Claim Adjuster Resume Samples - Page 8

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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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71

Claim Adjuster

Verified validity, analyzed payment and agent liability on claims submitted

  • Participated in peer coaching
  • Implemented all MAGIC training into phone calls with customers, clients, agents, and interoffice personnel
  • Member of a process review initiative that renovated and automated processes in the claims department.
  • Liaison between claims and the IT departments to ensure the new processes were implemented accurately
  • Conceptualized and developed procedures for a paperless work flow
  • Utilized lean thinking to revitalize procedures in the claims department including paperless procedures
  • Participated in developmental training to learn about and utilize customer service oriented skills
Candidate Info
8
years in
workforce
4
years
at this job
72

Agent / Property Claim Adjuster

2000 - Present, The Hartford

  • Perform scoping and estimating in Southwestern United States with an emphasis on residential property claims.
  • Provide assistance and guidance to several independent insurance adjusters related to evaluation of construction specifics and estimating of damages.
  • Provided consulting to independent adjusters for written reports to be presented to insurance carriers.
  • Currently licensed in 17 states.
Candidate Info
21
years in
workforce
14
years
at this job
MA
English
73

Sr. Claim Adjuster for Allstate Insurance

and handled claims in a seven (7) state area. I was primarily responsible for the following:

  • Responding to claims in a timely manner and setting reserves;
  • Obtaining medical records and preparing summary of same;
  • Completing an investigation based upon witness statements and police report;
  • Determining liability based upon comparative negligence laws;
  • Evaluating damages based upon special and general damages obtained;
  • Negotiating claim on behalf of the insured throughout a series of settlement negotiations with plaintiff's attorney and/or mediator; and • Monitoring trial proceedings
Candidate Info
12
years in
workforce
6
years
at this job
C
Paralegal
BA
Bachelor of Arts
Insurance Company
74

Sr. Claim Adjuster

Administers and manages General Liability, Auto Liability for both property damage and personal injury claims along with Product Liability Chemical Exposure such as Benzene claims. Asbestos and Pollution Claims for National Commercial Accounts.

  • Prepares client and excess carrier reports.
  • Handles claims which are in litigation and understands legal concepts of policy and explanation of complex claim settlements.
  • Prepares and presents files for claim reviews and settlement authority.
  • Handle First Party Property Damage and subrogation.
  • Adept in multi-tasking environment requiring prioritization, organization, and sustained follow-through.
  • Conducted outside investigations when necessary/plausible.
  • Have attended or participated in mediations when required.
Candidate Info
36
years in
workforce
3
years
at this job
75

Claim Adjuster

Handle New York and Delaware No Fault Claims
. Review coverage and determine eligibility
. Set up No Fault claim
.Contact claimants and explain coverage
. Monitor claim and follow up with claimants on their treatment
. Identify possible fraud cases and refer to investigating department
. Set up Independent Medical Examinations and Peer Reviews
. Communicate with claimants or attorney
. Completing NF10 forms and sending delay letters
. Calculating wages and mileage
. Issuing payments for wages, mileage, household
assistance and any out of pocket expenses
. Setting upMed Approval with instructions on processing the medical bills for each claim

Medical Bill Examiner

  • Make payments to providers for medical bills relating to auto accidents
  • Review bills and compare to Eob's to ensure all information including ICD9 and CPT codes are correct
  • Customer Service; answering all provider questions regarding medical bills
  • Ensure bills are paid in a timely manner to maintain regulatory compliance Continuously achieve production score
Candidate Info
12
years in
workforce
8
years
at this job
HS
High School Diploma
BS
Accounting And Management Studies
76

Claim Adjuster

Supervisor of first reports department, leading a team of 5-6 employees.

  • In charge of distributing and monitoring the workload of the first reports team.
  • Managing all incoming claims department documents via email and fax.
  • Performing liability investigations per company and industry guidelines.
  • Being observant of fraud indicators.
  • Reviewing estimates.
  • Approving and issuing payments.
Candidate Info
16
years in
workforce
15
years
at this job
BA
Bachelor of Arts
77

PIP Claim Adjuster

Southfield, MI
(currently Sedgwick, previously QBE Insurance 2003-Present

Investigation of first and third party litigated and non-litigated high-risk automobile claims.

  • Maintain Michigan PIP claim files in accordance with the Michigan No-Fault Law including catastrophic claims.
  • Attend depositions, settlement conferences and facilitations.
  • Interact with attorneys, providers, case managers and other top professionals in the field.
  • Communicate with the policyholder to ensure quality customer service.
  • Evaluate third party losses and prepare settlement negotiations.
  • Report to MCCA and re-insurers.
Candidate Info
41
years in
workforce
13
years
at this job
78

Claim Adjuster

Utilized Diamond and Xcelys to process out-of-network providers'
claims at PPO level

  • Interpreted related policies and procedures to ensure Dell's
  • Monitored, analyzed, and updated Dell's compliance actions in reference to new and evolving benefit legislation
  • Served customers ranging from world's largest businesses and public-sector organizations, to small and medium businesses, and
  • Met and exceeded set standard of 85 claim adjustments per day while maintaining 95% accuracy
Candidate Info
6
years in
workforce
4
months
at this job
HS
High School Diploma
79

Casualty Claim Adjuster

  • Handled Auto Liability Claims including Attorney Represented - Gathered and analyzed required data to complete investigations and make informed decisions.
  • Negotiated, settled and closed claims.
  • Determined and informed claimants of final decision on liability.
  • Aggressively Investigate Claims, determined Coverage, and established Liability.
Candidate Info
4
years in
workforce
1
year
at this job
80

Inside Casualty Claim Adjuster (teleworker)

  • Investigated, evaluated and settled low to moderately complex 1st and 3rd party automobile,
  • Completed coverage and liability investigations
  • Managed use of and expense of outside vendors
  • Complied with same day/next day telephone contact in accordance with Best Practices
  • Obtained facts to evaluate coverage, negligence, medical necessity and causation/damages
  • Reassigned claims involving injury to appropriate No Fault/Casualty Claims Departments
  • Identified subrogation opportunities; handled adverse subrogation and arbitration
Candidate Info
5
years in
workforce
1
year
at this job
BA
Bachelor of Arts

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