Claim Specialist Resume Samples

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Claim Specialists are in charge with reviewing insurance claims and determining whether client claims are covered by insurance policies or not. Our collection of Claim Specialist resume samples reveals job responsibilities such as checking insurance claims, collecting insurance and evidence, making sure filling procedures have been followed, disbursing funds to clients, and consulting with experts in other fields for complex claims. Most resumes in the field focus on skills such as knowledge of claim filling procedures, analytical thinking, decision making, recordkeeping, integrity, and computer competences. Education requirements vary by employer and range from high school diploma to college education.

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1

Customer Service Manager / Insurance Claim Specialist

Resolved customer complaints arising from faulty flooring products and installation issues.

  • Hired and supervised all flooring installation crews.
  • Inspected job sites and documented resolution activity.
  • Filed claims with manufacturers and tracked manufacturer reimbursements.
  • Completed approximately 20 assignments per month from homeowner insurance carriers.
  • Performed site inspections to determine the extent of property damage due to water, fire or vandalism.
  • Completed repair / replacement estimates using the Xactamate program and submitted estimates to the insurance companies.
  • Assisted customers with flooring selections, and arranged repairs / replacements according to the carrier's guidelines.
Candidate Info
31
years in
workforce
10
years
at this job
BS
Science / Business
2

Complex Property Damage Claim Specialist

Oversee claims processing, including law suits, arbitration, and multiple vehicle accidents. Asses, develop, and review cases related to vehicle theft and arson. Command investigations and appropriate action involving arbitration and lienholder interest cases. Collaborate with internal clients to resolve claims with due diligence, effectively establishing and maintaining continually positive working relationships.

  • Achieved Top Third in production of Complex PD Employees.
  • Outstanding customer service, focused on follow through and accountability.
  • Recognized and identified potential fraudulent claims.
  • Resolved coverage questions.
Candidate Info
14
years in
workforce
1
year
at this job
Associate
3

Claim Specialist

  • Successfully resolved all types of property claims within an assigned territory.
  • Performed all 2-story and steep roof inspections for the local claims office with 6 adjusters.
  • Assisted Catastrophe Services Claim Teams where and when needed, providing quick and accurate resolution to large numbers of claims in varying geographic locations.
  • Utilized as a dispute resolution resource resolving differences between policy holders, contractors and insurance company.
Candidate Info
29
years in
workforce
4
years
at this job
BA
Criminal Justice / Sociology
4

Quality Assurance Claim Specialist II

Responsible for identifying potential areas of risk concern regarding claims and escalated them for additional verification or investigation.

  • Researched claims and identified and reported deficiencies, inconsistencies, and/or misrepresentations as required.
  • Provided quality control FNMA and FHLMC claims selected by chase Pipeline Prioritization System and submitted findings to management.
  • Reviewed loan files to ensure all compliances were met regarding investor guidelines, credit quality, and data integrity for investors/clients such as FNMA and FHLMC.
Candidate Info
27
years in
workforce
1
year
at this job
AS
Applied Science
5

Claim Specialist

  • Identified, investigated, evaluated, obtained and utilized critical information required to accurately and objectively adjudicate complex Long Term Care claims
  • Made claim eligibility determinations based on the claimant's contract and other information provided at time of claim, as well as determined the need for additional information to properly determine risk
  • Effectively managed and prioritized a work queue and multiple job responsibilities in a fast-paced environment, frequently with aggressive deadlines
  • Recognized and worked within a structured environment with clearly defined SOP's to ensure consistency of claims practices and resolutions
Candidate Info
31
years in
workforce
2
years
at this job
HS
High School Diploma
AAS
Associate of Applied Science
6

Claim Specialist

Initiate claim negotiations with insureds, claimants, and attorneys. Control adjustment expenses through settlement of first party claims. Apply knowledge of building industry and repair techniques. Provide factual, legal and medical analysis. Comply with governmental/company regulations.

  • Received "National Spirit of State Farm Award" for outstanding leadership and "Remarkable Service Award" for excellence in customer service.
  • Minimized delays by demonstrating scheduling flexibility.
  • Utilized proven customer service skills to provide a simple, caring, and personalized experience to both internal and external customers.
  • Added value with a willingness to assist team members with issues requiring immediate attention.
  • Handled complex claims and acted as a subject-matter expert.
  • Positively engaged with team members and management to share perspective and support of company goals.
  • Established familiarity with many contacts in the industry which enabled efficiency in addressing unique and difficult challenges.
  • Built and leveraged relationships to assist in diligent investigations.
Candidate Info
28
years in
workforce
24
years
at this job
AS
Supervision Technology
BA
Bachelor of Arts
7

Short Term Disability Claim Specialist

  • Promoted to operations disability leave administrator.
  • Efficiently utilized Microsoft excel by importing text file data and create data model, modify pivot table fields, import data from spreadsheets and create customized tables, format spreadsheets, V-look up, create relationships between imported data.
  • Daily demonstrate the ability to provide detailed examination of data, medical documents, claim history from beginning to end as a basis for leading clinical round table discussion.
  • Demonstrated effective verbal and written communication skills interacting with administrators, claimants and providers.
  • Disability claim management certified.
Candidate Info
5
years in
workforce
2
years
at this job
HS
High School Diploma
BS
Business Administration
8

Claim Specialist

  • Processed claims quickly and accurately; Investigated claim issues
  • Made recommendations to management for process improvements
  • Researched issues and obtained proper supporting documentation in a timely manner as requested by the investor
  • Managed application of claim funds received
  • Validated all funds have been received prior to claim being closed
  • Monitored claim process reports to ensure all required responses are filed in time
Candidate Info
3
years in
workforce
1
year
at this job
AS
Business
9

Claim Specialist

Processing/reprocessing claims in a timely matter accurately and effective for doctors and hospitals.

  • Following processing procedures set forth in mentor to provide quality customer service.
  • Researching medical documents for dispute payments, sending medical notes to various medical physicians for approvals/denials on underpayments, overpayment or denials.
  • Provide payment to claims accordingly to the member's benefit plan guidelines along with a letter to the provider, notifying them about their dispute.
Candidate Info
4
years in
workforce
BA
African American Studies
10

Claim Specialist

  • Wrote memos and correspondence for claim handling activities
  • Recommended and negotiated settlement offers
  • Investigated an analyzed client complaints to identify and resolve issues
  • Conducted claim and estimate re-inspections
  • Communicated with injured parties and legal representatives for claim handling
  • Obtained all necessary information to complete proper evaluation
  • Investigated Agent Draft Authority claims, determined losses and reported findings
  • Mentored new claim staff members
  • Reviewed data to verify validity of claims
Candidate Info
8
years in
workforce
5
years
at this job
BA
Communication

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