Claims Rep Resume Samples

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Guide the recruiter to the conclusion that you are the best candidate for the claims rep job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

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MZ
M Zboncak
Marcelo
Zboncak
645 Thelma Parkway
Houston
TX
+1 (555) 885 2129
645 Thelma Parkway
Houston
TX
Phone
p +1 (555) 885 2129
Experience Experience
06/2014 present
Dallas, TX
Senior Claims Rep-field
Dallas, TX
Senior Claims Rep-field
06/2014 present
Dallas, TX
Senior Claims Rep-field
06/2014 present
  • Manage all administrative claim functions such as reserving, claim payments and file notes via electronic means and at times from remote locations
  • Participate in company sponsored educational programs to develop and maintain knowledge of products, producers and industry trends
  • Manage the salvage process
  • Prepare written investigative reports for the claim file to document all activity related to the loss
  • Maintain currency on case law and construction prices/methods/procedures
  • Conduct field investigation to include site inspection, diagram, photographs, interview and secure recorded statements of those possessing facts concerning the loss
  • Foster and maintain relationships with independent agency force
11/2008 03/2014
Dallas, TX
Claims Rep-field
Dallas, TX
Claims Rep-field
11/2008 03/2014
Dallas, TX
Claims Rep-field
11/2008 03/2014
  • Participate in other projects or other duties as assigned
  • Negotiate with contractors or repair facilities regarding extent of damage and method of repair
  • Regular attendance
  • Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
  • Performs all other duties as assigned
  • Other duties assigned by management
  • Consistently meet established productivity, schedule adherence, and quality standards
11/2001 07/2008
Boston, MA
Claims Rep
Boston, MA
Claims Rep
11/2001 07/2008
Boston, MA
Claims Rep
11/2001 07/2008
  • Provide excellent customer service
  • Interpret Fee for Service (FFS) and capitated provider contracts
  • Analyze and identify trends and provides reports as necessary
  • Analyze and adjudicate claims to ensure accurate payment
  • Accurately process professional and institutional claims
  • Review claims on a periodic basis
  • Meet Department Quality and Accuracy Standards
Education Education
Bachelor’s Degree
Bachelor’s Degree
The University of Texas at Austin
Bachelor’s Degree
Skills Skills
  • Excellent time management ability
  • Strong focus delivering outstanding customer service
  • Strong desire to launch your career to the next level!
  • Demonstrated strong written and verbal communication skills
  • Accurately resolve coverage and compensability issues
  • Achieve fair, equitable and timely claim dispositions
  • Handle claim files in a manner consistent with Claim quality standards and goals
  • Develop advanced functional knowledge to appropriately interpret and apply insurance coverage
  • Apply general mathematical knowledge and / or financial analysis to achieve results
  • Maintain current knowledge of claim loss cost containment initiatives, and use them appropriately and consistently with company practices and procedures
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11 Claims Rep resume templates

1

Claims Rep-iii Resume Examples & Samples

  • Learning the activities/tasks associated with his/her role
  • Works under direct supervision
  • Relies on others for instruction, guidance, and direction
  • Work is reviewed for technical accuracy and soundness
  • Primary duties may include, but are not limited to
  • Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made
  • Researches and analyzes claims issues. Requires HS diploma or equivalent; up to 1 year of related experience; or any combination of education and experience, which would provide an equivalent background. Good oral and written communication skills; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.)
2

Claims Rep-guest Claims Resume Examples & Samples

  • Proven experience and strong understanding of property and casualty insurance and claims handling
  • Demonstrated strong technical skills, including scene investigations, evaluation and negotiation of liability claims
  • Computer proficiency within a Windows environment, including Outlook, Word, Excel, and PowerPoint
  • Proven ability to deliver concise and informative written summaries in memo and presentation format, with appropriate business writing and usage of professional grammar
3

Claims Rep-iii Resume Examples & Samples

  • Up to 1 year of related experience
  • Good oral and written communication skills; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.)
  • Microsoft Word, Excel, and Outlook experience preferred
4

Senior Inside Claims Rep-nac Resume Examples & Samples

  • Obtains information about vehicle damage losses from customers, claimants or other Insurance Companies through telephone and written reports
  • Arranges appraisals, reviews appraisal reports, communicates with customers, claimants, attorneys, and repair shops, etc. May secure title or other documentation required to sell vehicle for salvage
  • Secures the essential facts about the vehicle damage, assesses liability/compensability, negotiates settlements within prescribed authority and explains denials to policyholders and claimants
  • Uses internet and Liberty Mutual contracted vendors for pricing and/or validation of inventoried items
  • May assist in the training, coaching and counseling of less experienced Senior Inside Claims Representatives
  • Must be able to work in a fast paced, team-oriented environment
  • High School Diploma or equivalent training plus 1-2 years claims experience
  • Strong working knowledge of the various operations with the Claims Department and the ability to handle multiple claims work systems is required
  • Must demonstrate a proficient understanding and use of the basic policy/contract coverages and be able to recognize questionable coverage/contract situations which necessitate supervisory involvement
  • Ability to handle total loss
5

Claims Rep Resume Examples & Samples

  • Answer incoming calls from a queue; respond to/resolve claims in accordance
  • Two years of customer service and call center experience
  • Typing of 40 wpm
  • Proficiency in MS office and Windows-based applications
  • Proficiency with fax machine, copier, printer, telephone
  • Excellent dispute resolution/ customer service skills
6

Claims Rep., First Response Center Resume Examples & Samples

  • Effectively communicate problems or need for potential changes to allow the team leader to take further action
  • Records the accident or loss situation into the system with accurate and detailed information in order to determine the cause of loss, bodily injury, accident benefits and extensive property damage exposure (s). Where necessary identify appropriate services required by the client for example, emergency services, appraisal, rental vehicle, towing services etc
  • Apply working methods according to procedure. Where coverage exists, direct claimants through the claims settlement process by explaining coverage and procedures (in non-technical terms), recommended suppliers, and by informing the claimant of his/her obligations and responsibilities to move the claim toward settlement. Where coverage does not exist, inform the client by explaining the terms of the insurance contract
  • Participate openly and actively in coaching sessions by providing input and feedback to Telephone Unit, Team Leader and Quality Assurance Analyst
7

Claims Rep-field Resume Examples & Samples

  • Review assignments to determine severity, coverage and appropriate action
  • Manage all administrative claim functions such as reserving, claim payments and file notes via electronic means and at times from remote locations
  • Negotiate with contractors or repair facilities regarding extent of damage and method of repair
  • Industry designations such as AIC, CPCU, SCLA, CCLA or PCLA are preferred
  • Strong negotiation and problem solving skills
  • Individual must be analytical, precise and have the ability to work independently
8

Claims Rep-inside Resume Examples & Samples

  • Review assignments to determine severity, coverages and appropriate action
  • Conduct phone interviews and take recorded statements from all parties possessing facts regarding the claim
  • Write reports for the claim file to document all activity related to loss
  • Evaluate the loss/damages
  • Prepare files for arbitration
  • Negotiate with contractors or repair facilities regarding extent of damage and method of repair. Recover salvage and sell to appropriate salvage buyer
  • Keep current on court cases, changes in law, values and prices of property and materials
  • Promote positive working relationships with agents
  • Perform other job duties as assigned
  • Regular attendance
  • Four year college degree is preferred. A high school diploma is required
  • 1 - 3 years of property and casualty insurance claims experience
  • AIC, SCLA, CCLA or PCLA designation preferred, or complete within orne ore more within two years of hire
  • Ability to meet appropriate state licensing requirements as needed
  • Ability to read, comprehend and interpret policy language and apply to loss
  • Must possess negotiation skills, human relations skills, analytical skills, organization skills as well as oral and written communication skills
9

Claims Rep IAP Wc-claims Trainee Resume Examples & Samples

  • Attendance and completion of designated classroom claims professional training program
  • Performs on-the-job training activities including
  • Ability to meet or exceed the organization's Core Competencies
10

Senior Multiline Claims Rep Resume Examples & Samples

  • Minimum 5 years prior Special Lines estimating experience
  • Able to quickly build rapport and successfully effect settlements
  • Excellent organization and problem-solving skills
  • Proficient in basic computer skills, including proficiency in using claims and estimating systems
  • Valid driver's license and good driving history
  • Individual will work in the field, office, body shops, or service center
  • Limited travel will be required to training classes or areas needing additional staffing
  • Company-provided cell phone for use during work hours
11

Claims Rep Resume Examples & Samples

  • Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
  • Authorize appropriate payment or refer claims to investigators for further review
  • Analyze and identify trends and provides reports as necessary
  • Consistently meet established productivity, schedule adherence, and quality standards
  • Accurately process professional and institutional claims
  • Responsible for editing and adjusting of claims per the EDI daily audit report
  • Analyze and adjudicate claims to ensure accurate payment
  • Interpret Fee for Service (FFS) and capitated provider contracts
  • Review claims on a periodic basis
  • Meet Department Quality and Accuracy Standards
  • Interfaces with other departments to obtain necessary information required for resolution of claims
  • Advise management of any claim issues or inappropriate and/or incorrect billing
  • Other duties assigned by management
  • An education level of at least a high school diploma or GED
  • 2 - 3 years’ experience as a Medical Claims Examiner
  • Experience in contract interpretation
  • Intermediate experience with Word and Excel
  • Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
  • 1 - 2 years’ experience of Institutional Claims processing
  • Prior Medicare, HMO experience
  • Working knowledge of Medical Terminology, ICD9, CPT4, UB92/1500 forms
  • Excellent Data Entry skills needed
  • Revenue and HCPCS coding skills helpful
12

Claims Rep IAP Liability Resume Examples & Samples

  • Ability to meet or exceed position specific competencies
  • Concern for order, quality and accuracy
  • Knowledge of personal computer applications including Microsoft Office products
  • Ability to demonstrate excellent oral and written communication, including presentation skills
  • Ability to demonstrate effect teamwork skills
13

Senior Claims Rep-field Resume Examples & Samples

  • Review and interpret policy coverage to determine whether the claim is payable under the policy, deductible, actual cash value or replacement cost
  • Conduct field investigation to include site inspection, diagram, photographs, interview and secure recorded statements of those possessing facts concerning the loss
  • Prepare written investigative reports for the claim file to document all activity related to the loss
  • Manage the salvage process
  • Maintain currency on case law and construction prices/methods/procedures
  • Foster and maintain relationships with independent agency force
  • Participate in company sponsored educational programs to develop and maintain knowledge of products, producers and industry trends
  • Participate in other projects or other duties as assigned
  • Minimum of five years of multi-line claims experience
  • Minimum of five years of commercial property and casualty claims experience
14

Homeowner Field Claims Rep Resume Examples & Samples

  • Investigate, analyze, evaluate and settle insurance claims involving property damage losses
  • Deliver exceptional customer service through professional and timely communication including telephone, email and written correspondence
  • Determine value of a claim and negotiate settlements within prescribed limits of authority, in accordance with established procedures, contractual obligations and all state regulatory requirements
15

Claims Rep First Response Center Resume Examples & Samples

  • Listen to client needs and treat each encounter as unique and clarify clients request to ensure they are well served
  • Provide clients with value-added service in explaining claims procedures and coverage and offering clear and complete information based on client needs
  • Meet productivity objectives set by the department in terms of average handle time, after call work, service levels, abandoned percentages, overall adherence compliance and number of incoming telephone calls handled
  • Collaborate with other departments to ensure missing policies are offered to clients
  • Adapt quickly to systems changes and/or modifications
  • Take appropriate action to complete various insurance claims transactions
  • Identify needs and proactively seek coaching to generate improvement opportunities
16

Multiline Claims Rep-southern California Resume Examples & Samples

  • Investigate, analyze and determine Progressive's liability concerning loss or damages
  • Negotiate settlements with claimants
  • Bachelor's degree or a combined total of five years of work experience and/or college education
  • Annual gainshare bonus of up to 16% of your salary! Progressive rewards each of us with an annual bonus based on company performance
  • Wellness program with discounts & rewards
17

Senior Work Comp Claims Rep Resume Examples & Samples

  • Plan recommend, reserve and execute the investigation, valuation, disposition and settlement of claims for the California jurisdiction
  • Achieve fair, equitable and timely claim dispositions
  • Properly assess the indemnity, medical and expense exposure of assigned claims
  • Set reserves accurately and in a timely manner
  • Accurately resolve coverage and compensability issues
  • Plan, organize and establish priorities, determine realistic completion dates
  • Use services of others appropriately
  • Develop advanced functional knowledge to appropriately interpret and apply insurance coverage
  • Develop technical and jurisdictional expertise
  • Maintain current knowledge of claim loss cost containment initiatives, and use them appropriately and consistently with company practices and procedures
  • Identify and initiate mitigation, subrogation and other recovery opportunities on assigned claims
  • Identify fraud indicators and initiate investigation on assigned claims
  • Apply general mathematical knowledge and / or financial analysis to achieve results
  • Handle claim files in a manner consistent with Claim quality standards and goals
  • Dedicate your focus to ensuring our customers have a positive and pleasant experience
  • Workers’ compensation claim handling with experience handling California claims
  • Certification exams and adjusting licenses as required by state
  • Outstanding interpersonal skills working within a dedicated, supportive team
  • Strong focus delivering outstanding customer service
  • Demonstrated consistent high level of performance and achievement over career span E
  • Excellent time management ability
  • Strong desire to launch your career to the next level!
  • NO AGENCIES PLEASE **
18

Claims Rep Resume Examples & Samples

  • Responsible for accurate and timely adjudication of claims according to guidelines
  • Analyze, process, research, adjust, and adjudicate claims with the use of accurate procedure/revenue and ICD-9/ICD-10 codes, under the correct provider and member benefits, i.e. co-payments, deductible, etc
  • Claims processing based upon contractual and/or St. Joseph Heritage Healthcare agreements, involving the use of established payment methodologies. Division of Financial Responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures
  • Alerts manager or supervisor of issues that impact production and quality, i.e. incorrect database configurations, non-compliant claims, etc
  • Resolves issues as presented or as referred by the Customer Service Coordinator
  • Process claims based on compliance regulations and time frames
  • Maintain quality and productivity standards as set by department
  • Resolve provider or physician group (network) claims inquiries and apply resolution in a timely fashion
  • Responds to questions from Customer Service Coordinators
  • Explains processing guidelines and internal processes when needed
  • Review services for appropriateness of charges and apply authorization guidelines during claims processing
  • Prepare written requests to providers; follow-up and handle completion of claim for returned correspondence
  • Good Customer Service and organizational skills required
  • Meet and maintain established quality and production standards
  • Develop and maintain effective working relationships with all levels of staff and providers
  • Handle multiple tasks and meet deadlines
  • Effectively utilize computer and appropriate software and interact as needed with St. Joseph Heritage Healthcare Claims Processing Systems
  • Revenue Codes, CPT-4/HCPCS, ICD-9/ICD-10 codes
  • Industry pricing methodologies, such as RBRVS, Medi-Cal and Medicare Fee Schedules, etc
  • Benefit interpretation and administration
  • One Care Connect/Medi-Cal guidelines and regulations
19

Subrogation Claims Rep Resume Examples & Samples

  • Pursue subrogation recovery in one or more jurisdictions from other carriers, uninsured motorists, and other parties on auto, medical, and/or property claims
  • Handle claims in accordance with regulatory and statutory requirements
  • Review claim files to evaluate recovery potential and take appropriate action in support of recovery strategy
  • Prepare and submit demands to appropriate parties
  • Refer cases to outside recovery agencies and attorneys when necessary
  • Correspond and negotiate within settlement authority with third parties and other carriers
  • Communicate with internal and external partners, including but not limited to member insureds, claimants, attorneys, service providers, recovery agencies, governmental entities and other carriers
  • May initiate arbitration or oversee files in arbitration and litigation
20

Claims Rep Resume Examples & Samples

  • Florida 6-20 All-Lines Adjuster License in Good Standing
  • Ability to work under deadline pressures and handle multiple priorities
  • Demonstrated strong organizational skills and attention to detail
  • Demonstrated excellent time management skills
  • Demonstrated ability to effectively solve problems and make decisions
  • Demonstrated ability to handle confidential information
  • Ability to work in multiple computer programs and in a paperless claims environment
  • Minimum 5 years of experience handling liability claims (Including Bodily Injury, Property Damage, Auto BI, PIP, Auto Property Damage, Discrimination, ADA Compliance and subrogation, etc.)
  • Previous experience handling Florida claims
  • Proven bilingual ability