Claim Adjuster Resume Samples - Page 3

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A Claim Adjuster investigates insurance claims by interviewing both the claimant and the witness, analyzing police and hospital records, and inspecting property damage to determine how liable the company is for the claim. Sample Claim Adjuster resumes will include such skills as multi-tasking involving liability investigations, research, phone calls, e-mails and faxes in a fast-paced environment, and identifying and investigating suspicious claims. Typically, Claim Adjuster resumes will include a four-year degree in a business-related field, as far as an educational background is concerned.

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21

Workers Compensation Claim Adjuster - Licensed

  • Interviewed all parties involved in the initial reporting of a workers' compensation claim.
  • Investigated claim reports to determine compensability
  • Ensured data accuracy and timely processing while adhering to legislature regulations/laws and company rules/policies.
  • Researched and maintained files through legal proceedings to ensure timely processing of all bills associated with a claim.
  • Research and assign medical codes according to incidents to ensure Medicare compliance.
Candidate Info
10
years in
workforce
1
year
at this job
HS
High School Diploma
BA
Bachelor of Arts
Paralegal Studies
22

Auto Damage Claim Adjuster

Confirmed and investigated coverage for auto accident, vehicle theft, and vehicle fire claims.

  • Investigated and determined liability for multiple vehicle accidents.
  • Managed the vehicle repair process by payment of appraisals, supplements, and monitoring the rental exposure.
  • Referred files appropriately based on suspicious facts of loss, damages, or where subrogation potential was evident.
Candidate Info
7
years in
workforce
3
years
at this job
Bsba
23

Claim Adjuster III

Was responsible for investigating, negotiating and settling large sized Homeowners claims.

  • Created documentation process which clearly layout claims involving damaged structural and personal property using pertinent information gathered.
  • Complied closely with Department of Insurance Regulation reaching one of the lowest violation rates in the company.
  • Consistent leader in customer service score using patience and sympathy to provide professional responses when speaking to a wide variety of people in various stages of expectation.
  • Proactively reached out to insured to keep them informed with claim process and addressed any concerns with consideration to reduce their stress level.
  • Coordinated with vendors and reviewed structure repair estimates.
  • Determined when to investigate potential fraudulent claims and prepare for subrogation.
  • Managed catastrophic losses and after hour emergency situation.
  • Handled California and out of State claims including Texas, New Hampshire, New Mexico, Maine, Pennsylvania, and Hawaii.
Candidate Info
15
years in
workforce
11
years
at this job
Criminal Justice
24

Senior Claim Adjuster

  • Successfully managed large caseload of disability claims for the State of Michigan Long Term Disability Income Replacement Plan.
  • Provided contractual, medical and financial analysis in a timely and accurate manner.
  • Calculated benefit payments and overpayments.
  • Communicated effectively with policyholders, legislators, claimants, vendors and the medical community.
Candidate Info
18
years in
workforce
6
years
at this job
AS
Life & Health Insurance
Employee Benefits
Life & Health Insurance/ Human Resources Management Speciality
25

MATERIAL DAMAGE CLAIM ADJUSTER (trainee)

Developed a strong understanding of insurance policies and claims procedures through multi-week training.

  • Conducts coverage and liability investigations for automobile claims in compliance with state law and company policy.
  • Utilizes many different avenues to obtain necessary documentation and investigation information.
  • Coordinates with field staff, body shops, specialized departments, and claimant carrier representatives to achieve efficient and positive claim outcomes.
  • Consistently exceeds metric goals while maintaining a workload of 60-100 claims.
  • Primarily handles New York and Michigan claims. Secondary states include Pennsylvania, Ohio, Indiana, and Oregon.
Candidate Info
5
years in
workforce
2
years
at this job
BS
Integrated Language Arts Education
26

Claims - Liability Claim Adjuster, Property Claim Adjuster and Claim Examiner

Conducted interviews/recorded statements of insured, claimants, fire and police personnel, cause and origin experts, and witnesses; Investigated property damage and bodily injury claims to determine extent, cause of loss, and liability/exposure

  • Negotiated settlement with 1st party property owners/insured and 3rd party claimants within authority
  • Confirmed coverage and full understanding of insurance contract/policy and their exclusions
  • Prepared written reports of findings for claims manager, attorneys, general manager
  • Attend litigation hearings, settlement conferences, case evaluation
  • Prepared correspondence for Appeal Committee and Large Loss Committee
Candidate Info
27
years in
workforce
15
years
at this job
HS
High School Diploma
27

Claim Adjuster

  • As an entry level claim adjuster, trained and handled both first and third party property, liability and auto claims.
  • Assigned and managed independent adjusters and appraisers.
  • Drafted and resolved binding arbitration cases.
  • Worked with SIU in resolving fraudulent claims.
Candidate Info
6
years in
workforce
2
years
at this job
BS
Philosophy
Insurance
28

Claim Adjuster

Initiates claims review or appeals as indicated on assigned explanations of benefits with various medical insurance.

  • Worked the Epic systems and completed 25-35 claims per hour and did exceed my goals and expectations while saving the company a lot of man hours.
  • Worked and covered other departments while employees were out sick.
  • Follow up on all pending claims.
Candidate Info
17
years in
workforce
8
years
at this job
HS
High School Diploma
C
Telecommunications
29

Claim Adjuster

Examine and process automotive warranty claims filed by the customer from the initial filing to completion. Process includes matching the customer to the correct vehicle, logging required parts, providing labor estimates from the repair facilities, also setting up the claim for payment to the repair facilities.

  • Assesment of expenses and confirmation of policy compliance.
  • Promoted from customer service to claims adjuster
  • Consistently exceeds daily phone requirements, statistics and yearly reviews.
  • Assists customers effectively by solving customer disputes
  • Made payments to repair facilities after the approval of the claim.
  • Assisted in the loss and prevention department for review of specific claims and repair facilities.
Candidate Info
20
years in
workforce
13
years
at this job
HS
High School Diploma
30

Customer Service Agent/claim Adjuster

Provided prompt, accurate and courteous replies to written and telephone inquiries relating to medical benefits and coding

  • Assisted members with Spending Accounts(FSA, HAS)
  • Reviewed medical policies with providers to ensure proper coding
  • Adjusted bodily injury claims
  • Assisted with reviewing records to determine primacy of coverage
Candidate Info
4
years in
workforce
2
years
at this job
BS
Bachelor of Science
Environmental Science

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