Claims Representative Resume Samples
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Claims Representative Resume Samples
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TB
T Beer
Trace
Beer
591 Adams Islands
Los Angeles
CA
+1 (555) 189 8964
591 Adams Islands
Los Angeles
CA
Phone
p
+1 (555) 189 8964
Experience
Experience
Chicago, IL
Claims Representative
Chicago, IL
Morissette, Champlin and Tillman
Chicago, IL
Claims Representative
- Work independently to resolve customer issues by providing feedback to Management on Process Streamlining and Improvements
- Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments
- Develops and coordinates low level workers compensation claims' action plans to resolution, return-to-work efforts, and approves claim payments
- Provides input and assists Manager with related projects as active Team member
- Works closely with hospital Risk Managers and staff in providing claims advice to avoid potential exposure to the organization
- Performs most duties on an individual basis, and work has a direct bearing on Management results
- Work cross-functionally to assist with problem solving and project plan activities
Boston, MA
Field Claims Representative
Boston, MA
Buckridge, Stark and Yundt
Boston, MA
Field Claims Representative
- Working knowledge of computerized estimating software such as Audatex, CCC, Mitchell
- Working knowledge of computerized estimating software such as Xactimate
- Conducts physical inspections of damaged automobiles within a designated territory. Prepares estimates to repair damages and secures an agreed-upon repair price with the repair facility, including supplements and re-inspections. Responsible for identifying and moving total loss vehicles to our approved salvage vendor in a timely manner
- Performs other duties as directed
- Work toward claim resolution by maintaining regulatory compliance and fair claims practices within their authority
- Stay informed of changes in the collision repair industry as well as statutory and regulatory changes as they relate to material damage and communicate these changes to other claims personnel
- Participates in industry education or Home Office training as determined by Management. Performs other duties as assigned
present
Boston, MA
Senior Claims Representative
Boston, MA
Hermann, Ankunding and Quigley
present
Boston, MA
Senior Claims Representative
present
- Providing expertise or general support to teams
- Communicating across all lines of the organization as well as customers and vendors
- Reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances
- Analyzes and identifies trends for all appeals and grievances
- Make fact-based decisions
- Abiding by company and departmental policies and procedures
- Result-oriented and goal-driven
Education
Education
Bachelor’s Degree in Accuracy
Bachelor’s Degree in Accuracy
Iowa State University
Bachelor’s Degree in Accuracy
Skills
Skills
- Ability to understand insurance contracts
- Proficiency with computer platforms and applications
- Polished and professional demeanor
- Strong attention to detail
- Excellent communication skills
- Highly organized
- Ability to multitask
- Strong interpersonal skills
- Within 24-hours of receipt of bodily injury claim assignment, contact and interview claimant and other involved persons to obtain missing information not contained within claim
- For all non-bodily injury claims, communicate with claimant and any other involved persons within appropriate time frame, to obtain any missing information not contained in claim
15 Claims Representative resume templates
Read our complete resume writing guides
1
Casualty Claims Representative Resume Examples & Samples
- Adjust claim by evaluating and negotiating claims settlement. This is handled using investigative and negotiating skills with clients, claimants, attorneys and medical professionals. Also determine reserves needed and ensures they are applied
- Manage files through gathering of information through written or phone interactions, secure necessary documents (such as police reports, death certificates, medical information, property repair estimates, and witness statements) as needed to settle claim, and include proper documentation in the claims system
- 1 to 3 years relevant experience
- Negotiation and organization skills. Verbal and written communication skills. Interpersonal skills
- Required Certifications: Obtain state specific property casualty claims licensing as required
- Bachelor's Degree strongly preferred
- Preferred Certifications: Associate in Claims designation American Institute of Chartered Property Casualty Underwriters
2
Claims Representative Resume Examples & Samples
- Provide immediate guest liability claims services for Walt Disney World Co
- Evaluate liability and case exposure, and negotiate settlements directly with guests and attorneys
- Provide claims awareness training to parks and resorts
- Participate in initiatives to meet department’s goals and objectives
- 520 All-Lines Adjusters’ License with the State of Florida (or the ability to obtain within 6 months of hire)
- Minimum of three years experience handling liability claims (or equivalent claim-related experience)
- Strong technical skills, which include the investigation, evaluation and negotiation of claims
- Ability to work under deadline pressures and handle multiple priorities
- Ability to manage time wisely
- Availibility for periodic on-call responsibilities
- Must be flexible to new procedures and equipment
- Demonstrated strong organizational skills with attention to detail
- Demonstrated strong partnering skills
- Demonstrated problem solving and decision making skills
- Demonstrated ability to handle confidential information
- Strong background in medical terminology
- Demonstrated experience in conducting scene investigations
- High school degree or equivalent
3
Home Claims Representative Resume Examples & Samples
- 1-3 years of relevant experience required
- Experience with personal lines claims settlement
- Verbal and written communication skills. Interpersonal skills
- The ability to obtain state specific property & casualty claims licensing as required
4
Senior Field Claims Representative Resume Examples & Samples
- Conducts physical inspections of damaged automobiles within a designated territory. Prepares estimates to repair damages and secures an agreed-upon repair price with the repair facility, including supplements and re-inspections. Responsible for identifying and moving total loss vehicles to our approved salvage vendor in a timely manner
- Document claim files and issue timely payments as necessary
- Conducts re-inspections of automobiles following inspection by other resources or associates. Provides training to other associates within the organization
- 3-5 years of experience in inspecting damaged automobiles
- Obtain state specific property casualty licenses as required
- Working knowledge of computerized estimating software such as Audatex, CCC, Mitchell
- Ability to provide training to other associates
- ASE Certifications, I-CAR Coursework
5
Field Claims Representative Resume Examples & Samples
- Contact customers and repair facilities to schedule inspections and set expectations regarding the claim process
- 1-3 years of experience in conducting physical inspections of damaged automobiles
- Ability to review and analyze policy language and make coverage determinations
- Availability for limited out of town travel for catastrophe work
6
Personal Injury Protection Claims Representative Resume Examples & Samples
- Investigate, assess, negotiate and settle automobile first party medical claims
- Review initial claim assignment, confirm coverages, deny claims when appropriate, initiate first contact with injured parties, verify and investigate facts, set and maintain claim reserves, establish follow-up on claims, document claim files, and order Independent Medical Exams (IME) / Peer Reviews when necessary
- Prior Personal Injury Protection (PIP), Medical Pay, Workers Compensation, Nursing, and/or Bodily Injury/Casualty adjusting experience
- This would include client contact, injury and medical knowledge, and/or work loss investigation
- Must possess proven negotiation skills and strong organizational skills
- Adjuster licenses – will obtain at AAH if do not currently hold
7
Total Loss Claims Representative Resume Examples & Samples
- Settles all automobile vehicle claims that are deemed a total loss (not repairable). Utilizes market valuations, properly confirm options, condition, mileage, and follows all compliance and state regulations in determining appropriate claim settlement value. Utilizes designated internet and intranet sites to provide documented support of claim settlement decision
- Manages vehicle salvage claim in a timely manner to ensure appropriate salvage returns. Completes necessary documentation for claim files and incorporates to file(s)
- Excellent interpersonal, verbal and written skills
- Excellent research and organizational skills
- Past negotiation experience or dispute resolution
- Prior experience with auto personal lines claims settlement
- Associates or Bachelor Degree
- Associates in Claims Designation of Chartered Property Casualty Underwriters
8
Senior Casualty Claims Representative Resume Examples & Samples
- 1-3 years of relevant claims experience
- Ability to obtain state specific property casualty licenses as required
- Advanced knowledge of state compliance regulations and interpretation of state statues
- Excellent verbal, written and interpersonal communication skills in translating statutes into terminology that representatives understand
- Experience in personal lines property claim settlements (with a focus on property estimating) demonstrating expert knowledge
- Associate in Claims-designation-Am Institute of Chartered Property Casualty Underwriters
- Construction background or prior insurance related experience
9
Senior Home Claims Representative Resume Examples & Samples
- 1 – 3 years relevant experience
- Ability to work having a high degree of accuracy, strong attention to detail
- Experience with personal lines claims settlement as to demonstrate expert level knowledge
- Ability to obtain state specific property and casualty claims licensing as required
- Related insurance experience or a construction background
- Bilingual skills are preferred
- Previous experience in coaching or training others
10
CFS Claims Representative Resume Examples & Samples
- Analyze, organize, and maintain a large volume of business documents and tracking logs which directly impact the CFS department
- Coordinate requests between Distribution Clients, freight carriers, and colleagues to obtain appropriate proof of delivery documents to assist in resolving A/R deduction chargebacks
- Obtain andanalyze proof of delivery documents to prove clear of variances or identifydiscrepancies
- Analyze credit card chargeback disputes and retrievals, including identifying fraud and non-fraud chargebacks
- Maintain tracking logs for digitally filed claims as they are processed to the Accounts Receivable
- Maintain and organize the return documentation filing process for all return manifests
- Provide analysis of returns, claims, credit card chargebacks, and proof of delivery requests for monthly, quarterly, and annual reporting - including the use of Pivot Tables, V-Lookups, & Macros
- Provide various ad hocreporting as requested
- BS Accounting/Finance Degree from an accredited college/university (preferred)
- 1-2 years of Accounting, Finance, Credit, Accounts Receivable, Customer Service or related experience, preferred
- Excellent communication skills: verbal and written
- Excellent PC skills. Excel spreadsheet (Pivot Tables, V-Lookup, Macros)
- Ability to use various PC/CS utilities and Internet based utilities
- Excellent customer management skills
- Str on g interpers on al skills
- Must be able to exercise good independent judgment
- Well organized, with good time management skills
- Must be able to interpret objectives and coordinate day to day tasks
- Good at facilitating problem solving with customers and colleagues
- Ability to work under pressure with constant financial goals
11
Senior Field Claims Representative Resume Examples & Samples
- Staff Appraisers will be responsible for contacting clients and scheduling inspections within eight business hours of receipt of the assignment
- All assignments should be completed within two business days and will include providing the client with a digital or hard copy of the estimate, issuing payments, when applicable, and documenting the claim file
- Staff Appraisers will be required to negotiate an agreed repair price and provide a copy of the estimate to the repair facility when the vehicle is inspected at a repair facility or re-inspected at one of our DRPs
- Staff Appraisers will also be responsible for the timely management and re-inspection of supplements
- Staff Appraisers will assist our Casualty Team and our SIU Team with identifying and investigating potential fraud to include completing low velocity impact studies in the field
- 2-3 Years minimum experience inspecting collision damage in the field and writing estimates
- Valid driver’s license with a good driving record
- Solid understanding of regulatory environment and state statutes that affect the insurance industry; ability to translate this knowledge to procedures
- I-Car Certification or course work
- ASE Certifications
12
Claims Representative Resume Examples & Samples
- 520 or 620 All-Lines Adjusters’ License with the State of Florida
- Minimum of five or more years’ experience handling liability claims (or equivalent claim-related experience. Including Bodily Injury, Property Damage, Auto BI including PIP, Auto PD and subrogation. )
- Ability to work in multiple computer programs and in a paperless claims environment
13
Casualty Claims Representative Resume Examples & Samples
- Bachelor’s Degree or equivalent work experience
- Strong negotiation and organization skills
- Preferred Certifications: Associate in Claims designation Amer. Institute of Chartered Property Casualty Underwriters
14
Field Claims Representative Resume Examples & Samples
- Catastrophe claims handling, consisting of an average of 100 claims per month during periods of Catastrophe events, providing support in a timely fashion to all regions. During periods of non-Catastrophe, provide assistance with property personal line claim losses as needed. Inspects and evaluates home CAT claims. Conducts physical inspections of damaged homes within a designated territory. Prepares estimates to repair damages and secures an agreed-upon repair price with the contractor when required, including supplements and re-inspections. Scope claims utilizing technical expertise and information gathered to accurately determine physical claim value using company recognized resources and estimating/evaluating software
- Negotiates with contractors on revisions to repair costs including but not limited to: repair labor, customary or special discounts, betterment, paint allowances, material costs, and sublet repairs. Negotiate the claims with the customer leveraging appropriate resources and achieve agreement on value
- Working knowledge of computerized estimating software such as Xactimate
- Expected overnight travel on short notice for what could be extended periods of time in order to handle all assigned claim volume
- Obtain state specific property casualty claims licensing as required
15
Senior Home Claims Representative Resume Examples & Samples
- Adjust highest level claims by evaluating and negotiating claims settlement. Use investigative and negotiating skills with clients, claimants, attorneys and medical professionals. Determine reserves needed and ensure they are applied
- Manage file through gathering of information through written or phone interactions and securing necessary documents such as police reports, death certificates, medical information, property repair estimates, and witness statements, as needed to settle claim. This includes proper documentation in the claims system
- Act as subject matter expert and consulting resource for the unit. Develop and lead the training of less experienced representatives
- Identify and research process/procedure gaps and develop action plans to close the gaps. Read and interpret reports to develop process improvement
- Bilingual skills
16
Senior Casualty Claims Representative Resume Examples & Samples
- Adjust claims by evaluating and negotiating claims settlement. This is handled using investigative and negotiating skills with clients, claimants, attorneys and medical professionals. Also determines reserves needed and ensures they are adequately adjusted throughout the life of the file
- Manage files through gathering of information through written or phone interactions and securing necessary documents such as police reports, death certificates, medical information, property repair estimates, and witness statements, as needed to settle claims. This includes proper documentation in the claims system
- A minimum of 1-3 years of relevant claim adjusting experience required
- Thorough understanding of (multiple) state regulatory requirements related to personal lines claims settlements
- Excellent verbal and written communication skills. Excellent interpersonal skills
17
Damage Claims Representative Resume Examples & Samples
- Create a claim to track the status
- Contact parties involved to acquire information about the vehicle’s condition at each point
- Work with all parties involved to reach a resolution
- Assist insurance adjuster in settling claim
- Acquire photos of damage and estimate
- Communicate with parties involved on status and what is needed to proceed with claim
- Make payment arrangements once settlement is reached
- Assist others in department as needed
- Make arrangements for payment to customer and collect payment from vendor
18
REO Claims Representative Resume Examples & Samples
- Minimum of one (1) year mortgage or banking industry experience or an Associate’s/Bachelor’s degree in Business, Accounting or finance is required
- Real Estate Owned claims experience preferred
- Analytical, with an ability to identify and resolve problems
- Well organized, paying close attention to detail
- Knowledge of Servicing Systems LPS / MSP preferred
- Proficient with Microsoft Office Products, including Word, Excel, Powerpoint, etc
19
Claims Representative Resume Examples & Samples
- Requires HS diploma or equivalent
- Must be able to work 8:00-4:30 Monday Through Friday
- Experience in an office production environment preferred
20
Senior Claims Representative Resume Examples & Samples
- Providing expertise or general support to teams
- Meet production requirements as the organization changes
- Communicating across all lines of the organization as well as customers and vendors
- Reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances
- Applying state and federal guidelines when applicable
- Make fact-based decisions
- Addressing any business need by Manager and/or Company
- Abiding by company and departmental policies and procedures
- Result-oriented and goal-driven
- Analytical ability: Research skills combined with effective decision-making and superior interpersonal skills
- Ability to accept constructive criticism with being coached and growing as a professional
- Critical thinking abilities
- Must be knowledgeable in Microsoft office applications
- 5+ years of experience analyzing and solving customer problems in an office setting environment
- 5+ years of experience in Health Insurance processing claims, and grievances including investigations, negotiating settlements, and payments
- Experience with investigations, negotiating settlements, and payments
- Experience with research regarding Appeals and Grievances
- Moderate proficiency with computer and Windows PC applications (this includes the ability to learn new and complex computer system applications)
21
Senior Claims Representative Resume Examples & Samples
- Coordinates with the Claims Manager and / or Claims Supervisor on workflow issues and the handling of batches in date order
- Documents all claims production via the system BA screen (which tracks individual examiner production); online transactions to be tracked separately
- Responsible for weekly / monthly goal of batches to include meeting and maintaining a 95% quality standard and production standard of 35 claims per hour on transactions
- Evaluates each claim for appropriate coding of CPT and ICD codes against charges that are being billed and entered
- Responsible for inputting accurate batch accounts, invoice numbers, status codes to ensure accurate entry into Claims Processing system, which creates reporting
- Must meet and maintain 95% quality expectations; these are identified via errors tracked on phone calls, overpayments, unsolicited checks, appeals, TDI complaints and errors on processing
- Responsible to create and generate any overpayment documentation (notes in system, letter to typing) on all overpayments created by the examiner or any overpayments identified by examiner
- 2+ years of health care claims processing experience
- Medical terminology, 10-key and computer literacy with at least an intermediate level in Word, Excel and Outlook
- Exceptional ability to organize, prioritize and communicate effectively while meeting deadlines and production goals
- Must have commonly-used knowledge of claims examination concepts, practices and rules, ICD-10 and CPT coding and network contracts
- This position utilizes experience and judgment to plan, accomplish goals and effectively solve problems with given scenarios
- Ability to make decisions based on sound knowledge using resources provided
- Performs a variety of tasks that may require a limited degree of creativity and latitude
22
Securities Claims Representative Resume Examples & Samples
- Proficient in MS Outlook, Excel, and Internet Explorer
- Skills in researching and analyzing laws, rules and policies pertinent to unclaimed property
- Strong verbal and written communications ability
- Experience in financial planning or stock brokerage
- Knowledge of Unclaimed Property
23
Claims Representative Resume Examples & Samples
- Daily claim review and accurate entry of required claim data into claims data base system for both third and first party claims same day as receipt of assignment
- Within 24-hours of receipt of bodily injury claim assignment, contact and interview claimant and other involved persons to obtain missing information not contained within claim
- For all non-bodily injury claims, communicate with claimant and any other involved persons within appropriate time frame, to obtain any missing information not contained in claim
- Perform appropriate investigation based on claim type and damages; obtaining applicable investigative documentation/information (including available surveillance coverage) direct from property risk management and other departments as well as accessing varied company-wide hotel systems such as HOTSOS, Opera, etc., interview witnesses and other involved parties, review evidence, obtain additional investigative information such as photographs (if needed), police reports, etc. as necessary to allow for a proper investigation in compliance with company set policies and procedures
- Complete investigation within 30 days, barring unforeseen delays
- Evaluate investigation results and make determination as to extent of company’s liability, if any
- Obtain and assess appropriate documentation to substantiate reported loss including but not limited to: verification of MMSEA status, medical treatment records & bills, verification of wage loss, property loss/damage receipts & estimates, etc
- Review medical treatment records/bills and complete required Medical Evaluation form
- Maintain appropriate and sufficient reserves in recognition of potential financial exposure of claim, post accurate and timely claim payments in database system until claim is resolved
- Provide clear and timely verbal and/or composed written communication with all relevant parties
- Negotiate and resolve claims in a fair and equitable manner, within designated authority level, in compliance with company’s settlement practices, policies and procedures and conferring with management for any recommended settlement outside authority level
- Subrogate against third parties to pursue monies owed to property/company
- Identify potential to transfer risk based on established contracts, PO/BPO, etc. with proper and timely communication to obtain acceptance of tender and indemnification
- Maintain organized claim files, up-to-date claim notes in database system with appropriate diaries to allow for proper and timely progression of claim
- Daily review of in-coming mail and faxes (internal and external) with appropriate follow-up action performed timely
- Prepare and complete varied required claim forms and reports within scheduled deadlines
- At least 3 years of property and casualty claims handling experience
- Strong Working knowledge and ability in active listening, deductive/inductive reasoning, critical thinking, diplomacy and problem solving skills
- Working knowledge of principles of property and casualty insurance and fundamentals of tort law
- Working knowledge of basic medical terminology
- Detail-oriented and reliable
- Judgment and decision making abilities
- Strong negotiation skills to reconcile differences and bring resolve to claims in an expeditious and cost effective manner
- Strong oral communication in speaking to others to convey information effectively
- Strong reading, written comprehension as well as writing skills
- Proficient knowledge, ability and skills in claims database systems, varied computer systems and applications including but not limited to Microsoft Windows – Outlook, Word, and Excel
24
Claims Representative Resume Examples & Samples
- Works under direct supervision
- Relies on others for instruction, guidance, and direction
- Work is reviewed for technical accuracy and soundness
- Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made
- Researches and analyzes claims issues
- 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
25
Senior Claims Representative Resume Examples & Samples
- Must meet and maintain 95% quality expectations; these are identified via errors on processing phone calls, overpayments, unsolicited checks, appeals, TDI complaints and errors on processing
- Intermediate level knowledge of Medical terminology, 10-key, and computer literacy in Word, Excel and Outlook
- 1+ year of experience / commonly-used knowledge of claims examination concepts, practices and rules, ICD-10 and CPT coding and network contracts
26
Claims Representative Associate Resume Examples & Samples
- Analyze and identify trends and provide reports as necessary
- Supervision/guidance is required for higher level tasks
- 2 + years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
- Moderate Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
27
Claims Representative Resume Examples & Samples
- Communicate with wholesale customers, Sales Representatives, Customer Service, Compliance, Logistics, EDI as well as internal stakeholders regarding individual account portfolios on all aspects of claims
- Route the claim documentation to the appropriate department within the organization for further research and information concerning deductions taken, as well as approval or denial for the deduction
- Reconcile account balances as they pertain to deductions and credit/debit memos. Issue credit/debit memos for deductions proven valid. Work with the customer for repayment of deductions if proven invalid and negotiate partial claim payments or settlement agreements with customer
- Develop and maintain a good working relationship with customers and all internal adidas Group departments by responding to correspondence in a timely manner
- Constantly analyze customer behaviors to quickly identify problems or negative trends. Communicate with the Claims Manager immediately when items are identified
- This position may be responsible for sensitive Inter-company accounts such as Promo or Salesman Samples. These accounts are highly visible and political in nature therefore require an individual who can uphold the needed level of confidentiality and is highly professional in nature
- Extensive knowledge of credit and claims processes, account reconciliation, supply chain processes, and relationship management; strong negotiation skills
- Demonstrated behaviors that support: fostering Confidence, Creativity and Collaboration; role model adidas Group behaviors and deliver results with excellent verbal and written communication skills and the ability to prioritize and organize workload
- Analytical and decision-making skills, independently identifying and implementing solutions to problems and overcoming challenges
- Advanced knowledge of Microsoft Office applications: proficiency in Excel including spreadsheets, formulas, and pivot tables
- Knowledge of SAP, Document Management System (DMS), Access, Micro-Strategy, Dispute and Collections Management System (SAP) is a plus
- Proven experience in challenging existing process(es) in a professional manner and developing unique solutions with interpersonal skills, including the ability to quickly adapt communication style and approach as appropriate
- Bachelor's degree (B. A.) from a four-year college or university preferred; or two or more years related experience and/or training; or equivalent combination of education and experience
28
Claims Representative Resume Examples & Samples
- Insurance industry experience preferred, particularly within claims administration
- Superior level of accuracy and attention to detail
- Strong proficiency in PC skills, including MS Word and Excel
- Positive and outgoing personality that is willing to continue learning and growing within the Organization
29
Senior LTC Claims Representative Resume Examples & Samples
- This position is accountable for identifying, evaluating, and initiating referrals as needed to properly evaluate Long Term Care initial or ongoing eligibility reviews
- The lead point of contact for the Insured or their legal representative, to provide the status of the eligibility review and set expectations as well as answer general status or payment questions
- Make claim payments based on the claimant's contract and other information provided at initial time of claim or ongoing payments through the claims life cycle as well as determining need for additional information to properly determine risk
- Effectively manage and prioritize a work queue and multiple job responsibilities in a fast-paced environment, frequently within Service Level deadlines
- Responsible for incoming and outgoing calls to claimants, caregivers, facilities and other persons or entities involved in the claim to enhance the customer experience
- Accountable for recognizing and working within a structured environment with clearly defined SOPs to ensure consistency of claims practices and resolution
- Other duties as assigned, including surge coverage for the call center as needed
30
Lead LTC Claims Representative Resume Examples & Samples
- 2 years of experience in adjudicating Long Term Care claims
- Experience mentoring or training “Benefit Analysts” that are either new hires or as they develop from one role to another (OE to IE for example)
- Proven knowledge of medical terminology, anatomy and physiology, disease processes, medications and interpretation of lab results
- GNW experience as Specialist, Mentor, Coordinator or equivalent GNW experience
31
Claims Representative, / II / III Resume Examples & Samples
- Responds to customer questions via written correspondence regarding insurance benefits, provider contracts, eligibility and claims
- Analyzes problems and provides information/solutions
- Operates a PC/image station to obtain and extract information; documents information, activities and changes in the database
- Thoroughly documents inquiry outcomes for accurate tracking and analysis
- Develops and maintains positive customer relations and coordinates with various functions within the company to ensure customer requests and questions are handled appropriately and in a timely manner
- Researches and analyzes data to address operational challenges and customer service issues
- Uses computerized systems for tracking, information gathering and troubleshooting
- Required to meet department goals
32
Claims Representative Resume Examples & Samples
- Timely enter all assignments into the claims system (RMX)
- Review, investigate, and evaluate all property and casualty claims in a thorough and expeditious manner
- Set and maintain appropriate and sufficient reserves in recognition of the potential financial exposure of the claim
- Perform proper claims handling in a timely manner to include timely completion of investigation
- Perform site inspections for claims investigation as necessary
- Perform 24 hour claimant contact and timely index all personal injury claims
- Ensure verbal and composed written communication with all concerned parties related to a claim is performed timely
- Maintain proper and organized claim files
- Set and maintain appropriate diaries to properly and timely manage claims
- Maintain up-to-date claim information to include enhanced notes, reserves, and payments in claims system (RMX)
- Subrogate against third-parties to seek monies owed to property/company
- Apply technical knowledge, and superior judgment and interpersonal skills when interacting with guest/claimants and employees to ensure proper investigation and handling of claims
- Negotiate and resolve claims in a fair and equitable manner
- Resolve claims within settlement authority and confer with management and/or corporate for any claim outside settlement authority
- Report to Director of Risk Management the status, on a regular basis regarding claims activities, workload and special assignments
- Meet with guests/claimants in-house to interview, resolve claims, as necessary
- Assist in conducting training sessions for other departments and training of co-workers in the department, as needed
- Continue professional education in order to stay abreast of current insurance industry trends and standard by attending courses offered by accredited insurance industry organizations
33
Claims Representative Resume Examples & Samples
- Conducts investigations of potential claims, claims and lawsuits involving Steward hospital clinical staff and employees
- Prepares reports consistent with internal Policies and Procedures
- Works closely with hospital Risk Managers and staff in providing claims advice to avoid potential exposure to the organization
- Attends depositions of plaintiffs and defendants in pending litigation against TRACO insureds
- Works with defense counsel in retention of appropriate experts for TRACO defendants. Attends meetings to evaluate opinion and presentation of potential experts
- Makes recommendations as to disposition of matter, i.e. settlement or defense
- Maintains contact with attorneys, vendors, claimants and defendants to insure; cost-effective handling of claims. Conducts initial review of expense and legal bills to ensure compliance with litigation management and billing guidelines
- Complies with established departmental policies, procedures and objectives
- Ensures compliance with Medicare, Medicaid and SCHIP Extension Act and/or satisfaction of any outstanding liens on claim files
- Works on projects as directed
- Required Knowledge & Skills
- Bachelor's degree and three to five years insurance background with experience handling complex cases
- Superior analytical, problem solving, interpersonal and decision-
- Knowledge of Massachusetts and Federal law
34
Claims Representative Resume Examples & Samples
- 1 year work experience required-Health Care
- Strong typing skills with speed and accuracy
- Microsoft Word, Excel and Outlook software knowledge
- Team-oriented while also able to pursue personal and
35
Claims Representative Resume Examples & Samples
- Review claims for financial responsibility including determining coordination of benefits
- Review claims for duplicates, denials and referrals and ensures that claims information is matched to appropriate authorization
- Adjudicate claims appropriately per contract or standard processing guidelines which includes appropriate coding of CPT and ICD codes against charges that are being billed and entered
- Maintain prompt turnaround time on all claims and handle priority claims within 24 hours
- Handle all customer service audits and quality assurance errors / opportunities within 48 hours
- Coordinate with the Claims Manager and / or Claims Supervisor on workflow issues and the handling of batches in date order
- Document all claims production via the system BA screen (which tracks individual examiner production). Online transactions to be tracked separately
- Must meet and maintain 95% quality expectations. These are identified via errors tracked on phone calls, over-payments, unsolicited checks, appeals, TDI complaints and errors on processing
- Create and generate any overpayment documentation (notes in system, written communications) on all over-payments created by an examiner or any over-payments identified by examiner
- Must meet and maintain 30 claims per hour on productions
- Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction
- WAH / Telecommuting available after quality and production standards are met consistently
- 1+ years of health care claims experience
- Basic level of knowledge of claims examination concepts, practices and rules, ICD and CPT coding and network contracts
- More than two years of relative experience with Medical terminology, 10-key and computer literacy skills
- Proficient with Medicare processing guideline, working knowledge of medical contracts, RBRVS, facility and ambulatory payment methodologies
- This position utilizes experience and judgment to plan, accomplish goals and effectively solve problems
36
Claims Representative Resume Examples & Samples
- Identify and address wage exposures on medical claims
- Review and research wage loss expenses and documentation for payment consideration
- Review and interpret policy language when receiving a subrogation demand to determine if reimbursement is owed
- Follow up with customers, attorneys and medical providers
- Two or more years of college education or relevant work experience
- Work or educational experience must include
- Paid training, tuition assistance and career development
- Diverse, welcoming culture with Employee Resource Groups
- Wellness program with discounts & rewards
- Earning paid time off after first two weeks and the standard benefits (medical, dental, vision, 401k)
37
Claims Representative Resume Examples & Samples
- Develop relationships with customers over the phone to answer questions, obtain additional information and provide support throughout the claims process
- Investigate, analyze and document auto claims
- Interview all involved in an accident to determine coverage and liability decisions
- Validate damage is consistent with the report of the accident
- Collaborate with peers, such as Estimators to identify suspect damages or any unrelated prior damage
- Making decisions
- Solving problems
- Planning, prioritizing and organizing
- Effectively communicating verbally and in writing
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No Fault Claims Representative Resume Examples & Samples
- Obtain information and maintain records of accidents or personal property losses for policyholders and claimants through telephone and written reports
- Register claims, update status notes, establish target dates, schedule appointments and release payments on an automated system
- Ability to recognize questionable coverage or contract situation which may necessitate supervisory involvement
- Licensing required in some states
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Senior Claims Representative Resume Examples & Samples
- Investigates claim using internal and external resources including speaking with the insured or other involved parties, analysis of reports, researching past claim activity, utilizing evaluation tools to make damage and loss assessments
- Extensive and timely direct interaction with Insured's, Claimants, Agent's and Internal Customers
- Determines policy coverage through analysis of investigation data and policy terms. Notifies agent and insured of coverage or any issues
- Establishes claim reserve requirements and makes adjustments, as necessary, during the processing of the claims. Determines and negotiates settlement amount for damages claimed within assigned authority limits
- Writes simple to moderately complex property damage estimates or review auto damage estimates. Takes statements when necessary and works with the Field Appraisal, Subrogation, Special Investigative Unit (SIU) as appropriate
- Maintains accurate and current claim file/damage documentation and diaries throughout the life cycle of claim cases to ensure proper tracking and handling consistent with established guidelines and expectations
- Alerts Unit Leader to the possibility of fraud or subrogation potential for claims being processed
- Bachelor’s Degree preferred. High school diploma or equivalent required
- 1-2 years of experience. Claims handling skills preferred
- Strong customer service and technology skills
- Able to navigate multiple systems, strong organizational and communication skills
- License may be required in multiple states by state law
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Senior Work Comp Claims Representative Resume Examples & Samples
- 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
- Develop advanced functional knowledge to appropriately interpret and apply insurance coverage
- Maintain current knowledge of claim loss cost containment initiatives, and use them appropriately and consistently with company practices and procedures
- Apply general mathematical knowledge and / or financial analysis to achieve results
- Handle claim files in a manner consistent with Claim quality standards and goals
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Claims Representative Resume Examples & Samples
- Resolve and document auto claims as quickly and accurately as possible
- Bachelor's degree or a combined total of two years of work experience and/or college education
- Casual dress (yes, you can wear jeans to work!)
- Wellness program with discounts & rewards, and onsite gym at our large locations
- Onsite healthcare at large locations and the standard benefits (medical, dental, vision, 401k)
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Claims Representative Resume Examples & Samples
- Manages low to moderate complexity commercial subrogation/recovery claim investigation involving workers’ compensation. Determines if a claim should be negotiated, arbitrated or litigated through conclusion based on a thorough investigation and resolution strategy. Effectively manages loss costs and recovery claim expenses
- Manages all types of investigative activity or litigation on claims, including the posting of appropriate reserves in a timely manner. Coordinates discovery and litigation strategy with staff counsel or panel attorneys
- Negotiates low to moderate complexity settlement packages within scope of authority, settling recovery claims in the most cost effective manner
- Makes recommendations on subrogation/recovery claims processes and resolution strategies to management
- Analyzes recovery claims activities; prepares and presents reports to management and other internal business partners and clients
- Works with attorneys, account representatives, agents and insureds regarding the handling and/or disposition of moderate to high complexity subrogation/recovery claims
- Keeps current on state/territory regulations and issues, industry activity and trends. May participate in industry trade groups
- Provides guidance and assistance to less experienced claims staff and other functional areas where appropriate
- Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes
- Advanced technical and product specific expertise, subrogation/recovery claims resolution skill and knowledge of insurance and underlying claim principles, practices and procedures
- Strong communication, negotiation and presentation skills. Ability to effectively interact with all levels of CNA's internal and external business partners
- Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects
- Ability to deal with ambiguous situations and issues
- Creativity in resolving unique and challenging business problems
- Knowledge of Microsoft Office Suite and other business-related software
- Ability to adapt to change and value diverse opinions and ideas
- Ability to manage and prioritize multiple projects
- Ability to evaluate claims based on a cost benefit analysis
- Ability to fully comprehend moderate to 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
- Ability to implement strategies with a proactive long-term view of business goals and objectives
- Bachelor's degree or equivalent experience. Professional designation preferred
- Typically a minimum three years commercial subrogation experience in the workers’ compensation or liability lines of business
- LI-AM1
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Claims Representative Resume Examples & Samples
- Interprets basic policy coverages and determines if coverages apply to claims submitted, escalating issues as needed
- Sets activities, reserves and authorizes payment within scope of authority, settling claims in most cost effective and timely manner. Ensures prompt issuance of disbursements while effectively managing loss costs and claim expenses
- Participates in performing investigations and evaluating claims through contact with insureds, claimants, witnesses and experts
- Identifies and escalates serious claim developments to management efficiently and effectively
- Partners with attorneys, account representatives, agents, underwriters, doctors and insureds to develop a focused strategy for timely and cost effective resolution of claims
- Recognizes need for negotiation, participates in planning strategy and negotiates within scope of authority
- Identifies claims with third party recovery potential and coordinates with subrogation / salvage unit
- Analyzes claims activity and prepares reports for management review
- Keeps current on state / territory issues, regulations and trends
- Knowledge of claims and insurance industry theory and practices
- Developing technical expertise, product specific knowledge and negotiation skills
- Ability to negotiate and settle claims effectively
- Good interpersonal and communication skills. Ability to effectively interact with all levels of CNA's internal and external business partners
- Ability to work independently. Good time management skills
- Good analytical and problem solving skills. Demonstrates attention to detail
- The ability to exercise independent judgement and make sound business decisions effectively
- Completion of a formal claims training program or minimum six months of claims experience
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Claims Representative Resume Examples & Samples
- Manages low to moderate complexity commercial property recovery claim investigations and pursues recovery from the responsible party. Effectively manages loss costs and recovery claim expenses
- Negotiates, arbitrates or litigates subrogation cases reaching the appropriate resolution based on investigative facts developed
- Effectively manages vendor relationships to include forensic experts and recovery counsel
- Effectively develops and documents subrogation strategies leading to the appropriate outcome
- Works with account representatives, agents and insureds regarding the handling and/or disposition of the recovery claim
- Keeps current on state/territory regulations and issues, industry activity and trends
- Moderate technical and product specific expertise related to commercial property recovery claims. Possesses knowledge of insurance and underlying claim principles, practices and procedures
- Good communication, negotiation and presentation skills. Ability to effectively interact with all levels of CNA's internal and external business partners
- Good analytical and problem solving skills, with the ability to manage and prioritize multiple projects
- Ability to fully comprehend moderate claim facts and issues; and to further articulate analyses of claims in presentations to business partners and management as well as in internal reports
- Typically a minimum three years claims experience
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Claims Representative Resume Examples & Samples
- Listen to client needs and treat each encounter as unique and clarify clients request to ensure they are well served
- Effectively communicate problems or need for potential changes to allow the team leader to take further action
- Provide clients with value-added service in explaining claims procedures and coverage and offering clear and complete information based on client needs
- 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
- 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
- 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
- Take appropriate action to complete various insurance claims transactions
- Participate openly and actively in coaching sessions by providing input and feedback to Telephone Unit, Team Leader and Quality Assurance Analyst
- Identify needs and proactively seek coaching to generate improvement opportunities
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Claims Representative Initial Solutions Team Professional Services Resume Examples & Samples
- Sets reserves and authorizes payment within scope of authority, effectively settling claims in most cost effective manner and ensuring timely issuance of disbursements
- Coordinates and performs investigations and evaluates claims through contact with insureds, claimants, witnesses and experts
- Utilizes negotiation skills to develop settlement packages
- Works with attorneys, agents, brokers and insureds regarding the handling and/or disposition of claims
- Analyzes claim activities and documents files properly
- Input information into claims systems
- May provide guidance and assistance to other claims staff and functional areas
- Keeps current on state/territory regulations issues as well as industry activity and trends
- Solid knowledge of claims and insurance industry theory and practices
- Demonstrates technical knowledge
- Strong interpersonal, written and oral communication and negotiation skills. Must have the ability to effectively interact with CNA's internal and external business partners
- Ability to exercise independent judgment and make critical business decisions effectively
- Knowledge of Microsoft Office Suite as well as other business-related software
- Completion of a formal claims training program or minimum six months of claims experience. One to two years of claim experience preferred
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Claims Representative Senior Resume Examples & Samples
- Responsible for handling one or more of the following issues within turnaround standards
- Ability to handle most claim types/cases/issues that are submitted to the team you are supporting
- Manage team Questions/Escalations SharePoint/Email
- Submit SOS (Urgent)issues
- Submit P&P (Policy and Procedure) update requests
- Submit new macro requests or macro updates
- Review team quality rebuttals and support team remediation plans/initiatives
- Perform desk visits or coaching and development for team members as needed
- Complete required individual development courses/trainings
- Meet and maintain minimum quality and productivity standards
- Provide assistance managing unit and department workflow
- Work special projects and OT as necessary
- Back-up for other areas such as, but not limited to
- Supervisor tasks and/or meetings (i.e. inventory, huddles, resource meetings, etc)
- Extended check-out releases
- Other SMEs
- Training
- Host/Attend meetings such as, but not limited to
- Quality related meetings
- P&P Calls
- SME meetings
- 1+ years of experience as a Claims Representative in Managed care, Healthcare, or Medical Insurance Claims
- Ability to use PC to search several applications (Screens) simultaneously to find data and navigate efficiently between them while recording data in appropriate places
- Ability to create, edit, sort, and store documents and spreadsheets in MS Word and Excel
- 2+ years of experience as a Claims Representative in Behavioral Health Claims
- Extensive Knowledge of CSP Facets Claims Software
- Knowledge of Behavioral Health and Substance Abuse Services
- Ability to work independently and be self-motivated to achieve production goals
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Customer Claims Representative Resume Examples & Samples
- Arrange appraisals, review appraisal reports and communicate with policyholders, claimants, physicians, medical providers, attorneys and repair shops
- Secure essential facts about accidents, assess liability and compensability, negotiate settlements and explain denials to policyholders and claimants
- High School diploma or equivalent plus 1-3 years of related customer service experience
- Proficiency in understanding basic policy and contract coverage
- Strong oral and telephone communication skills
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Claims Representative Resume Examples & Samples
- To investigate, evaluate, manage and resolve short and long term disability claims within prescribed best practices and dollar authority granted by the Director. This would include investigation, determination of eligibility, medical management, return to work coordination
- Coordination with Plant ER, LR, Medical and related to appropriately manage outcomes
- Provides input and assists Manager with related projects as active Team member
- Direction and interaction with vendors that would include surveillance and medical providers
- Performs claims review and maintenance
- Assists plant personnel with disability process and questions pertaining to status of claims, or related topics
- Liaison for SOX and Price Waterhouse audits
- Responsible for benefit calculation period and appropriate forms to be filed, etc
- Provides assistance to Manager with analytic benchmarks and related to assist in evaluating success in disability management
- Ability to provide excellent customer service to Plant locations
- Other duties as deemed essential by the Manager or Director
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Senior Commericial Claims Representative Resume Examples & Samples
- Successful demonstration/completion of the Senior Claims Representative prerequisites, proficiencies, and exams, as required based on unit assignment
- One year of prior claims or two years of related industry experience
- Commercial non-auto liability experience preferred
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Claims Representative Associate Resume Examples & Samples
- Interfaces with, and obtains information from, claimants, clients, vendors and other resources
- Conducts limited investigations, appropriately documents information, evaluates losses and exposures and recommends appropriate settlements to conclude claims
- Analyzes and evaluates various coverage, liability, exposure and damage issues
- Maintains effective and ongoing communication with various internal and external contacts
- High School Diploma
- Minimum of 1 year related claims experience required
- Knowledge of accepted industry standards and practices
- Computer experience with related claims and business software
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Inside Claims Representative Resume Examples & Samples
- Hours for this position are: 9:00 a.m. to 5:30 p.m. EST
- Establishes immediate contact with all parties involved in the claim
- Handles claims within designated authority, ensuring compliance with appropriate statutory laws. Verifies coverage, establishes and maintains reserves, takes recorded statements and processes correspondence, reports and records. Documents claim files and facilitates processing of claims with respective branch offices
- Reviews claims in process , updates customers , and submits final reports to file
- Evaluates and negotiates claims, recognizes subrogable situations and initiates action. Issues checks for settlement or declines payment within designated authority
- Responds to claim inquiries from Policyholders, Agents and branch office personnel
- Learns and maintains knowledge of medical management/FPB laws for each state, including recognition of bodily injury claims. Learns and maintains knowledge of liability laws for each state. Learns and maintains knowledge of motor vehicle codes
- Obtains additional information as required to determine ERIE's liability
- Responds to intercompany-arbitration applications. Files contentions and supporting documents on behalf of the insured/driver
- Develops and maintains working knowledge of statutory laws and assigned field office procedures
- Attends industry-related training programs and attends other training sessions to stay current on policy changes, interpretation or new legislation
- The first five duties listed are the functions identified as essential to the job. Essential functions are those job duties that must be performed in order for the job to be accomplished
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PIP Claims Representative Resume Examples & Samples
- Accurately pay claims based on policy provisions, state regulations, fee schedule and best practices
- Initiates immediate contact with injured parties to obtain a recorded statement on injuries and the facts of the loss
- Determines and investigates eligibility on all personal injury claims
- Collaborates with our internal nurse case management unit on pre-certifications, medical necessity, independent medical exams and medical director reviews
- Partners with SIU and Subrogation to identify suspicious activity and subrogation claims
- Has the ability and knowledge to review medical bills and identify fee schedule compliance, up-coding and causality
- Has the knowledge and ability to assume responsibility of a pending desk and focus on reviewing PIP claims for future handling and large loss reporting
- Utilizes our claim, imaging, and third party systems daily to track the outcomes of claims
- Must have the ability to review reports and analyze your contribution to the overall department and make modifications when needed
- Communicates regularly with policy holders, agents, providers and internal customers through email, phone and mailing correspondence
- Initiates and conducts follow up on claims in accordance to company best practices by utilizing our automated diary system, reports and scorecard results
- Other duties/projects as assigned
- Bachelor's degree with 3-5 years New Jersey PIP Experience and/or equivalent combination of experience and education
- Strong knowledge pertaining to the NJ Fee schedule, Medical Terminology and the NJ PIP Regulation and Requirements
- Experience with Microsoft Outlook, Word, Excel and Access
- The ability to review reports and data and articulate your assessment and findings to your supervisor and/or upper management
- Proven ability to meet customer needs while promoting and providing exemplary service by informing customers of the claims process and ensuring a positive experience
- Strong organizational and time management skills are required for this position
- Familiar with New Jersey Fee Schedule Coding
- Strong analytical background
- Experienced with compliance and pattern and practice reviews
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Senior Life & Annuity Claims Representative Resume Examples & Samples
- Maintain case load of pending claims and ensure timely follow ups are done to ensure claim is handled in such a way as to meet or exceed the customer’s expectations
- Accountable for identifying, investigating, evaluating, obtaining and utilizing critical information required to accurately and objectively adjudicate claims
- Analyze all incoming documents for appropriateness and completeness, and determine whether claim is payable
- Identify areas of potential risk for the company, including potential fraud
- Work closely with legal department to resolve complex claim issues
- Handle claim inquiries on multiple product lines Relate to others and work well within a team structure to accomplish goals
- Document all calls clearly and concisely and completes follow-up work
- Serve as the first step in resolving claims adjudication issues and in the call escalation process
- Thoroughly research all available resources to locate beneficiaries or parties to which proceeds can be paid. This may include online research, file review, calling third parties and otherwise exhausting all possible methods for location before escheatment
- Handles all Inbound and Outbound calls necessary to handle case load of pending claims, as well as surge phone resource for inbound phone team
- May test system upgrades to validate system changes and functionality in regards to all upgrades
- May assist with Unclaimed Funds process
- Other duties as assigned to assist the department in reaching its goals
- Two-year college degree or equivalent life insurance, deferred annuity, or tax-related experience
- Process improvement focus with willingness to develop and maintain professional growth
- Demonstrated ability to
- Initiate and adapt quickly to change
- Communicate effectively (i.e., verbal, listening, and written skills)
- Relate to others and work well within a team structure to accomplish goals
- Work independently with minimal supervision
- Organize daily activities and remain current with assigned tasks
- Analyze a situation and make sound decisions based on the information available
- Working knowledge of insurance products for both life and deferred annuities
- Knowledgeable in accounting and tax-deferred products
- Fixed life and/or annuity claims experience with demonstrated record of above average performance
- Demonstrated knowledge of and proficiency with Claims and business administration systems
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Claims Representative Resume Examples & Samples
- Manage and leverage the customer interactions by serving the needs of our customers and resolving claims inquires within the set timeframe established by the department
- Investigate/process claims and obtain relevant documents to determine loss
- Interact with customer, branch operations, and other Brink’s partners to effectively process claims
- Manage claims process activities in Microsoft Dynamics accurately and in a timely manner
- Assist/ Support Manager in analyzing, planning, decision-making and problem-solving activities to support claim settlement
- Resolve claim issues promptly and follow-up on outstanding issues
- Communicate claim status to Managers, Branch Ops. Personnel and customers on regular basis
- Work in compliance with department & finance business processes and rules
- Enforce the process amongst agents, field operational partners and customers
- Follow best practices through the complete customer lifecycle, from initial data gathering to resolution
- Communicate effectively with customers, branches and other units to identify root cause, accuracy of claims requests or any other clarification that is received with appropriate follow ups to ensure timely resolution of the cases
- Work independently to resolve customer issues by providing feedback to Management on Process Streamlining and Improvements
- Assist with special projects as and when required by the Supervisor or Manager
- Minimum of 2 years’ experience in a corporate environment
- Minimum of 2 years’ experience using Microsoft Office products to include Word and Excel
- Minimum of 2 years’ experience with direct customer interaction
- High school education
- Brinks product line specific support or Operations experience
- Experience working in a Team Environment
- Advanced usage of Excel
- Experience using Microsoft Dynamics or similar systems of record
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Claims Representative Resume Examples & Samples
- Confirms coverage of claims by reviewing pet policies and documents submitted in support of pet claims
- Analyzes coverage using reason codes and communicates coverage positions via an EOB
- Conducts, coordinates, and directs investigation into claim
- Communicates with pet parent via e-mail and/or phone when needed to request additional information in support of a claim
- Maintains FIGO resource guide
- Process claims either directly or indirectly
- Prepares reports by collecting and summarizing information on an excel spreadsheet
- Adheres to Fair Claims Practices regulations and internal Claims Quality Performance Objectives
- Participates in special projects or assists other team members as requested
- Knowledge of insurance industry or claims handling preferred, or
- Successful completion of 2 years as a Claims Technician or Claims Analyst
- Excellent written and oral communication skills
- Strong organization and time management skills
- Ability to deliver outstanding customer service
- Intermediate skills in Microsoft Office products (Excel, Outlook, Power Point, Word)
- Strong desire for continuous improvement
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Claims Representative Resume Examples & Samples
- Establish and maintain strong relationships with customers, build credibility and gain trust while operating with integrity at
- A passion for customer service
- Prior claims handling experience
- Demonstrated ability to effectively and persuasively communicate to a variety of customers
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Claims Representative Resume Examples & Samples
- Able to work with minimal supervision; takes initiative for own performance and that of unit
- Strong sales skills supporting small commercial business lines
- Direct sales skills
- Outbound and cold calling skills
- Strong communication skills both verbally and written
- Must be able to work effectively as part of a team
- Must be goal oriented and success focused
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Claims Representative Resume Examples & Samples
- Prepare financial planning reports on behalf of the representative which follow the enterprise advice model
- Provide support to representatives to successfully deliver the advice model to the clients
- Advanced knowledge of financial planning concepts
- Assist in developing guidelines and procedures
- Answer general financial planning questions from the field representatives
- CFP or equivalent designations or experience is strongly preferred
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Claims Representative Resume Examples & Samples
- Technical Skills related to area of concentration
- Willingness/ability to learn quickly
- Ability to analyze situations and synthesize information
- Interpersonal communication skills
- Knowledge of company organization
- Horace Mann operations
- Inquisitive
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Claims Representative Resume Examples & Samples
- Maintain software applications, including upgrade, enhancements, and patches
- Diagnose and resolve system problems
- Ensure application performance, reliability and quality
- Work cross-functionally to assist with problem solving and project plan activities
- Respond to inquiries, requests in a timely fashion
- Effective written and verbal communications in a professional manner to Management, Business Partners, Associates, and external resources
- Installing and implementing programs and upgrades
- Diagnosing and resolving system problems in coordination with other technical team members
- Shared responsibility for application system reliability and defects
- College level experience with multiple web programming languages (such as C#, C++, Visual Basic, Java)
- Desired knowledge of EAI/TIBCO or Java framework
- Some knowledge of SDLC and Project Life Cycle principles
- Good knowledge of Windows PC's, browsers and peripheral devices
- Analytical problem solver with good communication (verbal and written)
- Strong understanding of web application testing technologies, methods, and techniques
- Working knowledge of one or more modern programming languages (C#, Visual Basic, Java, C++)
- Working knowledge of Visual Studio and modern code repository products
- Strong work knowledge of SDLC and Project Life Cycle principles
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Senior Claims Representative Resume Examples & Samples
- Associates will receive calls from internal and external customers verifying coverage and status of payments
- This position promotes advocacy for the customer and focuses strongly on customer satisfaction
- Computer skills and data input skills are critical to be successful in this position
- Must have a desire to help internal and external customers by being empathetic and
- Demonstrating patience and providing accurate information
- Outgoing and energetic attitude
- Multi-tasking ability
- Excellent problem-solving capabilities
- Computer experience (must be able to navigate between multiple applications and input data quickly)
- Emotional fortitude for high stress situations
- 2+ years operational experience in office work environment working with healthcare or Financial Protection Products (Experience working within a customer service role interacting with internal and external customers)
- Ability to use Excel Spreadsheets to sort/filter information
- Ability to use Microsoft Outlook to send and store emails and to set meetings and use Calendar
- Work Hours Monday - Friday 8:00am - 6:00pm - Flexible to work any shift between these hours and must be flexible to work occasional overtime as needed
- Bachelor's Degree or higher
- 2+ years of call center experience (As CSR or claims rep.) related to healthcare or financial protection products
- 5+ years of experience analyzing and solving customer problems in an office setting environment working with financial protection products
- Military Service
- Ability to multitask which includes the ability to listen and respond to customer while using computer to review status of policy, enter data, or propose solutions
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Claims Representative Resume Examples & Samples
- 3+ years of casualty claims handling experience preferred
- Proficiency with typing and computer skills required
- Must have claim related computer systems experience
- Experience with Guidewire is a plus
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Claims Representative Resume Examples & Samples
- 2+ years of experience of handling all aspects of the claim process which includes coverage, liability, and auto material damage
- Experience with First Call Bodily Injury Settlements is a plus
- Non-standard auto property damage claims experience a plus
- California auto claims handling experience a plus
- Guide wire experience is a plus but not required
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Liability Claims Representative Resume Examples & Samples
- Learn about the job by participating in a 12 week paid training program, including University of Farmers course work, ranked Top 10 by Training Magazine
- You will need to strategically and efficiently plan your day to ensure timely settlement of claims
- Our adjusters love helping others, including each other. They regularly meet with other team members to discuss case challenges and consult on best solutions, as well as cover caseloads for peers when necessary
- 1-3 years’ experience working with customers to surpass their expectations and ensure they are satisfied with their experience, regardless of the outcome
- Ability to interact at all levels of the organization and with a variety of customers in their time of need
- Adept knowledge and comfort using various computer programs and search techniques in order to efficiently manage your daily diary of tasks
- Strong communication and interpersonal skills are a must
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Claims Representative Resume Examples & Samples
- Worker characteristics are normally acquired through the successful completion of an Associate's degree (2-year program); 6 - 12 months of related experience; or equivalent combination of education and experience
- Written and verbal communication skill to effectively and professionally correspond with claimants and insureds
- Some analytical ability necessary to evaluate relevant information essential in resolving routine collision and comprehensive claims
- Requires the occasional exercise of independent judgment which may have moderate impact on the Company in areas such as costs, consumer loyalty, and legal complications
- Requires critical attention to detail
- Good organizational skills needed to manage a high volume of claims
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Total Loss Claims Representative Resume Examples & Samples
- Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary; may inspect damaged property, and review loss reserves and adjust or opens hidden exposures as necessary
- May assist with file reviews and audits
- May also assist manager with preparing reports and completing projects
- Demonstrate the ability to find answers to more complex issues with insurance law and may be a source of direction / assistance for other representatives
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First Notice of Loss Claims Representative Resume Examples & Samples
- Take new loss reports from customers via telephone for all lines of business
- Verify/analyze coverage and determine course of action
- Triage the automobile claim to provide exceptional service
- Direct customer to access program, approved car rental vendor and/or process immediate removal of total loss to salvage yard
- Assign claims to appropriate claims handler
- Enter faxed claims into our automated systems
- Handle incoming calls and correspondence from Insureds, Claimants and Agents regarding questions or problems associated with claims
- Service inquiry calls from customers
- Document claims files and maintain control of work through documentation or diary system
- Update MCS on a continual basis to accurately reflect current activity on a file
- May handle minor claims during heavy claim volume
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Claims Representative Resume Examples & Samples
- South Carolina or Rhode Island adjusters license required within 3 months of hire
- Excellent communication, organization, negotiation, leadership and interpersonal skills
- Previous claim handling experience is required
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Claims Representative 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
- Review and interpret policy coverages to determine whether the claim is payable under the policy, deductible, actual cash value or replacement cost
- 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
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Claims Representative Resume Examples & Samples
- Investigates, analyzes and resolves claims involving damage to customer & general public property, personal injury or motor vehicle by using established department procedures and problem solving skills
- Assumes responsibility for developing specialized expertise on claims arising in the utility business
- Manages field investigations of all serious injury and vehicular damage incidents under the supervision of Claim Manager
- Develops reports in a timely manner using the data collected and any expert or witness information collected
- Establishes strategic negotiating positions when settling claims with claimants or attorneys
- Provides litigation support to Claim Manager & attorneys defending cases against the Company, including the preparation of witnesses and gathering Company records
- Maintains cordial and professional relationships with claimants, customers and individuals who have experienced property loss/damage or medical injury
- Develops and effectively communicates complex information accurately, concisely and comprehensively, both orally and in written form
- Serves as a witness in various litigation proceedings
- Periodic, regular 24/7 on-call for after hours and weekend phone response on claim events
- Occasional storm restoration duty for company during major events
- A minimum of 5 years gas utility operations experience perferred. Minimum two year college degree is preferred. Experience as an investigator or adjuster for a self-insured or a casualty insurance company also preferred
- Strong understanding of the rules of negligence, company tariff protections as well as state and local laws
- Excellent oral and written communication skills including strong negotiating skills
- Strong organizational skills including the ability to manage and process multiple priorities
- Ability to establish credibility and maintain relationships both internally and externally
- Strong interpersonal skills and the ability to self-manage
- Demonstrated strong analytical skills
- Proficient in word processing and other business software including database applications
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Claims Representative Resume Examples & Samples
- Investigates, analyzes and resolves claims involving damage to customers & general public property, personal injury or motor vehicle by using established department procedures and problem solving skills
- Occasionally serves as a witness in various litigation proceedings
- Periodic, regular 24/7 on-call for after hours and weekend phone response on significant claim events
- Bachelor’s Degree or 3-5 years of relevant third party claims handling experience
- Knowledge of gas and electric utility operations is a plus
- Strong interpersonal skills and the ability to self manage
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Field Claims Representative Resume Examples & Samples
- Create an estimate of damages for 1st and 3rd party material damage
- Inspect damaged property and complete appropriate estimates and documentation
- Work toward claim resolution by maintaining regulatory compliance and fair claims practices within their authority
- Maintain relations with both internal and external customers
- Identify potential subrogation and fraud referral opportunities and refer to the appropriate representatives when potential exists
- Stay informed of changes in the collision repair industry as well as statutory and regulatory changes as they relate to material damage and communicate these changes to other claims personnel
- As a mentor for other field representatives
- Assist with file reviews and file audits as needed
- Possess basic knowledge of material damage
- Ability to obtain and maintain adjuster licenses as required
- Ability to operate electronic devices including computers, cameras and cell phones
- Ability to create estimates by way of estimating software
- Possess effective interpersonal skills
- Possess effective negotiation skills
- Possess effective skills in time management, organization, the ability to work under pressure, adhere to project deadlines and remain flexible in a changing environment
- Possess knowledge of estimatics software (Mitchell/CCC/Audatex, etc.)
- Successful completion of one or more of the industry related courses or workshops: I-CAR training, structural damage analysis, steering and suspension, RV and heavy equipment and/or ASE
- Possess 1+ years of experience as a material damage estimator either in the insurance industry or the collision repair industry
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Senior Bodily Injury Claims Representative Resume Examples & Samples
- Develop a basic understanding and knowledge of state laws and regulations applicable to claims handled, including state unfair claim practice laws, and exhibit the basic ability to independently interpret these laws and regulations as it relates to handling of bodily injury claims assigned
- Determines if potential subrogation or fraud issues exist and refers to appropriate claim unit for handling, with recommendation on plan of action, or may independently determine to handle issues to conclusion
- Gather, analyze and evaluate, for settlement purposes, all supportive medical documentation (may include obtaining medical authorizations, medical and lost wage records as necessary)
75
Liability Claims Representative Resume Examples & Samples
- Investigate coverage and liability of claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, insureds, witnesses and others having pertinent information
- Analyze information in order to evaluate assigned claims to determine the extent of loss, taking into consideration contributory or comparative negligence. Assign medical or other experts to case and arrange for medical examinations when necessary
- Process incoming calls and correspondence from insureds, claimants and agents regarding questions or problems associated with claims. Interact with underwriters and agents on claim resolution
- Evaluate, negotiate and resolve claims within delegated authority. Handle general liability and auto liability files from start to finish
- Update claims system on a continual basis to accurately reflect status of each assigned file and to initiate percentage of negligence on the part of the insured to determine "chargeability"
- Receive and approve expenses incurred to investigate, process, and handle a claim
- Prepare check requisitions for all loss and expense payments
- Explore contribution on all claims assigned
- Prepare for and participate in claims review and settlement conferences
- Close claim by issuing check or denial and securing appropriate releases
- Strong time management and organizational skills
- Negotiation and claim disposition skills with proven problem-solving ability
- Strong judgment and decision making skills
- Moderate proficiency with standard business-related software
- Minimum of three years of claim handling experience preferred
- Industry training/designations preferred
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PIP Claims Representative Resume Examples & Samples
- Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submit to manager for approval
- May handle more complex files with appropriate supervision to develop skills
- Successfully completes Claim Representative trainee program, or equivalent external training program
- Can handle most types of comprehensive losses (theft, fire, and vandalism), accurately identify total losses
- For claims involving injuries, have a general understanding of how to review, evaluate, and negotiate injury claims
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Senior Claims Representative 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
- Use services of others appropriately
- Develop technical and jurisdictional expertise
- Identify and initiate mitigation, subrogation and other recovery opportunities on assigned claims
- Identify fraud indicators and initiate investigation on assigned claims
- Dedicate your focus to ensuring our customers have a positive and pleasant experience
- Current Western Workers Compensation Core Claims Representative
- Certification exams and adjusting licenses as required by state
- Strong focus delivering outstanding customer service
- Strong desire to launch your career to the next level!
- “Core Communication, Customer Focus and Talent DNA badges strongly preferred for Current Claims Staff”
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Claims Representative, / II / III Resume Examples & Samples
- Treating every claim as if it was your own
- Taking accountability
- Helping to resolve problems; desire to “dig deeper”
- Ability to connect the dots for our consumers (members/providers)
- Ownership of an issue that may not belong to you
- Previous experience using PC, database system, and related software (word processing, spreadsheets, etc.)
- Ability to work independently as necessary, take ownership and pay attention to detail
79
GAP Claims Representative Resume Examples & Samples
- Handle initial report of loss and control costs. Investigate and maintain a complete and thoroughly documented claim file
- Treat customers in a courteous, friendly and professional manner. Provide timely, thorough, accurate information and assistance
- Conduct timely investigations including recorded statements
- Identify subrogation and/or salvage situations in a timely manner to protect the interests of the Corporation
- Develop subordinates
- Maintain necessary licensing and continuing education
- 3 + years in financial services or similar industry is needed. Prior leadership experience is preferred. Education may be used as a proxy for experience
- Perform technical tasks required to support ongoing business operations
- Skilled technician in a hands-on environment, often highly specialized
- Typically requires advanced knowledge of Microsoft Office Programs
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Claims Representative Resume Examples & Samples
- Good computer navigation skills including excel and word, critical thinking skills
- Ability to use good judgment and follow written workflows
- Medical billing and coding and/or healthcare claims industry background is a plus
- Willingness to learn and follow Anthem attendance guidelines
- Someone who understands the potential for full time employment following completion of temp assignment
81
Claims Representative Resume Examples & Samples
- Process claims requests from the following information systems: NJMMIS; RMOD/MARS; Microfiche; and the Shared Data Warehouse
- The temporary Claims Rep would receive claim requests, verify that a proper HIPAA-compliant authorization and other necessary information have been submitted, process the claims data, compile the required material, and prepare a fee letter or response letter
- Upon receiving the signature of the Supervisor of BAAU, the Claims Rep would mail the completed claims package, file the request package, and process the data for entry into the database systems
- The Claims Rep would also maintain the file and access the database on request
- Claims Rep would also support the BAAU by answering the phone and taking messages, maintaining files, utilizing the Medicaid Eligibility System or NJMMIS to verify eligibility, and do other information lookups for the BAAU
- At least 2 years of previous Claims Representative experience. Must be recent
- Highly proficient with MS Office
- Organized
- Able to prioritize workload
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Liability Claims Representative Resume Examples & Samples
- Bachelor's degree
- Solid computer, grammar and multi-tasking skills
- Strong attention to detail, time management and decision-making skills
- Must be comfortable working in a fast-paced, high-volume call center
83
APD Claims Representative Resume Examples & Samples
- Investigates, confirms coverage, determines liability, establishes damages, reports status and negotiates the settlement of assigned cases (has authority to make payment of assigned claims within prescribed limits)
- Initiates the sale of salvage vehicles, personal property, and miscellaneous salvage items. Reports theft, fraud, and arson losses as required to state and industry agencies
- Performs most duties on an individual basis, and work has a direct bearing on Management results
- Computer skills - MS Word, Excel, Outlook
84
Liability Claims Representative Resume Examples & Samples
- Material Damage Settlements
- Liability Decision Making
- Coverage Investigations
- Time Management Skills
85
Claims Representative Resume Examples & Samples
- Interprets policy coverages and determines if coverages apply to claims submitted, escalating issues as needed
- Partners with attorneys, account representatives, agents, underwriters, and insureds to develop a focused strategy for timely and cost effective resolution of claims
- Ability to handle claims with a proactive long-term view of business goals and objectives
86
Casualty Claims Representative Resume Examples & Samples
- Adjust claim by evaluating and negotiating claims settlement
- This is handled using investigative and negotiating skills with clients, claimants, attorneys and medical professionals
- Also determine reserves needed and ensures they are applied
- AIC,CPCU or similar designations
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Senior Claims Representative Resume Examples & Samples
- Your services exceeded customer expectations
- Investigate claims to determine liability, including reconstruction of complex events, obtaining evidence and statements of claimants and witnesses, obtaining photos, and gathering evidence
- A Bachelor’s degree in business administration or a related field or an equivalent combination of education and experience
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Claims Representative Resume Examples & Samples
- Establishing and maintaining strong relationships with customers, building credibility and gaining trust while operating with integrity at all times
- Utilizing verbal and critical thinking skills to gather information and data; making sound decisions based on a mixture of analysis and judgment
- Working directly with customers while exercising professionalism, diplomacy and negotiating skills to successfully resolve claims
- Communicating and working within a team environment and with various levels of leadership throughout the department and the organization
- Achieving targeted performance goals to manage costs and support The Hartford’s industry-leading operational claim standards
- Completing state-mandated forms or letters timely and accurately to ensure compliance with regulatory requirements
- Administering claim benefits through interpretation and analysis of the insurance contract and evaluating exposures for setting reserves to fulfill our contractual obligations
- Bachelor’s degree or equivalent work experience is strongly preferred
- 1+ years of General Liability or Auto Liability claims experience
- 1+ years of experience in a customer service environment, with an emphasis in providing exceptional customer service. Restaurant, retail, hospitality and finance work experience a plus
- This is a fast-paced, high-volume position, so the ability to handle multiple and competing priorities simultaneously is needed
- Excellent communication skills, both verbal and written a must
- The ideal candidate should enjoy research, investigation and negotiation
- Employees will work in a collaborative team environment, but should possess the skills to be able to make independent decisions
- This position resides in a heavy phone volume environment where the ability to gather and process information quickly is important. (Mainly outbound calls or return phone calls from customers)
- Establish and maintain effective relationships with internal and external customers, while consistently demonstrating honesty, integrity, courtesy and respect when interacting with others
- Effective decision making ability is a must, including strong critical thinking and analytical skills
- Obtain and maintain licensing to handle claims in required states. Hartford provides training and pays for cost to obtain and maintain state licensing
- The ability to negotiate skillfully while demonstrating diplomacy and tact to avoid or diffuse stressful situations
- Knowledge of and proficiency with MS Office
- Experience resolving challenging customer service situations in a highly professional manner
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Senior Claims Representative 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
- Registers claims, updates status notes, establishes target dates, communicates with others, schedules appraisals and releases payments on the automated system within limit of authority
- 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
- 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
90
Senior Work Comp Claims Representative Resume Examples & Samples
- Plan recommend, reserve and execute the investigation, valuation, disposition and settlement of claims
- Outstanding interpersonal skills working within a dedicated, supportive team
- Demonstrated strong written and verbal communication skills
- Demonstrated consistent high level of performance and achievement over career span
- Excellent time management ability
- Strong desire to launch your career to the next level
91
Senior Claims Representative Resume Examples & Samples
- Review assignments to determine severity, coverage and appropriate action
- 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
- Manage all administrative claim functions such as reserving, claim payments and file notes via electronic means and at times from remote locations
- Prepare written investigative reports for the claim file to document all activity related to the loss
- Negotiate with contractors or repair facilities regarding extent of damage and method of repair
- 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
- 4 year college degree preferred plus 5 years of multi-line experience plus AIC, SCLA or Legal Principles, CCLA and PCLA of the AEI series. If you don’t have designation, complete one or the other within 3 years. Once obtained, work towards CPCU
- Meet the appropriate state licensing laws required to handle “multi line” claims
- 5 years total multi-line experience in claims to function properly in position
92
Claims Representative Resume Examples & Samples
- Bachelors of Science in Nursing or other clinical degree with previous clinical experience
- Professional liability claims management experience
- Three to five years’ experience in insurance industry claims management (or comparable clinical hospital experience)
93
Claims Representative General Liability Resume Examples & Samples
- Communicates claim action with claimant and client
- May process low-level lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
- Developing knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as applicable to line of business
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Claims Representative Resume Examples & Samples
- Manages general liability claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level
- Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency
- Processes complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review
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Claims Representative Resume Examples & Samples
- Manages general liability and automobile claims by gathering information to determine liability exposure; assigns reserve values to claims, making claims payments as necessary, and settling claims up to designated authority level
- Approves and processes assigned claims, determines payments due, and manages action plan pursuant to the claim or client contract
- Knowledge of commercial automobile regulations, offsets and deductions, disability duration, medical management practices and procedure as applicable to line of business
96
Claims Representative Resume Examples & Samples
- Contacts all parties involved to complete full investigation (as required by line of business) of the facts and damages relevant to the claim
- Provides effective and timely communication to all internal and external stakeholders regarding claim status and other inquiries such as fraud, subrogation recovery, reserve adequacy and underwriting risks
- Document files in a timely fashion with all appropriate claim information
- Correspond with intermediaries via email or telephone during the life of the claim
- Meet established performance metrics by setting work related goals, communicating with management to report progress and assisting with assigned special projects to support the achievement of department objectives
- Support QBE values in personal work behaviors, decision-making, contributions and interpersonal interactions; manage own career development by soliciting feedback and valuing other perspectives
- General understanding of relevant laws and regulations across multiple jurisdictions
- Understanding of market trends and organizational strategies
- Working knowledge of Microsoft Office Suite, general computer software and database systems
- Utilize effective communication to effectively influence and persuade decision makers; understand the needs and goals of customers and actively look for ways to meet them
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Senior Claims Representative Resume Examples & Samples
- Produce large loss reports with analysis to ensure appropriate claim reserves
- Review and evaluate claims for coverage and further claim handling procedures to conclude within required statutory time frame
- Interpret policy/contract language and evaluate coverage issues of multiple policies/contracts/endorsements, including identifying potential coverage issues and referring claims to Claims Unit Leader as needed, and determining liability and evaluating damages of all exposures related to the claim
- Identify and refer claims to subject matter experts or manager in a timely manner to maximize claim outcomes; ensure files are documented with all appropriate claim information
- Provide effective and timely communication to all internal and external stakeholders regarding claim status and other inquiries such as fraud, subrogation recovery, reserve adequacy and underwriting risks; build close partnerships throughout the life of the claim
- Support claims workflow efficiency by accurately documenting portfolio progress, referring high risk exposures outside authority levels and seeking opportunities that enhance operational knowledge
- Utilize judgment and industry skill set to apply case reserves independently; review reserves on assigned claim files and recommend additional case reserves or other necessary changes
- Contribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value “can do” people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun
- 4 years claims handling experience; increasing levels of responsibility
- Working knowledge of claims administration best practices and procedures
- Working knowledge of insurance products and services
- Understanding of relevant laws and regulations across multiple jurisdictions
- Identify relevant information and understand it’s impact
- Encourage open communication, cooperation and knowledge sharing
- High attention to detail
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No Fault Customer Claims Representative Resume Examples & Samples
- Reviews medical records and bills to verify claimed treatment is causally related to the accident and is reasonable and necessary given facts of the claim
- Learns to use internet and Liberty Mutual contracted vendors (i.e. Smart Advisor, AIS) for evaluation of medical payments
- Processes Wage Claims, No Fault and medical payment claims. Secures and reviews appropriate medical documentation to verify treatment and causal relationship
- Good oral and telephone communication skills as well as typing skills required
99
Senior Claims Representative Resume Examples & Samples
- One or more years of experience with disability claims preferred but not required
- Work in a fast - paced environment
- Ability to multi - task, this includes ability to understand multiple products and multiple levels of benefits within each product
100
Customer Claims Representative Resume Examples & Samples
- Relevant Finance Diploma and 1 year Customer Service / Claims experience
- Experience in retail or FMCG environment
- Understanding of Logistical processes and Supply chain environment
- PC literate (Ms Office Suite) with Excel at an Intermediate level
- Oracle and/or SAP will be advantageous
- Excellent telephone skills and above average communication skills (written and verbal)
- Analytical skills
- Ability to work under pressure and deal with difficult customers
101
Claims Representative Resume Examples & Samples
- Authorize appropriate payment or refer claims to investigators for further review
- 4 plus years of experience analyzing and solving customer problems in an office setting environment using the telephone and computer as the primary instruments to perform job duties
- Authorization to work in the United States
- Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
102
APD Claims Representative Resume Examples & Samples
- Personal contacts are a major part of activity and include policyholders, claimants, agents, witnesses, repair facilities, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and all other people’s incident to the investigation and processing of claims
- MS Office and Typing skills
- Ability to multi-task and work in a fast pace environment
103
Claims Representative Resume Examples & Samples
- Processes auto claims; assesses damage, makes payments, and ensures claim files are properly documented and correctly coded based on the policy
- Develops and maintains action plans to ensure state required contract deadlines are met and to move the file towards prompt and appropriate resolution
- Identifies and pursues subrogation opportunities; secures and disposes of salvage
- Communicates claim action/processing with insured, client, and agent or broker when appropriate
- Maintains professional client relations
- Familiarity with personal and commercial lines policies and endorsements
- Familiarity with property estimating software
104
Claims Representative Resume Examples & Samples
- Minimum two year college degree is preferred
- Experience as a handling electric or/gas utility operations experience preferred
- Experience as an investigator or adjuster for a self-insured or a casualty insurance company also preferred
105
Senior Claims Representative Resume Examples & Samples
- This position is part of a job family. Placement will be determined by skills and qualifications of the candidate
- Investigates the more complex claims within prescribed limits (i.e., situations involving structural damage, fire losses, serious injury claims, and total losses) by determining applicable policy coverage, evaluating damages and assessing liability. Obtains and analyzes a wide variety of documentation related to the claim (i.e. accident reports, ISO reports, medical records, police reports, written estimates, witness accounts, etc.) and draws the proper conclusions related to claim investigation
- Completes physical inspections of the more extensive property damage losses (when necessary), evaluates damages, and prepares written estimates according to policy provisions and liability
- Initiates first contact with insureds, claimants, and all relevant parties to gather basic information, obtain recorded statements (when necessary), and explain the overall claims process
- Maintains continuous communication with all affected parties regarding each step of the claims process
- May temporarily perform Senior Claims Representative duties in other company locations when catastrophes occur, or as other business needs dictate
- Education equivalent to graduation from high school (or the equivalent in related work experience)
- Maintains the appropriate adjuster's licensing as required by the states in which we do business
- Two or more years’ experience as a Claims Representative – Field (or the equivalent)
- Must have the knowledge to investigate and settle one or more of these larger and/or complex claims types: structural damage, fire losses, serious injury claims, and total losses
- Education equivalent to graduation from college with a degree in business, insurance or agribusiness (or the equivalent)
- Experience with insurance company operations and financial services products
- Possesses good knowledge of policy coverages and construction estimating and demonstrates the ability to serve as a subject matter expert and knowledge resource to others, including management
- Demonstrates excellent oral and written communication, including telephone etiquette, possesses good decision-making skills and the ability to persuade and negotiate effectively, possesses the ability to handle potential conflict effectively and constructively, and demonstrates good organizational skills, analytical ability, and detail orientation and knowledge of basic math and geometry
- Possesses the ability to multi-task while interacting effectively with financial representatives, claimants, insureds, internal staff members, and external contacts, and must be able to work independently in the field or as a member of a team
106
Senior Claims Representative Resume Examples & Samples
- Possesses good knowledge of policy coverages and construction estimating
- Demonstrates the ability to serve as a subject matter expert and knowledge resource to others, including management
- Possesses the technical expertise to occasionally serve in the absence of a Specialist as business needs dictate
- Working knowledge of Microsoft Word, Excel (or their equivalents), Xactimate, and/or other claims estimating software
- Possesses competent knowledge with residential and commercial construction techniques
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Claims Representative Trainee Resume Examples & Samples
- Bachelor’s Degree preferred
- No experience necessary
- Ability to obtain and maintain state adjuster/appraiser licenses
- Previous insurance related and/or customer service experience is preferred
- Possess effective oral and written communication skills
- Exercise effective time management and negotiation skills
- Ability to maintain confidentiality
- Possess personal computer and math skills
108
Claims Representative Senior Resume Examples & Samples
- Analyze high exposure claims, set reserves, determine compensability, pay benefits and settle claims with established dollar authority
- Develop and manage workers' compensation claims action plans to a resolution, coordinate return-to-work efforts, and approve claim payments
- Prepare claims for settlement and negotiate settlement with best outcome
- Manage and direct all cases to closure in the most efficient and effective way possible
- Communicate claim action/processing with claimant and client in a professional and timely manner
- Provide work direction and guidance to claim representatives and serve as a technical resource within your assigned unit
109
Claims Representative Resume Examples & Samples
- Conduct a thorough investigation by contacting injured workers, medical providers and locations/stores to determine if the claim is allowed under the applicable workers’ compensation statutes
- Determine financial exposure and maintain adequate reserves based on analysis of injury, related medical care and expected periods of disability and/or permanent impairment
- Obtain related medical records and communicate with medical providers to develop and authorize appropriate treatment /treatment plans. Review and analyze medical bills to confirm charges and treatment are causally related and billed according to applicable fee schedules, guidelines or statutes
- Interact and coordinate information with key personnel in multiple departments
- Prior claims handling experience preferred
- Claims Designation and college degree preferred
- This position will require typing speed between 55 – 65 wpm
- Must have above average mathematical skills, including the ability to compute rates, ratios, and percentages, and the ability to work with mathematical concepts such as probability and statistical inference
- Proficiency with Microsoft office, Outlook, and Claims Information Systems
- Strong analytical skills and must be able to multi-task
110
Senior Claims Representative Resume Examples & Samples
- One or more experience with disability claims preferred but not required
- Managing a caseload of initial liability and ongoing Financial Protection claims
- Effectively and professionally utilize sound judgment, technical knowledge, communication skills, and focused resources (medical, vocational, legal, etc.) to manage claims to appropriate conclusion in accordance with applicable internal and external regulations, policies and procedures
111
Senior Claims Representative Resume Examples & Samples
- The Claims Rep will work in a call center environment while answering internal and external
- Customer questions regarding claims, enrollment, policy, payment status, general information, etc
- Provide expertise or general claims support by reviewing, researching, investigating, processing and adjusting claims information
- Document appropriate payment or refer claims to investigators for further review
- Associates will receive calls from internal and external customers verifying coverage and status of Payments
- Must have a desire to help internal and external customers by being empathetic
- Experience working within a customer service role interacting with internal and external customers and multiple levels of benefits within each product
- Ability to create and modify spreadsheet, documents, and emails with Microsoft Word, Microsoft Outlook, and Microsoft Excel
- Flexibility to work any shift between 8:00 am - 6:00 pm Monday through Friday and work occasional overtime as needed
- Medical Terminology
- Familiarity with claims within the insurance industry
- Bilingual fluency
- Ability to be flexible and ability to prioritize, this includes ability to understand multiple products
112
APD Claims Representative Resume Examples & Samples
- Customer service experience, preferably in a retail or fast pace environment
- For applicants who do not meet the education requirements, two (2) years working as a manager, assistant manager or lead estimator in an auto body repair facility is required
- Must achieve minimum passing scores on all claims training exams
- Good computer skills such as proficiency using MS Word, Excel, and Outlook
- Proficiency use of smart phones and apps
113
Claims Representative Resume Examples & Samples
- Independently processes a range of transactions including those which are moderately complex using documented procedures and multiple software applications
- Handles multiple processes/functions within the team
- Identifies, investigates and evaluates questionable transactions. Researches policy transactions and history as required
- Communicates with internal associates and external customers or agents regarding outstanding requirements, or transaction issues and problems. Resolves escalated calls and issues
- Documents status of transactions and contacts received and initiated
- Knowledge of Jackson’s product lines, claims process and organizational structure
- Good verbal and written communication skills to interact professionally with coworkers, management and external customers
- Ability to communicate and interpret moderately complex issues and requests
- Ability to navigate and utilize multiple software and mainframe computer applications
- Ability to effectively manage the demands of a high volume, image based work environment
- Ability to assist others by providing on-the-job training
- High School diploma or equivalent (G.E.D.)
- 0-1 years work experience
114
Claims Representative Resume Examples & Samples
- Manages first party property, casualty and/or medical reimbursement claims based on multiple/additional coverage and/or programs as defined by client-specific program
- Makes coverage determinations based on investigation/evaluation and communicates claim actions with claimant and client
- Adjudicates proper settlement up to designated authority level
- Works directly with underwriter/client on high value and complex cases
- Handles high volume of claims, phone calls and correspondence ensuring claim files are properly documented; meets quality and production goals; and meets customer guidelines and deadlines
- In-depth knowledge of first party property and casualty claim adjudication as applicable to line of business
- Excellent analytical and interpretive skills
115
Liability Claims Representative Resume Examples & Samples
- Receive assigned claims of lower complexity, verify coverage and determine course of action
- Analyze information in order to evaluate assigned claims to determine the extent of loss, taking into consideration contributory or comparative negligence. Assign medical or other experts to case and arrange for medical examinations when necessary, within authority
- Evaluate, negotiate and resolve claims within delegated authority. Handle general liability and auto liability files from start to final disposition
- Receive and approve expenses incurred to investigate, process, and handle a claim. Prepare check requisitions for all loss and expense payments within authority
- Explore contribution/recovery on all claims assigned
- Participate in ongoing claims training
- Understanding of Commercial and Personal liability policy language and endorsements
- Energetic team player with strong interpersonal and communication skills
- Adjuster licenses in states requiring same
- Effective damage evaluation and negotiation skills
- Must be highly organized with ability to handle multiple tasks simultaneously to meet deadlines
- Demonstrated sound, balanced and timely decision making skills
- 1-5 years of Commercial and Personal Lines liability experience preferred
116
Claims Representative, CBO Resume Examples & Samples
- At least one year of accounts receivable experience preferred, preferably in a physician practice, hospital, or medical facility
- Experience working with third party payers required
- Proficiency in using a computer and familiarity with computer applications required
- Experience using Microsoft Office Excel, Word and Outlook preferred
- Knowledge of computerized billing systems, such as Epic, preferred
117
Claims Representative Ca-liability Resume Examples & Samples
- Participates in an intensive training program in a supervised learning environment, which includes training in claims investigation, liability determination, coverage confirmation, establishing damages, and negotiation of claims settlement
- Investigates, confirms coverage, determines liability, establishes damages, reports status and negotiates the settlement of assigned cases
- Initiates the sale of salvage vehicles, personal property, and miscellaneous salvage items
118
Claims Representative Resume Examples & Samples
- At least 2 years experience as a Claims Assistant
- Associates Degree or higher preferred
- Completion of Certificate of General Insurance program or other claims-oriented education programs preferred
- Proficient with Microsoft Office Word and Excel
- Strong verbal and communication skills
- Prefer some customer service and administrative experience
- Demonstrate attention to detail and ability to follow procedures
- Team player
119
Claims Representative Resume Examples & Samples
- Request confirmation and information from insurance companies, agents, or insureds within 24 hours
- Key into agency management system and forward claim documentation to carriers timely
- Communicate with insured's contact person same day or within 24 hours on status of claim, coverage concerns, resolutions
- Keep records current in electronic database, including claims dates or medical/third party notices
- Under direction of Claims Manager, communicate with producers, insurance adjusters, and representatives with timely follow-up
- Maintain up-to-date (electronic and manual) claim records and information necessary for claims department per established standards and procedures
- Using online system, follow up with companies, insureds, loss payees, and third party claims issues within established time limits to ensure proper handling of claims and document activity
- On impacted/disputed claims, timely communicate with Claims Manager for review of claim issues and status. Contact insurance department personnel, as requested by Claims Manager, for action and other follow up
- Under direction of Claims Manager, provide claim payment and activity information with changes/updates to interested parties within 72 hours from request
- Phone messages, claim notification and inquires activity pursued on a same or next day basis per standards and procedures
- Key detailed claims activity and costs into agency management system and/or electronic programs as established by standards and procedures
- Maintain proper documentation and filing of correspondence and activity with insurance company and insured on problem claims
- Complete and maintain daily work and report to Claims Manager as directed
- Complete and maintain proper documentation and timely follow up for resolution with insurance companies and insureds on problems with policy coverage or claims
120
Field Claims Representative Resume Examples & Samples
- Adjusts all types of claims. Inspects damaged property and vehicles, and determines claims related damage
- 1-3 years of Insurance Claims experience
- Customer service lead experience, preferably in a retail environment
- Experience working remote highly preferred
- *Candidate qualifications may be reviewed against the requirements for the associated levels of this position's core function***
- Self-starter, driven and able to work in a fast pace environment
- Proficiency use of smart phones and applications
121
Casualty Claims Representative Senior Resume Examples & Samples
- Pursuant to Company lines of business and strategies and good faith claim handling practices: investigates, negotiates and settles (within authorized limits) assigned claims
- Manages payment of all Michigan No Fault benefits by using proper medical bill review, medical management tools and SIU investigation process as needed
- Establishes and maintains positive relationships with both internal and external customers resolving conflict around disputed benefits and providing excellent customer service
122
Claims Representative Resume Examples & Samples
- Multi line business experience desirable
- Experience servicing claims of the highest complexity required
- Proficiency with Microsoft Office and industry-related software preferred
- Advanced understanding of insurance principles necessary
- Advanced technical knowledge and skills among peers required
123
Claims Representative Resume Examples & Samples
- Four year college degree or equivalent combination of education and work experience required
- Ability to service claims of low to moderate complexity, as normally acquired through 3-5 years experience
- Moderate computer and line of business technical software skills required
- General knowledge of negligence and subrogation principles desired
- Advanced organization and planning recognition skills required
- Valid driver’s license with a level of financial responsibility required by the Club in an acceptable motor vehicle driving record required for field position
- Advanced interpersonal skills required
124
Claims Representative Resume Examples & Samples
- Over 8 million members
- More than 9,000 employees
- Over 110 locations
125
Claims Representative Resume Examples & Samples
- Review and research assigned claims by navigating multiple computer systems and platforms and accurately capturing the data / information necessary for processing (e.g. verify pricing, prior authorizations, applicable benefits)
- Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents / certificates)
- Communicate and collaborate with members and providers to resolve claims errors/issues, using clear, simple language to ensure understanding
- Learn and leverages new systems and training resources to help apply claims processes / procedures appropriately (e.g. on-line training classes, coaches/mentors)
- Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance
- 1+ years of Customer Service Representative (CSR) experience
- 1+ years of experience in claims processing environment (payer or provider side)
- Experience in Microsoft Excel (data entry, sorting, creating / modifying spreadsheets) and Microsoft Word (create / edit documents)
- Meet work schedule including the required training period, Monday through Friday, 8 hour work day (example: 8:00am – 5:00pm CST)
- COSMOS and CPW experience
- Previous Medicare / Medicaid processing
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Casualty Claims Representative Resume Examples & Samples
- College degree or equivalent plus 1 - 2 years of relevant experience required
- Excellent communication skills are critical to success in this position, as well as strong analytical and problem solving skills, with the ability to negotiate and cope with stressful situations
- Experience and knowledge of casualty claims is preferred
- You must be a self-starter and enjoy working independently
127
Onsite Claims Representative Resume Examples & Samples
- Anticipates customer needs and proactively identifies solutions, be accountable for improving business operations
- Accounts receivable follow up and resolution
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Working Hours - business hours - 40 hours standard, OT if business needs dictate but not regular
- Previous experience working in a client facing role and / or working onsite at a client site
128
Assistant Claims Representative Resume Examples & Samples
- Work with Sales, Customer Service, Technical Services, and other departments to ensure correct and timely invoicing and the resolution of claims for material defects and pricing discrepancies
- Evaluate claims for reconciliation and to provide route cause analysis for prevention of future claims
- Assist Sales and Customer Service with the Sales Agreement system to ensure correct order entry and invoicing
- Assist the sales and product teams with creating and maintaining sales agreements
- Issue monthly, quarterly and annual customer rebates and surcharges
- Calculate monthly rebates, accruals, and payments
- Clear invoices from daily suspense report
129
Claims Representative Resume Examples & Samples
- Adaptability is the key to success in this role as you will juggle multiple tasks and take on new cases daily, while monitoring and following up on existing claims
- Engage in difficult conversations with customers who have had a loss or suffered an injury, empathizing with their situation in order to build excellent rapport and assure they are taken care of and put at ease
- The training will also include current claims systems, processes and strategy
- Employees will be required to complete an exam with a passing grade at certain phases of the training
- Reports theft, fraud, and arson losses as required to state and industry agencies
- Personal contacts are a major part of activity and include policyholders, claimants, agents, witnesses, repair facilities, contractors, police a nd fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and all other persons incident to the investigation and processing of claims
- Strong problem solving skills are necessary to investigate answers that are not always apparent
130
Claims Representative Resume Examples & Samples
- Knowledge of insurance policies and medical terminology helpful
- Ability to make sound decisions while using good judgment in evaluating claims
- Effective and efficient at working a computer
- Ability to meet travel requirements of the job with limited notice
131
Senior Claims Representative Resume Examples & Samples
- Industry designations such as AIC, CPCU, SCLA, CCLA or PCLA are preferred
- Minimum of five years of multi-line claims experience
- Minimum of five years of commercial property and casualty claims experience
- Strong negotiation and problem solving skills
- Individual must be analytical, precise and have the ability to work independently
132
Claims Representative Resume Examples & Samples
- Processes claims edits from receipt to completion
- Utilizes claims and ancillary systems and adheres to processing procedures resulting in the finalization of basic claims edits
- Maintains working knowledge of policies and procedures and attends additional training as needed
- Maintains required workload to meet or exceed established Quantity (Production) and Quality goals in accordance with departmental standards
- Performs routine claim adjustments
- High school diploma or GED
- 2 years relevant work experience or equivalent combination of training and/or post high school education
- Successful completion of required training (within four months of hire)
- Knowledge of data entry and standard office procedures
- Alpha-numeric keyboarding skills at a minimum of 6,000 ksph
133
Senior Claims Representative Nac-safeco Resume Examples & Samples
- 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
- Strong working knowledge of the various operations with the Claims Department and the ability to handle multiple claims work systems is required
134
Claims Representative Resume Examples & Samples
- A minimum of 1+ BI experience handling injury claims is preferred
- States handled CA, OR and some MT
- Ability to work Monday - Friday, 8:00 am - 5:00 pm PST or 10:00 am - 7:00 pm CST
135
PIP Claims Representative Trainee Resume Examples & Samples
- Responsible for investigating, evaluating, negotiating, and settling Personal Injury Protection (PIP) claims
- Responsibilities include but are not limited to: reviewing a person's injuries and loss of earnings claims after an accident; analysis of coverage and conducting investigation of injuries and causal relationship to claim; proactively interact with healthcare professionals to monitor treatment and disability and determine need for independent medical examinations; maintain cost containment practices regarding indemnity and expense payments on claims; negotiate claims with insured's, claimants, attorneys and providers; recognize and investigate recovery possibilities; comply with state regulatory requirements and maintain work according to individual/company goals; work in a team environment; other duties as assigned
- Ability to make prompt insured and claimant contact, investigate claims, analyze loss facts and coverages, and process claims payments timely
- Claims may involve multiple sub-limits of coverage; maintains current knowledge of changes in state
- May oversee files that use, but not limited to: medical management tools, such as case management, independent medical examinations and peer review; may oversee large loss, litigation and catastrophic losses
- Bachelors degree or equivalent business experience
- Knowledge of no-fault regulatory requirements for the state of New York (NY)
- Well-developed communication and organizational skills,
- High degree of initiative and mature judgment, excellent customer service skills and the ability to resolve conflicts
- Microsoft Windows applications and general computer skills required
- Selected candidates will be required to successfully obtain/maintain appropriate licensing and/or educational requirements
- Has understanding of how to review, evaluate, and negotiate injury claims. Will demonstrate ability to handle more serious injuries
- Demonstrates a basic understanding of medical terminology and functions of the human body
- Demonstrates a basic understanding of anatomical terminology associated with injury claims, CPT and ICD coding
136
Lead Claims Representative Resume Examples & Samples
- Solely responsible for entire process to recover revenue for all networks with respect to TPL cases. Communicates with third party insurance company or attorneys to open, follow, and negotiate settlements on TPL cases
- Maintains a current understanding of claims adjudication and processes to determine appropriate charges for inclusion on the TPL case
- Audits unresolved cases and submits additional charges as necessary
- Independently negotiates settlement amounts when disputed/appealed
- Responsible for coordinating tasks of other individuals within the department related to TPL to be able to perform functions in another’s absence
- Works closely with the networks to develop procedures, TPL forms, and medical record retrieval as it pertains to TPL cases
- Understands TPL policies and procedures established by NSS as well as the HMOs contracts
- Phone follow up with patients when incomplete information is received to complete the patient questionnaire or status update
- Responsible for reviewing subpoena requests to determine liability type of TPL case
- Accurate data entry of patient account information in the IDX system
- Orients, trains and mentors current and new employees as needed
- Requires four (4) year’s experience in medical/institutional claims processing within a medical group/IPA setting
- One (1) year experience with third party liability claims required
- Previous experience with computerized claims processing/transaction system and medical coding (CPT, ICD10, and HCPCs) required
- Knowledge of liability civil codes, HMO lien rights and other laws affecting functions of this position
- Ability to work under pressure by prioritizing work activities and re-negotiating deadlines
- Possess excellent verbal, written and interpersonal communications skills to communicate effectively with individuals at all levels of the organization
- Excellent organizational and prioritization skills
- Possess critical thinking and problem resolution
- Knowledge of HIPAA and AB1455
- Ability to work independently, but also as a team player, supporting and promoting intra and inter-departmental teamwork
- Possess a professional and mature demeanor, maintaining a positive attitude with changing conditions
- Ability to make sole judgment calls with confidence
- Ability to lead and delegate tasks as needed
137
Quick Claims Representative Resume Examples & Samples
- Receives claim assignments involving less complex material damage settlements. Verifies coverage, conducts limited investigation of facts and documents all appropriate information. Reviews loss exposures to ensure correct line of coverage is opened. Opens additional exposures as necessary
- Evaluates and adjusts claims within limit of authority. Summarizes claims in excess of authority and submits to manager for approval
- Makes appropriate contacts to discuss a settlement when necessary; extends an offer to appropriate party; documents all file activity and payment/settlement information in claim file clearly outlining basis for settlement
- Performs other projects and assignments as directed
- Develops a working knowledge of systems and technology used within the company
- Associates degree preferred or equivalent insurance related experience
- Obtaining/Maintaining appropriate licensing or educational requirements
- Basic understanding and interpretation of vehicle repair estimates
- Has a solid understanding of material damage coverages and exhibits basic knowledge of policies & procedures in resolving claims. May need some assistance from supervisor
- Complies with the company material damage guidelines
- Demonstrates the capability of consistently handling claims within rep authority
138
Claims Representative Resume Examples & Samples
- Provides a consistent, positive, and satisfying claims experience for our clients by delivering superior claims service
- Investigates claims by determining applicable policy coverage, evaluating damages, and assessing liability. Obtains and analyzes a wide variety of documentation related to the claim (i.e., accident reports, ISO reports, medical records, police reports, written estimates, witness accounts, etc.) and draws the proper conclusions related to claim investigation
- Completes physical inspections of damaged property (when necessary), evaluates damages, and prepares written estimates according to policy provisions and liability
- Communicates and negotiates with a variety of individuals regarding investigation and settlement of claims. This includes insureds, claimants, attorneys, public adjusters, contractors, body shops, insurance carriers, and other involved parties
- As applicable, travels to loss location and evaluates property damage, determines coverage, and estimates damages
- Completes timely referral of claims to the appropriate level of authority as dictated by claim severity or complexity
- May temporarily perform Claim Representative duties in other company locations when catastrophes occur, or as other business needs dictate
- Demonstrates excellent oral and written communication, including telephone etiquette
- Possesses the ability to multi-task while interacting effectively with financial representatives, claimants, insureds, internal staff members, and external contacts
- Must be able to work independently in the field or as a member of a team
- Experience with insurance company operations and financial services products and familiarity with basic construction
- Some experience or knowledge of the property/casualty claims adjusting process
- Previous experience within the insurance and/or financial services industries with a sound understanding of the company / financial representative relationship
- Working knowledge of Microsoft WORD and Excel (or their equivalents), Xactimate, and/or other claims estimating software (as applicable)
139
Claims Representative Resume Examples & Samples
- Assist with claim investigation by ordering police reports, requesting dispatch and following up on service delays and requested information not received
- Sort, index and distribute incoming mail for adjusters within your line of business
- Request and obtain policy information on losses as requested by adjusters
- Communicate and work effectively with customers to ensure the level of service provided meets or exceeds expectations
- Process letters, apply applicable supports and mail according to established workflow
- Process reserves and loss/expense payments as directed by adjuster
- Process cash receipts within the authorized guidelines
- Manage open and closed filing for adjusters
- Answer incoming status calls from customers and branch team members
- Manage time effectively by organizing and prioritizing duties
- Assist adjuster and vendor manager in resolving billing issues (i.e.: Safelite, Corvel, CEI and appraisal companies)
- Strong PC navigation skills including a working knowledge of Windows operating system, Outlook and the Internet
- Demonstrate ability to meet or exceed established performance standards
- Excellent verbal and written skills
- Work effectively in a team environment
- Demonstrate active listening skills
- Demonstrate initiative by taking appropriate or necessary action with minimal guidance
140
Claims Representative Resume Examples & Samples
- Estimates the cost of repair or replacement of damaged or stolen property and vehicles. Determines and reports on subrogation potential
- Experience with sales and customer service in a fast pace environment
- Experience in contract negotiations preferred
- Experience with ownership of processes or projects
- Preferred working knowledge in a legal environment/capacity – i.e. law firm
- General medical terminology knowledge preferred
- Working knowledge of meeting deadlines preferred
- Excellent communication skills both written and oral
- Proficiency in MS Word, Excel and Outlook Investigation and negotiation skills
- Problem solving, investigation and negotiation skills
- Time management skills and being proactive
- Proficiency in navigating through multiple applications and software
- Proficiency in using double monitors and toggling between systems
141
Senior Bodily Injury Claims Representative Resume Examples & Samples
- May work with attorneys in resolving serious and complex lawsuits which may mean: conduct negotiations and settlements within authority level, track and document the quality of service provided by defense counsel and manage litigation and recovery costs, and assist manager with research of complex issues and development of defense strategies on litigated files
- Is proficient and able to train others in using all systems and technology used within the company
- Demonstrate the capability of consistently handling aggregate file exposures of at least $15,000
- Demonstrate proficiency in file audits to agreed standard of efficient claims quality
- Has thorough knowledge of claims policies and procedures in resolving claims and/or providing technical direction to claims representatives
- Often a source of directions for others on claim policies and procedures
- If handling material damage, can accurately handle any type of material damages claim within limit of authority
- When handling injury claims, can review, evaluate and negotiate any type of injury claim, and demonstrate ability to handle more serious injuries
- Demonstrates effective leadership and mentoring skills
- Demonstrate an understanding of the functions of other departments, such as Policy Ops and Marketing
142
Claims Representative, / II / III Resume Examples & Samples
- Analytical and researching skills is preferred
- Strong Interpersonal communication skills is preferred
- WGS, FACETS, and NETWORX PRICER is preferred
143
Claims Representative Resume Examples & Samples
- 1 year Administrative experience
- 1 year Customer service experience
- Incumbent must be able to move about the office and between floors
- Utilize standard office equipment
- Access filing system/cabinets
- Communicate effectively and efficiently in person or by telephone
144
Field Claims Representative Trainee, Senior Resume Examples & Samples
- Create a estimate of damages for 1st and 3rd party material damage
- Summarize claims in excess of authority and submit to manager for approval
- Negotiate settlements, make settlement payments and document all activities in the file
- May assist with file reviews and file audits as needed
- Bachelor's Degree or in-lieu of degree equivalent education, training and work-related experience in any combination of the areas: automobile estimates, collision repair and/or insurance environment
- Possess valid driver licensing and continuing education to keep license current
- Possess solid knowledge of material damage
- Possess 3 years of experience as a material damage estimator either in the insurance industry or the collision repair industry
- Ability to problem solve, resolve conflicts and empathize with customers
- Possess solid knowledge of estimatics software (Mitchell/CCC/Audatex, etc.)
- Possess 5 years of experience as a material damage estimator either in the insurance industry or the collision repair industry
145
Claims Representative Resume Examples & Samples
- Promptly investigate new commercial auto, general liability and product claims
- Review coverage forms and contracts to interpret applicable coverage then communicate the analysis to our customers
- Evaluate the facts and develop and execute plans to resolve bodily injury and property damage claims
- Review medical documentation to determine the value of bodily injury claims
- Document all decisions, correspondence, reports and discussions
- Negotiate the settlement of bodily injury and property damage claims with claimants and their legal counsel
- Pay claims within assigned authority limits
- Interpret coverage and communicate the analysis to our customers
- Present an overview of specific claims to customers and company associates
- Knowledge of insurance policies and coverage, claim payment procedures, insurance regulations and familiarity with medical and legal terminology is preferred
- Previous insurance experience and/or coursework are required
- Analytical skills to review, exercise judgment and evaluate claims to make sound decisions
- Ability to review and interpret complex and detailed documents
- Effective computer and math skills beneficial
146
Claims Representative Resume Examples & Samples
- Daily claim review and accurate entry of required claim data into claims database system same day as receipt of assignment
- Communicate with claimant and any other involved persons within appropriate time frame to obtain any missing information not contained in claim
- Investigate and assess property damage and property loss claims, and review applicable documentation to substantiate value of reported loss
- Complete investigation within 30 days of assignment
- Provide clear, timely verbal and/or composed written communication to all relevant parties
- At least 2 years of property and casualty claims handling experience
147
Member Service Claims Representative Resume Examples & Samples
- Intake calls from ACD queues and adhere to telephone performance requirements for call response times and abandonment rates
- Respond to questions about eligibility, benefits and procedures for accessing behavioral health services
- Perform data entry of specified request
- Educate providers about alternate claims submission & verification services provided by Beacon/CHIPA
- Follow health plan specific contract guidelines
- Attend all department and general staff meetings
- Forward patient and provider complaints per health plan guidelines
- Other administrative duties as assigned by Manager of Member Services
- Resolve complex claims issues from providers and payors
- Knowledge in CPT codes, ICD 9 and ICD 10
- Knowledge in Claims
- Quoting eligibility, verifying both member demographic and provider contracting information
- Proficient knowledge in Medicare and Medical as well as experience working in a call center environment
148
Claims Representative Resume Examples & Samples
- 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 one or 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
149
Claims Representative Associate Resume Examples & Samples
- High School Diploma / GED (or higher) or 10+ years of equivalent working experience
- 1+ years of Customer Service Representative (CSR) experience or 1+ years of experience in an office setting, call center setting or phone support role
- Successful completion of the UnitedHealth Group new hire training and demonstrated proficiency
- Consistent attendance with ability to meet work schedule including the required training period
- Ability to remain focused and productive each day though tasks may be repetitive
150
Non-injury Liability Claims Representative Resume Examples & Samples
- Develop a working knowledge of systems and technology used within the company
- Identify customer needs and work to meet those needs using appropriate customer service skills
- Demonstrate a thorough understanding of the NGIC Insurance brand and ability to exhibit the behaviors
151
Field Claims Representative Resume Examples & Samples
- Minimum of 3 years Homeowners/Property Claims Experience
- Bachelor's degree or 3 years of relevant work experience
- Relevant experience includes Claims or Customer Service experience that required the ability to think critically, problem solve, and effectively communicate verbally and in writing
152
Field Claims Representative Resume Examples & Samples
- Minimum of 3 to 5 years Homeowners/Property Claims Field Experience
- Bachelors degree or equivalent relevant work experience
- The candidate must be capable of working independently to complete inspections of damaged risks, evaluate coverage, compete damage estimates and settle small to moderate losses
- Familiarity with Xactimate is preferred
153
Claims Representative Resume Examples & Samples
- Experience with first party property claims: Personal
- Licensing required: FL Property and Casualty Claims Adjusting License or the licensing requirements for any other State in which work is performed by Company
- Ability to analyze an insurance policy and review an estimate
- Basic MS Windows and Office computer skills especially Microsoft Word/Excel
- Demonstrated skills in using basic office equipment and Microsoft desktop software applications
- Basic knowledge of insurance adjustment processes and requirements
- Ability to communicate clearly and accurately, both verbally and in writing
- Ability to access, organize and maintain information needed in the performance of specific work tasks
- The adjusters need to be licensed, either Agency or self-Appointed
- Multiple State Licenses would be a plus
154
Senior Claims Representative Resume Examples & Samples
- Providing a consistent, positive, and satisfying claims experience for our clients by delivering superior claims service
- Investigating claims by determining applicable policy coverage, evaluating damages, and settling assigned claims. Obtains and analyzes a wide variety of documentation related to the claim (i.e., statements, photos, property estimates, etc.) and draws the proper conclusions for the claim
- Coordinating activities with vendors on property claims to bring claims to a conclusion according to policy provisions
- Initiating first contact with insureds and all relevant parties to gather basic information, obtains recorded statements (when necessary), and explains the overall claims process in accordance to Best Practices
- Maintaining continuous communication with all affected parties regarding each step of the claims process
- Communicating and negotiating with a variety of individuals regarding the evaluation and settlement of claims. This includes insureds, claimants, attorneys, police officers, repair technicians, insurance carriers, and other involved parties
- Referring claims exceeding own personal authority level to management for their review, along with recommendations for handling
- Evaluating and interpreting state-specific policies and laws in each of the states where the organization conducts business
- Developing and utilizing resources to best service policyholders and control claim costs
- Education equivalent to graduation from high school; a college degree in business, insurance or related discipline is preferred
- One or more years as a Claims Representative – CPCU, or the equivalent in related work experience
- Previous claims adjusting experience within the IAA family of companies and previous user experience with Siebel (or similar systems) is preferred
- Possesses good knowledge of policy coverages for the assigned claims type, basic personal computer knowledge with keyboarding proficiency, and knowledge of Microsoft Office Outlook, Word, and Excel
- Demonstrates the ability to handle the more complex claims under less supervision than afforded to Claims Representative – CPCU, demonstrates the ability to deal effectively and empathetically with a wide variety of internal and external contacts, and must be committed to working in a fast-paced, team-oriented environment while meeting production goals required of the position
- Must possess these effective skills and abilities
- College degree in business, insurance, or related discipline
- Previous user experience with Siebel (or similar systems)
155
Claims Representative Resume Examples & Samples
- Primary role will be to process Medical Bills in accordance with Internal Departmental Demands and Goals as set forth by our Client needs
- Professional demeanor
- Works well in a group setting and individually
156
Senior LTC Claims Representative Resume Examples & Samples
- Effectively manage and prioritize a work queue and multiple job responsibilities in a fast-paced environment, frequently with aggressive deadlines
- Able to understand and interpret contract language, complex insurance laws, state legislative laws, disability processes, nursing home licensing and rehabilitative requirements
- Proven excellence in customer service which include: written and oral communication
- Experienced in using Windows applications (e.g. letter writing, spreadsheets, databases)
- Ability to work independently and remotely
- 18 – 24 months of experience in adjudicating ongoing Long Term Care claims
- Demonstrated understanding of single and cumulative medical conditions, including their effect on physical/cognitive function, as well as their prognosis and rehabilitative potential
- Demonstrated experience in making sound business decisions using risk management and quality protocols
157
Senior Claims Representative Resume Examples & Samples
- Must possess good decision-making skills and the ability to persuade and negotiate effectively
- Possess the ability to handle potential conflict effectively and constructively
- Demonstrates good organizational skills, analytical ability, and detail orientation and knowledge of basic math and geometry
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Bodily Injury Claims Representative, Senior Resume Examples & Samples
- Evaluate and adjust claims within limit of authority and summarize claims in excess of authority and submits to manager for approval
- Determine subrogation or fraud potential and refer to Unit when potential exists or handles to conclusion
- May assist in training and development of Claim Representatives or serve as a mentor for claims representatives
- Bachelor's Degree or in-lieu of degree equivalent education, training and work-related experience
- Successfully completes Claim Representative trainee program
- Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine action plan, and rarely requires assistance on complex claims
- Demonstrate thorough understanding of the repair and replacement of property damages, to include mechanical components of a vehicle, and other potential exposures
- Demonstrate the ability to find answers to more complex issues with insurance law
