Work with other areas to support collection and cash application initiatives as required
- Manage settlement of funds to and from Client in a timely manner ensuring all applicable payment warranties and/or conditions are met
- Ensure assigned tasks are completed accurately and in accordance with Service Level Attributes (SLAs)
- Provide detailed information on client specific accounting/claims activities to support client sales opportunities
- Attend transactional audit/claim reviews (as necessary) with client and reinsurer at assigned client location. Prepare and facilitate premium / claim data information in advance of the review/audit
- Promote, build and maintain relationships with Brokers, Clients and Markets. Understand their issues and working practices in order to effectively resolve problems and/or queries
- Participate and support manager in team meetings and activities to share opinions, ideas, knowledge and solutions; maintaining strong working relationships and actively contributing to deliver outcomes
- Seek opportunities to increase own understanding and improve the services provided
- Collaborate with peers on complex or contentious reinsurance developments
- Support, assist and provide guidance to less experienced Colleagues as needed
- Perform other job related duties as assigned
- 5 + years of reinsurance/insurance, accounting/claims or professional experience
- Strong knowledge of reinsurance concepts and principles, laws and regulatory requirements (i.e., FATCA, etc.) and general business trends
- Strong track record of successful Client account management, relationship management, engagement and development
- Strong verbal and writing skills for complex communications (presentations, negotiations, etc.) with clients, markets and GC colleagues at all levels
22
Senior Claims Consultant Resume Examples & Samples
- Constantly liaising with clients, insurers, claimants, Brokers and external providers
- Handling complex and standard Financial lines claims
- Arranging and/or conducting investigations
- Negotiating through the determination and/or settlement process on behalf of your clients
- Preparing various client targeted reports including trend analysis
- Preparing for and attending client meetings, including annual or quarterly claims review meetings
- General administrative matters including data management and entry, reconciliations invoicing, filing and scanning
- A minimum of 3 -5 years of Claims experience ideally within Financial and Professional lines
- Compliance with Tier 1 (Insurance Broking) requirements
- Member of ANZIIF
- Strong interpersonal skills and a strong customer focus
- The ability to meet tight deadlines and successfully prioritise your work tasks
- A thorough knowledge of Word and Excel is essential
23
Claims Consultant Resume Examples & Samples
- Negotiates highly complex settlement packages, cost share agreements, sets direct reserves and authorizes payment within scope of authority, settling claims equitably and ensuring timely issuance of disbursements
- Makes recommendations on claims handling policy and processes to management
- Manages all types of investigative activity on claims to include contact with insureds, witnesses, experts, agents, doctors, etc
- Coordinates discovery and litigation strategy with attorneys, including managing complex relationships with multiple parties (i.e. defense and coverage counsel, carriers, etc.)
- Manages all aspects of reinsurance notification, billing and collection through analysis of direct claim activities, monitoring large loss notices, and interfacing with direct claims areas as well as reinsurance brokers and reinsurers on the most complex claims
- Maintains compliance with state/federal regulations. Stays current with legal and industry trends
- Maximizes use of internal resources (i.e. Claim Litigation Technicians) to ensure optimal Total Claim Outcome. Interfaces with Litigation Management Unit and coverage counsel
- Provide guidance and assistance to Claims Specialists and other Claims staff
- May be responsible for special claims projects and presentations
- Senior level knowledge of claims and insurance industry theory and practices
- Advanced technical and product expertise, claims resolution and knowledge of insurance, and claims principles, practices and procedures
- Strong interpersonal communication, negotiation and presentation skills. Ability to effectively interact with all levels of internal and external business partners
- Advanced analytical and problem solving skills with the ability to manage and prioritize multiple projects
- Bachelor's degree or equivalent experience. Professional designation or J.D. preferred
- Typically a minimum eight years claims experience focusing on environmental claims or mass tort
- Licensed in required states
- LI-MA1
24
Claims Consultant Resume Examples & Samples
- Thorough and detailed claim review, including medical, financial and occupational information
- Obtaining relevant information required to complete the claim review
- Liaising with claimants, providers and stakeholders
- Identifying opportunities and making recommendations for ongoing claim management
- Maintain accurate records and documentation
25
Quantum Claims Consultant Resume Examples & Samples
- Support and perform detailed analysis of project schedule delays, cost overruns, productivity, contracts, change orders and other issues related to design and construction
- Perform research and analysis of project cost records
- Perform data gathering activities including document review and supervision, and quality control
- Develop computer models of schedules, contractor production rates and costs using various software packages
- Deliver commercial advice on quantum matters to new and existing clients
- Advise on responses to commercial and contractual issues as they arise
- Prepare cost related claim reports
- Support company business development efforts
- Degree in Quantity Surveying or a related subject (BSc/BEng)
- 5 years plus quantity surveying and/or contract management & claims experience
- Good analytical, investigative and problem solving skills
- Possesses a flexible approach to work, and be prepared to work overseas for short periods
- Fluent in Chinese and English, speaking and writing, mandarin preferable
- Good team working skills and the ability to work efficiently and accurately under pressure
26
Claims Consultant Resume Examples & Samples
- Manages highly complex investigations of claims, including coverage issues, liability, compensability and damages. Determines if a major claim should be settled or litigated and implements an appropriate resolution strategy accordingly. Effectively manages loss costs and claim expenses
- Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes
- Ability to fully comprehend complex claim facts and issues; and to further articulate analyses of claims in presentations to business partners and management as well as in internal reports
- Bachelor's degree or equivalent experience. Juris Doctor is preferred
27
Claims Consultant Resume Examples & Samples
- Highest level individual contributor directly reviewing claims to determine nature of loss, coverage provided and scope of claims
- Responsible for timely evaluation, reserving and disposition of assigned claims
- Makes recommendations for settlement/disposition of claims
- Will provide technical advice and/or training to lower level claims associates
- Prepares required reports to senior management
- Travels to mediations or settlement conferences as required
- 4 year college degree or equivalent in related work experience
- 8-10 years related experience handling claims in a primary personal lines insurance environment
- Law degree and CPCU preferred
- Proficiency with Word, Excel, PowerPoint and OneNote required
- Non-resident licenses where required
28
Senior Claims Specialist / Claims Consultant Resume Examples & Samples
- Extensive experience of handling general liability and construction claims of a complex nature
- Helps develop insurance programs for clients which include the creation of policy and
- 10+ years claims experience in general liability and construction claims
- College degree required, graduate/law degree a plus
- Construction industry client experience
- Ability to create the most complex and successful strategies for risk mitigation
- Knowledge of claim handling & claim adjudication processes and procedures
- Current on case law and appellate decisions to use in the adjudication of claims
- Understand company products, services, global network, and industry practices
- Travel required, primarily within New York
29
Senior Claims Consultant Resume Examples & Samples
- Constantly liaising with clients, insurers, claimants, brokers, Solicitors and Loss Adjusters
- Learning and interpreting policy wordings
- Determining claims settlements for under-deductible claims and liaising with the State Manager on complex claims
- A minimum of three to five years of Claims experience
- Exposure to Liability and Professional Indemnity Insurance claims would be highly regarded
- A bachelor’s degree in Insurance, Law or a related field ideal but not essential
30
Specialty Claims Consultant Resume Examples & Samples
- Negotiate settlements mitigate losses and control expenses on our company’s largest losses
- Recognized as the company consultant in a field providing technical guidance assistance and training to lower level associates
- May be subject matter expert (SME) to coordinate consistent countrywide handling of specific large losses
31
Specialty Claims Consultant, MPL Resume Examples & Samples
- Must possess or secure and maintain appropriate state adjuster license(s) and continuing education credits
- Possesses a high and extensive level of technical knowledge and skills including product and industry
- Negotiate settlements, mitigate losses and control expenses on our company’s largest losses
- Maintain a high level of communication with leadership
- Responsible to provide consultation and participation in the development of large claim strategies handled by both independent and staff adjusters
- May co-adjust cases to facilitate learning and to impact file
- Typically has 6-10 years specialty claims handling experience, ideally with MPL
- Maintains constructive working relationships despite differing perspectives
- Ability to negotiate skillfully in difficult situations with both internal and external groups. Demonstrates ability to win concessions without damaging relationships
- Easily adapts to new or different changing situations, requirements or priorities
- Cultivates an environment of teamwork and collaboration
- Proficient using Claims systems (i.e. CSS, PMS etc.)
32
Specialty Claims Consultant, LPL Resume Examples & Samples
- Works with high authority limits on assignments reflecting a very high degree of technical complexity and coordination
- Recognized as the company consultant in a field providing technical guidance, assistance and training to lower level associates
- Typically has 6-10 years specialty claims handling experience, ideally with LPL
- Dedicated to meeting the expectations and requirements of internal and external customers
- Makes decisions in an informed confident and timely manner
- Demonstrates strong written and verbal communication skills. Promotes and facilitates free and open communication
- Understanding of applicable statutes regulations and case law
- Thinks critically and anticipates, recognizes, identifies and develops solutions to problems in a timely manner
- Operates with latitude for un-reviewed action or decision
- Proficient in MS Office, Excel, Word, Internet etc
33
Senior Claims Consultant Resume Examples & Samples
- Helps develop and execute the strategies for large & middle market accounts to help identify coverage based on applicable policies, manage claims and overall programs in conjunction with WTW safety and service teams
- Handles complaints, arbitrates disputes and negotiates alternative solutions
- Consults with clients to help mitigate their risk
- Support new business with sales presentations and RFP
- Monitor the performance of trading partner’s services for your clients
- Ensure appropriate program design and documentation - service scope aligns
- Directly handles clients as primary consultant including complex consulting and strategy
- Maintain direct relationships with key clients
- Manage the appropriate level of resources for your clients
- Participate in strategic large client meetings as required
- Extensive experience of handling multi-line claims with focus on workers compensation and general liability claims of a complex nature. Experience with additional lines including property, auto liability, EPL & construction defect claims would be a benefit
- 5+ years claims experience in workers compensation and general liability claims
- High School diploma and college degree required
- Ability to analyze and provide concise conclusions
- Ability to problem solve and work independently
- Travel required, primarily within Pennsylvania, NJ, & NY
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Junior Claims Consultant Resume Examples & Samples
- To manage the relationships with an allocated client base and provide day to day troubleshooting advice and support on claims related issues
- Undertake claims file audits for Insurer claim files
- CII certification or similar will be beneficial for this role
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Principal Claims Consultant Resume Examples & Samples
- Demonstrable Life Claims experience assessing Retail or Group Claims
- Exposure to litigation matters and mediation processes, including FOS and SCT
- Claims investigation expertise including previous experience in the identification of valid and non – legitimate claims
- Strong financial acumen and previous specialist experience in a dispute resolution environment
- Displays attributes of a positive change champion for the implementation of any initiatives
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Claims Consultant Resume Examples & Samples
- Manage percentage market commercial risk claims for various Lloyds Insurers end to end
- Manage client accounts on a national basis including fire & peril, business interruption and property damage claims for commercial insurers
- Interpret ISR commercial policy wordings and applying accurately
- Building and developing external business relationships with loss adjusters, brokers, Underwriters and Coverholders
- Managing claim in accordance with Lloyds reporting version 4 compliance
- Comply with relevant legislation such as Insurance Code of Practice, and other relevant legislation / regulations and policy requirements
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Assistant Claims Consultant Resume Examples & Samples
- Data entry of incident reports and processing of other claims related information in Enterprise
- Preparing and sending routine correspondence and other documents using Company templates
- Maintaining files and the filing system, including creation of new files, timely and accurate filing of documents, archiving and retrieving files and recording file movements
- Develop claims knowledge and technical abilities
- Reading and routing incoming mail and faxes
- Making copies of correspondence or other printed materials
- Providing ad-hoc administration and clerical support to team members as required
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Senior Claims Consultant Resume Examples & Samples
- Compile underwriting material for insurers (e.g. compilation and maintenance of database of hundreds of environmental reports - Phase I & II Environmental Assessments, asbestos, lead paint, etc.) for environmental coverage
- Administrative Support to JBG Risk Manager with information requests and strategic initiatives
- Compliance review of insurance certificates and small contracts
- Coordinate invoice processing and tracking
- Loss Control site visits – facilitate and follow-up
- Respond to RFI’s from site personnel
- Coordinate and oversee claims management strategies on reserving, settlement and closure to bring claims to resolution
- Communicate and go on-site as necessary to locations to assist with all internal claims management activities
- Participate and manage quarterly claims reviews
- Maintain an internal active diary system of claims that are being managed
- Coordinate for team internal claims update to Risk Management as requested / required, such as an internal claims review
- Monitor claims reporting to third party administrator and report claims as required
- Manage return to work with internal and external partners
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Motor Claims Consultant Resume Examples & Samples
- End to end claims management
- Settling claims within client service instructions, company guidelines and delegated authority
- Building and developing external business relationships
- Attending client meetings where applicable
- Preparing Standard Client Reports within Service Instructions as required
- Comply with relevant legislation such as The General Insurance Code of Practice, and other relevant legislation / regulations and policy requirements
- Resolve complaints in accordance with company guidelines
- Identify potential fraud/recovery indicators for claims where applicable
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Litigated Claims Consultant Resume Examples & Samples
- Reviews/acts on reports/forms; responds to inquiries; seeks legal opinion and early resolution; and communicates resolution to appropriate parties
- Responds to decisions, agreement, and/or court order; creates action plan; determines need for examination; gains client authorization
- Identifies cases for settlements/redemptions
- Gathers/documents additional information and coordinates with client designees
- Requests legal/private investigation; assigns to and coordinates with local counsel; monitors local counsel performance
- Responds to plaintiff's counsel, union, employee, or client requests
- Identifies issues; formulates defense strategy
- Establishes/adjusts accrued liability
- Approves administrative expenses
- Identifies subrogation opportunities and manages process
- Attends mediations or hearings as needed
- Works with partners to affect early return-to-work
- Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business
- PC literate, including Microsoft Office products
- Analytical and interpretive skills
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Claims Consultant Resume Examples & Samples
- Provides training 1x1, or at the department level, as new claims examiners are hired, or in the event of a significant change in process or system. Serves as an informal mentor or coach to claims examiners as determined by the Operations Manager
- Provide thought leadership to all levels of claims examiners as well as providing consultation to BSA's and Operations Managers. Make claims decisions that have long lasting impact by setting precedent that will have an effect on future matters
- Examines claims that contain the highest level of complexity, or claims where a Sr. Examiner is unable to make a claim decision due to unique or highly complex circumstances. Acts in the capacity of "claims specialist" and is the last line of defense within the unit in making a claim decision
- Performs lead non-supervisory level analyst work, often addressing consistency, accuracy, quality, continuous improvement, and/or standardization of processes
- Accountable for the development and maintenance of NAIC compliant claims processes across all lines of business. Responsible for monitoring the claims environment for process gaps or industry changes that may affect compliance
- Represents Claims Operations in the Member Dispute Resolution Program (MDRP) process serving as the subject matter expert and chief decision maker. This individual is also responsible for representing Thrivent in claims cases that result in litigation or appealed decisions to include coaching other team members throughout the process
- Provide oversight for compliance/audit reviews and serve as subject matter expert fulfilling audit requirements under the direction of Compliance Analysts. Represents the business unit in face to face meetings with internal and external auditors, as well as provides leadership to other team members involved with the process
- Assists the Operations Manager as needed monitoring and providing oversight for the timely completion of claims processing and the directing of work assignments among all team members including Claims Examiners and Service Representatives to ensure timeliness standards are maintained
- Subject Matter Expert for Death Claims in relation to ongoing projects, both within the claims area and other departments as needed
- Resolve escalated member and FR cases
- High school required. College degree preferred
- Minimum 7 years relevant experience
- Expert level knowledge of death and/or medical claim administration and operations as well as pertinent laws and regulations
- Must possess strong interpersonal skills, as well as excellent verbal and written communication skills
- This role will require the candidate to interact with a team of 20+ associates, and requires emotional intelligence, leadership skills and coaching capabilities
- Lean Six Sigma green belt, or GBA
- Professional credentials preferred (e.g. LOMA, ICA)
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Senior Claims Consultant Resume Examples & Samples
- To deliver projects for clients, including process improvements, writing procedure guides and providing training
- Complete claims data analysis and provide reports on claims trends to clients
- You will have proven claims experience across Casualty, EL, PL and Motor claims – any experience of Property and/or Business Interruption claims will be beneficial
- Ideally you will have worked with clients to advise on claims, reduction of claims spend, process improvements and/or claims trends
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Claims Consultant Resume Examples & Samples
- Promptly enter or update claims information into appropriate claims application(s) in compliance with any local service standards
- Manage a portfolio of corporate clients under a variety of insurance classes, including: Property, Liability, Marine, Plant & Equipment
- Distribute (report) new claims notifications, or updates, to all insurers for all policies or coverages
- Communicate with clients, colleagues, third parties or insurers for status updates, information requests, instructions or query resolution
- Prepare for and attend client meetings, including annual or quarterly claims review meetings
- Analysing and interpreting policy wordings
- Negotiating through the determination and/or settlement process on behalf of clients
- Meeting standards as outlined through external agreements and internal unit standards
- Prepare settlement documentation and where appropriate facilitate collection of claims monies
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Claims Consultant Resume Examples & Samples
- Independently managing appeals of adverse life, life waiver of premium, disability, and long term care claim benefit determinations in compliance with the state laws and/or federal regulatory requirements and in conformity with company guidelines
- Independently and effectively exercising critical thinking by conceptualizing, analyzing, evaluating, and interpreting medical, financial, and other relevant information gathered to establish claim directions and effectively reach claim and claim appeal determinations
- Using creative problem solving, critical thinking, and empathy skills to professionally and timely support and provide accurate solutions/answers to complex disability, life, life/disability waiver of premium and long term care inquiries from brokers, disability claims administrators, regional sales office associates, Individual Life Financial (ILFS) associates, and Employee Benefits (EB) associates. This position will be a primary support for third party claim administrators
- Respond to legal, attorney, and department of insurance inquiries when requested by Claims Support Manager
- Effectively assist their Claims Support Manager with administrative and risk management tasks as assigned to achieve individual, team, and enterprise strategic goals for empowerment with accountability, quality, timeliness, customer service, relationships, associate development, and process documentation. This includes training, mentoring, coaching, and performing quality and authority limit claim audits for less experienced claim associates as well as effectively completing process mapping and documentation
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Senior Claims Consultant Resume Examples & Samples
- Participate and manage quarterly claims reviews with the TPA for managed claims
- Develop and Monitor goals for claim mitigation within stores
- Work with stores safety to help identify and reduce claim trends
- Monitors and reports the effectiveness of third party claims administrators with regard to this position’s assigned case load
- Responsible for legally mandated mailings
- Act as an internal resource for Workers’ Compensation questions
- Utilizes TPA RMIS system for claims management
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Liability Claims Consultant Resume Examples & Samples
- Interpret public liability policy wordings and assessing availability of indemnity/applying accurately
- Managing liability claims end to end, attend and run settlement conferences
- Litigated and un-litigated claims
- Manage client accounts on a national basis
- Consideration of indemnity, liability and quantum under a policy
- Building and developing external business relationships – liaising with investigators, solicitors, and other third party providers
- Preparing standard client reports within service instructions
- Achieve monthly productivity level as designated by management
- Be familiar with and comply with relevant state legislation (e.g.: PIPA, Victorian Wrongs Act) and other relevant legislation / regulations and policy requirements on a national platform
- Resolve complaints in accordance with company guidelines and Insurance Code of Practice
- Identify opportunities for process improvement
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Claims Consultant Resume Examples & Samples
- Lodging new claims for assessment and record details throughout the process including information gathering, treatment requests and obtaining incident reports
- Gathering and following up on information in order to assist in determining cover, including making cover decisions for low risk claims
- Accurate interpretation of ACC legislation pertaining to Claims Management
- Managing incoming calls that come through from our customers and, where possible, dealing with inquiries, or directing the call to the appropriate person
- Generating and sending appropriate correspondence to follow up on claims and sending referrals to specialists
- Keep updated records and provide these to key stakeholders in a timely manner
