Insurance Claims Specialist Resume Samples
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Insurance Claims Specialist Resume Samples
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O Rohan
Oceane
Rohan
35406 Lurline Crossing
New York
NY
+1 (555) 178 2571
35406 Lurline Crossing
New York
NY
Phone
p
+1 (555) 178 2571
Experience
Experience
Houston, TX
Insurance Claims Specialist
Houston, TX
Ledner Inc
Houston, TX
Insurance Claims Specialist
- Ensuring that unit’s key performance targets are met
- Taking pro-active steps to effectively manage customer expectations in order to achieve overall customer service proposition
- Produce claims reports and analysis for the Kier captive and for internal use to identify trends and areas for improvement
- Contacting customers and other parties (i.e.employer, claimants, third parties such as medical providers, repair centres, etc.)
- Contribute to improving the performance of the insurance department as a whole by putting forward new ideas
- Provide an advisory claims service including training to insurance reps within Kier and other personnel
- Assist with the recovery of uninsured losses including those within the excess
San Francisco, CA
Insurance Policy & Claims Specialist
San Francisco, CA
Hudson Group
San Francisco, CA
Insurance Policy & Claims Specialist
- Manage claim submissions and provide oversight and guidance to project teams, including the following tasks
- Identify and analyze risks associated with policies with the Risk Manager
- Foster and demonstrates a workplace inclusive of creating opportunity, serving others, building trust, innovation, and exceeding expectations
- Manage insurance policy records and files related to the GHSC-PSM project global supply chain activities
- Develop and maintain claims instructions, guidance documents, and associated tools and templates for the project
- Process new insurance policies, modifications to existing policies and claim forms with various insurance brokers and/or underwriters
- Obtain information from field and project staff to verify the accuracy and completeness of information on claims forms, applications and related documents, and company records
present
Boston, MA
Business Insurance Complex Workers Compensation Technical Claims Specialist
Boston, MA
McGlynn, Strosin and Okuneva
present
Boston, MA
Business Insurance Complex Workers Compensation Technical Claims Specialist
present
- Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management
- Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols
- Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insured
- Establishes and maintains accurate reserves on all assigned files; makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority
- Confers directly with policyholders on coverage and resolution strategy issues
- Demonstrated proficiency in Excel and PowerPoint
- Develop effective working relationships with insurers, adjusters and lawyers
Education
Education
Bachelor’s Degree in Flexibility
Bachelor’s Degree in Flexibility
Loyola Marymount University
Bachelor’s Degree in Flexibility
3 Insurance Claims Specialist resume templates
Read our complete resume writing guides
1
Business Insurance Complex Workers Compensation Technical Claims Specialist Resume Examples & Samples
- Investigate claims to determine whether coverage is provided, establish compensability and verify exposure; resolves claims within authority and makes recommendations regarding case value and resolution strategy to Branch Office Management and HO Examining on cases which exceed authority
- Participates in pricing, reserving and strategy discussions with HO Examining and Examining Management
- Works closely with staff and outside defense counsel in managing litigated files according to established litigation management protocols
- Identifies and appropriately handles suspicious claims and claims with the potential to develop adversely
- Identifies and appropriately handles claims with third party subrogation potential, SIF and MSA exposure
- Establishes and maintains accurate reserves on all assigned files; makes timely reserve recommendations to Branch Office Management and HO Examining on cases which exceed authority
- Prepares for and attends mediation sessions and/or settlement conferences and negotiates on behalf of LMG and LMG Insured
- Demonstrates the ability to understand new and unique exposures and coverage
- Demonstrates the ability to understand key data elements and claims related data analysis
- Confers directly with policyholders on coverage and resolution strategy issues
- Coordinates and participates in training sessions for less experienced staff, including both Complex & non-Complex staff
- Bachelors degree or equivalent business experience required
- 5-7 years of related claims experience with 1-2 years of experience in complex claims
- Demonstrated proficiency in Excel and PowerPoint
- Excellent written and verbal communication skill required
- KY and DE license preferred
2
Insurance Claims Specialist Resume Examples & Samples
- Processes Workers’ Compensation claims via the online system or through the insurance adjuster
- Reviews forms for accuracy and liability
- Follows up with Supervisors on needed information
- Enters information into the system
- Answers WC questions from employees, adjustors, physician offices and Business Partners
- Assists adjuster in closing of the cases
- Processes Vehicle Accidents and General Liability cases via online system or through insurance adjuster
3
Insurance Claims Specialist Resume Examples & Samples
- Customer Service: provide professional and courteous customer service to all customers, including branch customers, policy owners, licensed agents, and branch employees
- Data Entry: Evaluate documents received and enter relevant information into computer system
- Information Gathering: Gather missing information before processing. Document Processing: Evaluate document and determine correct action
- Record Keeping: perform activities to assist with mail opening and record keeping requirements
- Fraud: Identify and report suspected fraudulent activity. Analysis of documents for completion and accuracy. Analysis of customer requests to determine proper course of action
4
Insurance Policy & Claims Specialist Resume Examples & Samples
- Process new insurance policies, modifications to existing policies and claim forms with various insurance brokers and/or underwriters
- Serve as the primary point of contact with insurance brokers. Coordinate meetings, discussions, and negotiations with brokers and project Risk Management and Chemonics and/or project leadership as necessary
- Manage claim submissions and provide oversight and guidance to project teams, including the following tasks
- Process claims and proactively manage individual claims from notification to closure, with the necessary level of involvement required for each claim depending on the claim category, value, and impact on project activities
- Complete claims submission trainings as necessary with broker(s)
- Obtain information from field and project staff to verify the accuracy and completeness of information on claims forms, applications and related documents, and company records
- Preside over claims investigations and track process
- Develop and maintain claims instructions, guidance documents, and associated tools and templates for the project
- Coordinate with project continual improvement teams as applicable given claims history
- Review needs for additional policies or changes to policies and provide recommendations to Risk Manager and GHSC-PSM leadership
- Manage insurance applications, as required, to ensure that all questions have been answered, compiling data on insurance policy changes, managing insurance renewal/termination dates and requirements, and processing insurance cancellations
- Manage insurance policy records and files related to the GHSC-PSM project global supply chain activities
- Identify and analyze risks associated with policies with the Risk Manager
- Review and track subcontract and partner insurance requirements and provide input to Risk Manager said insurance provisions
- Produce reports as required related to claims and coverage. Coordinate with field offices and project teams to ensure receipt of needed monitoring data according to regular schedule
- Represent the PSM project by liaising with the Supply Chain Solutions and other home office divisions related to risk management and insurance coverage for all aspects of project operations, but focusing on the global supply chain
- Foster and demonstrates a workplace inclusive of creating opportunity, serving others, building trust, innovation, and exceeding expectations
- Serve as acting Risk Manager, as needed
- Perform other duties and responsibilities as required
- Minimum 8 years of technically relevant work experience, preferably in insurance, logistics, procurement, finance, and/or operations
- Bachelor’s degree in a related field; alternately ten years or greater of related work experience in lieu of Bachelor’s degree considered
- Demonstrated work history and strong knowledge of the insurance claim process for damaged tangible goods; experience working with pharmaceutical and/or medical cargo helpful
- Ability to interpret insurance policy requirements and advise staff on options forward
- English fluency required; proficiency in a second language preferred
- Knowledge of company’s main client, USAID, and/or international development operations preferred
- Demonstrated ability to communicate clearly and concisely orally and in writing
- Willingness to work overseas for up to 4 to 8 weeks per year; experience living or working in developing countries preferred
- Strong administrative skills, word processing abilities, knowledge of MS Office applications, and attention to detail
- Demonstrated ability to follow standard practices and procedures, receive general instruction and supervision on work progress, and make significant contribution to end results
- Strong organizational and work prioritization skills
- Supervisory experience required
5
Claims Specialist Commercial Insurance Resume Examples & Samples
- Performance-based rewards based on stellar individual and team contributions
- High school diploma or GED, required
- Ability to research and problem solve, using analytical and critical thinking skills
- Healthcare and medical billing/collections experience is preferred
- Intermediate computer proficiency in Microsoft Office including: Word, Excel, and Outlook
- Demonstrated history of resolving challenging issues
- Deeply built values of TEAM!
6
Senior Insurance Claims Specialist Resume Examples & Samples
- Degree qualified or equivalent and/or experience in law, psychology, nursing or other relevant discipline
- Previous experience in same/ similar role in Claims or relevant industry
- Understanding of the NHS, understanding medical conditions, be able to assess and evaluate the claim, handle the claim, know principles of claims assessment, understanding rehabilitation process
- Have to have unwavering customer focus and put the customer at the heart of everything you do!
- A proven ability to lead, motivate and develop individuals to achieve success would be an advantage
7
Health Insurance Services, Claims Specialist Resume Examples & Samples
- Possess strong communication skills: conduct telephone interviews, provide benefits consultation, and upsell claimants where possible to paid services
- Research and identify optimal healthcare insurance options for customers based on needs assessment and plan selection criteria
- Facilitate customer transition to agency partners when possible, or provide healthcare insurance enrollment/disenrollment assistance as appropriate
- Develop an ongoing expertise of Medicare, Marketplace plans, and Medicaid, including coordination of benefits with employer coverage
- Acquire health insurance producer’s license in state of residence within first six months in role
- Be flexible and able to transition between the various Healthcare Insurance Services easily
- Project a calm, confident and empathetic demeanor, especially when assisting high need clients
- Maintain strict confidentiality of customer information, procedural manuals, client/prospect lists, information on new business ventures, and other confidential Allsup information
8
Insurance Claims Specialist Resume Examples & Samples
- Handling and settlement of various insurance claims in a cost effective and timely manner
- Accepting or denying a claim based on all documentation received
- Contacting customers and other parties (i.e.employer, claimants, third parties such as medical providers, repair centres, etc.)
- Utilizing diary system pro-actively resolve outstanding issues and ensure timely processing and closure of claims
- Ensuring that full and relevant data received via telephone, post, fax or e-mail is recorded accurately
- Taking pro-active steps to effectively manage customer expectations in order to achieve overall customer service proposition
- Ensuring that unit’s key performance targets are met
9
Insurance Claims Specialist Resume Examples & Samples
- Actively manage claims to ensure the best possible settlement and protect the captive and the group’s claims experience
- Provide an advisory claims service including training to insurance reps within Kier and other personnel
- Actively participate in claims review meetings to ensure accurate reserves are held and strategies to defend clams are optimised
- Produce claims reports and analysis for the Kier captive and for internal use to identify trends and areas for improvement
- Assist with the recovery of uninsured losses including those within the excess
- Develop effective working relationships with insurers, adjusters and lawyers
- Ensure that legacy claims are dealt with swiftly and efficiently
- Contribute to improving the performance of the insurance department as a whole by putting forward new ideas
- Attend training as required and take responsibility for own self development
- Carry out any other duties commensurate with the role and as deemed suitable by Kier
- Significant experience in commercial insurance claims management
- Associate of the Chartered Insurance Institute
- Knowledge of all classes of general insurance
- Experienced in handling major claims from start to finish including professional indemnity
- Knowledge of construction claims desirable
- Good IT skills – intermediate to advanced knowledge of Microsoft Office packages, especially Excel
- Able to demonstrate drive and self-motivation to achieve results
- Excellent influencing and negotiating skills to achieve desired outcomes
- Can demonstrate a track record of building relationships with insurers, adjusters and lawyers
- Experience of dealing with a captive an advantage
- Able to respond quickly and calmly to unexpected issues
