Claim Adjuster Resume Samples - Page 5

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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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41

Senior Claim Adjuster/manager

Manage, Investigate, evaluate, reserve, negotiate and settle assigned bodily injury claims in accordance with best practices.

  • Provide quality claim handling and superior customer service on assigned claims.
  • Reduced indemnity & expense ratios by 18%.
  • Promptly managed claims by completing essential functions including contacts, investigation, damages development, evaluation, reserving, litigation management and disposition.
  • Managed a team of subrogation representatives.
  • Managed team metrics driving revenue collections which exceeded goal by 78%
Candidate Info
17
years in
workforce
10
years
at this job
MBA
Business Management
42

Claim Adjuster

[company name]/ Hanover Insurance Windsor, CT
Claim Adjuster- Commercial Lines 8/2012- current

  • Investigated and resolved first and third party automobile claims for Commercial lines book of business.
  • Handled No Fault (PIP) claims for New York , New Jersey and Pennsylvania
  • Evaluated and settled bodily injury claims.
  • Interacted with insured, agents, claimants, attorneys, appraisers and auto body shops to settle claims appropriately.
  • Determined subrogation opportunities and pursued recoveries
Candidate Info
20
years in
workforce
2
years
at this job
43

Property Claim Adjuster

  • Field Adjuster. Defined and controlled scope of damage, determined cost of repair and approved settlement.
  • Residential concentration with some commercial accounts.
  • Successfully served on approximately a dozen CAT tours, including Hurricane Katrina. Tours for damages ranging from hurricane, hail and flood.
  • Collaborate with Underwriting to sell the product.
  • Great success was achieved by amicably resolving claims with high-end customers as illustrated by a 92% survey rating.
Candidate Info
10
years in
workforce
5
years
at this job
AS
Liberal Arts
BA
Political Science
44

Claim Adjuster

Personal Injury Protection / Medical Bill Payments (PIP/Med Pay)
Thoroughly reviewed all medical records, damage information and loss facts to determine injury causation and identify related and non-related injuries or conditions. Identified any pre-existing and/or subsequent medical injuries of conditions and assess their impact on the overall injury claim. Reviewed any applicable medical resources to assist in decision making and support for the evaluation of the insured medical records (IME-Internal Medical Exam). Complete a Decision Point medical bill review audit of the medical bills and treatment.

  • Identified any pre-existing and/or subsequent medical injuries or condition.
  • Confirmed patient's prognosis and treatment plan and compare to actual treatment.
  • Identified inconsistencies or indications of potential abuse regarding the treatment of patient.
  • Thoroughly documented the results of the treatment, damage investigation and evaluation.
  • Ensured the customer/Claimant is kept adequately informed, receives a clear explanation 96%.
  • Insured claimant contact 100%.
  • Complied with Good Faith Claim Handling Best Practices and DOI regulation 100%.
Candidate Info
32
years in
workforce
2
years
at this job
HS
Diesel Automotive
AS
Associate of Science
45

Senior Bilingual Customer Care Representative, Casualty Claim Adjuster

Tenacious focus on customer needs/concerns to provide excellent customer service in English and Spanish

  • Knowledge and translation of policy language
  • Creation of and participation in mentorship program
  • Participation in multiple internal engagement office committees
  • Investigated and analyzed evidence to determine liability
  • Negotiated injury settlements and claim processes with customers, claimants and attorneys for the mutual benefit of all involved parties
  • Legal Principles Claim Specialist designation by American Educational Institute, Inc
  • Organized and maintained manageable file inventory
Candidate Info
11
years in
workforce
8
years
at this job
BA
Spanish
BA
History
46

Claim Adjuster Assistant

All Lines Adjuster Lic. #1753888)
New York

  • Worked as a clerical assistant during Hurricane Sandy in the field Oct.-Dec 2012
  • Made initial and follow up phone calls, scheduled appointments, answered customer questions
  • Accompanied the adjuster to appointments and participated in assessing damages, scoping properties
  • Created reports and recommendations to supply insurance companies with accurate damage assessment
Candidate Info
10
years in
workforce
3
months
at this job
Education
47

Medical Claim Adjuster

  • 4 years experience as medical claims adjuster.
  • Processed medical claims, referrals and customer escalations.
  • Maintained first level contact via telephone with customers throughout claim process.
  • Responsible for claims verification process necessary for determining customer benefits along with claim mitigation procedures and customer support during mitigation process.
  • Conducted prompt and thorough investigations, evaluated facts, interpreted laws and regulations, and rendered determinations, including compensability and medical determinations.
  • Consulted with accountants, architects, construction workers, engineers, and lawyers in the evaluation of a claim. Continuously analyzed case facts and monitored activities in order to identify possible fraud and/or abuse, and/or third party liability throughout the course of the claim.
  • Considered the relative costs and benefits of potential actions to choose the most appropriate one. Resolved legal issues that could be handled without the use of a defense attorney. Negotiated with the claimant to settle the claim.
Candidate Info
21
years in
workforce
8
years
at this job
HS
High School Diploma
48

Auto Physical Damage Claim Adjuster

Responsibilities: Conduct fact-based investigations to finalize legal liability for single to multivehicle accidents. Analyze and negotiate percentages of liability with other insurance carriers. Ensure compliance with state statutes and regulations. Manage a large quantity of accident claims through self-motivation and organized multi-tasking.
.

  • Awarded each year for outstanding customer service at HIG's annual awards luncheon.
  • Developed claim macros and tools that improved efficiency and reduced process variances.
  • Served on HIG's Indianapolis Work Environment Committee.
  • Recognized for bringing resolution to difficult files while retaining customer loyalty.
Candidate Info
11
years in
workforce
6
years
at this job
BA
Communication Studies
49

Property Claim Adjuster

Evaluated and assessed claims from initial report to settlement

  • Compiled claim file, conducted research, and maintained timely updates to files
  • Assigned and dispatched outside adjusters, vendors, and contractors
  • Ordered and requested legal documents from insured and police reports from law enforcement
  • Completed claim handling in accordance with the insurance regulation laws and state specific laws including but not limited to licensed states.
  • Processed, drafted, and issued settlement payments to insured's', vendors, contractors, and claimants'
  • Mailed settlement payments with drafted letter and claim summary documents.
Candidate Info
22
years in
workforce
21
years
at this job
HS
Medical Billing And Coding
Medical Billing And Coding
50

Claim Adjuster I

Carmel, IN 2/2004-7/2013
Division of CNO Services, L.L.C., providing products and services in heart/stroke, cancer, accidental injury and Medicare supplemental insurance for individuals.
Claim Adjuster I
Processed and authorized payment of individual health insurance claims up to the authorization limit, specifically claims arising from heart disease, heart attack or stroke, including, but not limited to, the following:

  • Interpreted the provisions of various types of health insurance policies to determine whether benefits may be paid on claims as submitted.
  • Initiated investigations on contestable or unusually large claims to determine the validity of all expenses submitted for reimbursement.
  • Demonstrated working knowledge of Microsoft Word, Excel and Outlook as applicable in the claims area.
Candidate Info
59
years in
workforce
10
years
at this job
BA
Biology And German
MA
German Language And Literature

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