Claim Adjuster Resume Samples - Page 4

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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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31

Auto Liability Claim Adjuster

Conducted telephone recorded interviews with first party, third party and witnesses.

  • Responsible for negotiation attempts to settle bodily injury claim with the claimant prior to transferring file to Casualty or Litigation Department.
  • Processed and resolved first party personal injury protection and medical payment claims.
  • Negotiated liability negligence percentages with third party claimants and adverse carriers.
  • Processed and resolved first party personal injury protection and medical payment claims.
Candidate Info
4
years in
workforce
1
year
at this job
AS
Business Management
BA
Bachelor of Arts
32

Claim Adjuster

Analyzed and processed hospital, long term care, major medical, and surgical claim inquires for benefit decisions

  • Communicated claim decisions to guarantors and policyholders formal benefit letter i.e. Explanation of Benefits notice
  • Requested claim material from health care providers to render payout decisions
  • Responsible for providing administrative service for departmental supervisor
  • Verified and approved high dollar claims for payment release
Candidate Info
33
years in
workforce
3
years
at this job
33

Claim Adjuster

  • Audited medical bills for correct CPT and ICD-9 coding, initiated independent medical exams/peer reviews, and evaluated the results to ensure appropriate payment and assist in fraud prevention
  • Investigated and processed claims through administration of recorded statements
  • Negotiated with claimants, attorneys and other insurance carriers to regarding settlement
Candidate Info
15
years in
workforce
5
years
at this job
Business Administration
34

No Fault Claim Adjuster

  • Handled arbitrations
  • Investigated insured's accident
  • Reviewed policies
  • Paid medical providers accordingly
  • Handled over 1,000 claims start to closure
  • Promoted three times in recognition of outstanding performance - hired as a secretary, promoted to assistant then adjuster
Candidate Info
4
years in
workforce
4
years
at this job
HS
High School Diploma
AS
Liberal Arts
35

Claim Adjuster

  • Investigated claims against insurance for personal, casualty, property loss and damages
  • Examined claim form and other records to determine insurance coverage
  • Interviewed, telephoned, and corresponded with claimant and witnesses
  • Consulted police and hospital records
  • Trained co-workers in the job
  • Inspected property damage to determine extent of company's liability, varying method of investigation according to type of insurance
  • Prepared report of findings and negotiated settlement with claimant
  • Successfully handled auto claims
Candidate Info
10
years in
workforce
7
years
at this job
AS
Paralegal
36

Claim Adjuster

Investigates claims against insurance or other companies for personal, casualty, or damages and attempts to effect out-of-court settlement with claimant: Examines claim form and other records to determine insurance coverage.

  • Interviews, telephones, or corresponds with claimant and witnesses; consults police and hospital records to determine extent of company's liability, varying method of investigation according to type of insurance.
  • Prepares report of findings and negotiates settlement with claimant.
  • Recommends litigation by legal department when settlement cannot be negotiated.
  • Adjusted claims for Banker's employees, the city of Chicago, fire department and Inland Steel
  • Billed clients, doctor offices and hospitals.
  • Greeted client and/or their families when they entered the lobby often to pick up checks for death benefits
Candidate Info
12
years in
workforce
12
years
at this job
Computer Programming
37

Claim Adjuster

  • Investigated and analyzed polices, endorsements, coverage, facts, liability and damages on all assigned losses to ensure accuracy and timely
  • Managed the work of vendor partners to ensure their work met the company's quality expectations
  • Maintained all mail in a paperless environment, as well as, an active diary and phone calls within the company's standard
  • Obtained and documented information on the circumstances of the loss
  • Set initial reserve and evaluated as facts change; made or recommended
  • Researched, analyzed and interpreted policy language and state laws as needed
Candidate Info
2
years in
workforce
2
years
at this job
Business Administration
38

Claim Adjuster

Dallas, TX 2000 - 2010

Auto Theft and Fire
Handled claims files that involve automobile theft and fires for the United States. Review the insured policy to confirm coverage. Explain the coverage that applies to the claim in question to the insured. Made contact with all parties involved. Investigate the facts of the loss. Assign a field adjuster to inspect the damage vehicle. Recognize if there is potential fraud during the investigation. Concluded claim by payment where warranted.

  • Lead the unit by submitting files to subrogation and collecting > $275 in 2009, in 2008 collected >$354K in 2007 collected >$256K for the department.
  • Met performance standard of 98% Compliance with Good Faith Claim Handling Practices and State DOI Regulations, 98% compliance with TL Best Practices, Rental Guidelines, Policy Provisions, and Secured Proper information such as Lien Holder information, Titles and Power of Attorney.
  • Maintained 100% accuracy for paying state regulated fees in accordance to total loss claim handling. 98% on the overall accuracy for the settlement offer.
  • Effectively managed individual pending with a closing ratio of 95-102% for COLL, COMP & PROP suffixes.
  • Reviewed NICB/ISO reports to check vehicle recovery status and rule out similar reported loss.
  • Confirmed vehicle information with theft affidavit.
  • Referred a total of 367 files to SIU department in 2007, 2008 and 2009.
Candidate Info
42
years in
workforce
10
years
at this job
HS
Diesel Automotive
AS
Associate of Science
39

Claim Adjuster

Balanced ~50 calls per day while medically managing a 200+ organized file inventory

  • Demonstrated leadership skills by assisting peers on time management, follow up issues, claim handling and customer service
  • Translated policy language to customers who were unfamiliar with coverage and benefits
  • Investigated medical treatment/bills to ensure proper services were provided and billed accordingly
  • Expedited medical payment of bills as per NJ State regulations
  • Correspond and established rapport with customers on issues related to medical processing steps, precertification, coverage and deductibles.
  • Recognized for providing exceptional customer service by actively listening to customers and helping them recover from the unexpected
Candidate Info
14
years in
workforce
7
years
at this job
Human Services
40

Claim Adjuster

Investigate first party claims to determine the extent of damages, make approval/denial decisions and negotiate settlements with insured's in accordance with state and policy provisions. Collaborate with insurance agents, underwriters and special investigators to correct errors, rectify omissions and investigate questionable issues.
Outcomes:

  • Resolved more than five thousand claims throughout my tenure. Provided optimal service to policyholders, negotiated fair settlements and identified fraudulent claims.
  • Achieved numerous high percentage contact and closures results relating to 24 hour contact and 30 day closure.
  • Selected by supervisors to resolve complex claim issues; participate in quality control audits; and assist other team members with claim loads.
  • Maintained superior quality ratings in file handling and resolution office goals on a regular basis.
  • Developed a strong understanding of insurance policies and legal issues through hands on claim handling, coupled with in-depth, multi-week claim training.
  • Received In-Synch Nominee Performance Award (2005) and several service awards (2001, 2003, 2004)
Candidate Info
6
years in
workforce
6
years
at this job
Business Administration

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