Claims Adjuster Resume Samples

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Claims Adjusters make sure an insurer fulfills the promise made at the moment when the policy was sold. Key responsibilities listed on Claims Adjuster resume examples include investigating the claim, protecting insurer assets, noticing the insurer on the loss, checking insurance policy validity, liaising between the two parties, and resolving the claim. A well-written resume sample for Claims Adjusters highlights qualifications such as insurance claims expertise, excellent communication and negotiation skills, computer competencies, report writing skills, and detail orientation. Most Claims Adjusters hold a college degree in a business-related field.

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1

Service Advocate IV / Claims Adjuster

Utilize Corporate Medical Clearance Application (CMCA) to verify clearances for referrals, pre-certification, or prior approvals

  • Examine claim details to confirm applicable fees
  • Diligently research newly diagnosed illnesses and chronic conditions
  • Analyzed secondary payer claims
  • Exceeded departmental production and quality standard by servicing inquiries efficiently in a time sensitive manner
  • Per CMS guidelines verified claims payment, rejection, denial and the status of checks
  • Secured all necessary data and initiated corrective action as appropriate when an inquiry requires additional action (e.g., review, delayed processing, fraud).
  • Educated providers on Government guidelines for Medicare billing
Candidate Info
10
years in
workforce
4
years
at this job
AA
Associate of Arts
2

Workers Compensation Claims Adjuster

  • Process and adjust medical only workers' compensation claims within multiple jurisdictions.
  • Provided relationships with the claimant, insured, defense attorney as well as other professionals working within the claims arena.
  • Processed payments and state filings on claims within compliance of the workers compensation laws. Directed claimant toward necessary treatment and to follow all items involved to be in compliance with the state statutes.
  • Worked directly under the Claims Examiner.
Candidate Info
2
years in
workforce
2
years
at this job
3

Claims Adjuster/ Examiner

Plan, recommend and set reserves accurately and in a timely manner, execute the investigation, valuation, disposition and settlement of claims.

  • Properly assess the indemnity, achieve fair, equitable and timely claim dispositions.
  • Accurately determine and resolve coverage and compensability issues.
  • Review Photographs and written or audio taped statements. Take full audio detailed recorded statements. Conducted preliminary review of legal and vendor invoices.
  • Obtained underwriting files as needed.
  • Organized and maintained claim files.
  • Completed closed file checklist activities.
  • Prepared files for Audits.
  • Use services of experts and Origin and Cause investigators
Candidate Info
12
years in
workforce
4
years
at this job
BA
English Lit
Paralegal Studies
Insurance Adjuster Independent Adjuster
4

Claims Adjuster - Auto Liability Claims

  • Conducted investigations into auto liability claims, including analyzing data to determine extent of company's liability for loss and damages.
  • Led settlement negotiations with claimants, establishing mutually beneficial and satisfactory terms.
  • Communicated with medical professionals, law enforcement, witnesses, and claimants, drafting comprehensive records of interviews and statements for claims analysis.
  • Performed calculations of benefit payments and approved claims within monetary limits and guidelines.
Candidate Info
12
years in
workforce
2
years
at this job
BBA
Business Administration
5

Claims Adjuster

Responsible for McDonald's Corporate Account investigating claims, reviewing medical records, and bills to determine liability

  • Received "Exceeds Expectations" on past two yearly reviews
  • Maintain a 1:1 closing ratio with a pending of 180 cases
  • Negotiate with attorneys to resolve claims
  • Responsible for the training of new employees
  • Promoted from trainee to Claims Adjuster in less than two years.
  • Adjusters license in 47 states
Candidate Info
7
years in
workforce
3
years
at this job
BS
Management
6

Associate Claims Adjuster

Provide claims customer service via telephone and internet to members and third-party customers

  • Maintain up to date knowledge of Property & Casualty insurance products, services, and processes to include Property & Casualty insurance policy contracts and coverages
  • Investigate details of claims to make accurate and informed liability decisions
  • Connect with all new claim contacts with-in first 24 hours to meet [company name] business goals
  • Review claims appraisal documents to ensure accuracy & issue payments
  • Secure informative recorded statements from all parties involved and document within e-files while on the telephone
  • Offer customers information regarding the various products and services available at [company name]
  • Appointed SURGE team member -SURGE team members are responsible for supporting team member workload surges to meet business goals and performance metrics and assist team members to resolve questions
Candidate Info
3
years in
workforce
2
years
at this job
AA
Mathematics
7

Claims Adjuster

  • Responsible for all aspects of the claims process. Made liability decisions, issued payments, and managed injuries.
  • Maintained a high level of customer service in a fast paced setting.
  • Consistently achieved time related goals pertaining to claims handling and closure.
Candidate Info
5
years in
workforce
3
years
at this job
BS
Marketing
Cosmetology
8

Material Damage Claims Adjuster

Investigate facts of loss, determine and verify coverage/liability, evaluate settlement value and settlement options and negotiate material damage claims.

  • Balance daily activities that are set to follow up on pending claims and handle new claims as they are presented in a fast pace environment.
  • Analyze each claim deciding how to move the file forward in an efficient manner.
  • Maintain a relationship between the company and the policyholders and make sure that they understand the coverage's that are provided to them on their policy. Identify loss participants needs and work to meet those needs using appropriate customer service skills.
  • Understand state laws and regulations and apply that understanding to the claims handling process.
  • Determine subrogation or fraud potential and make referrals to the appropriate unit for further handling.
Candidate Info
8
years in
workforce
1
year
at this job
AA
Associate of Arts
BS
Recreation And Parks Management
9

Medicare Claims Adjuster (bilingual)

  • Planned, developed and administered health information system for health care facility.
  • Supervised staff in preparing for daily functions
  • Coordinated medical care evaluation with medical staff and developed criteria and methods for such evaluation.
  • Analyzed patient data for reimbursement, facility planning, quality of patient care, and risk management.
Candidate Info
5
years in
workforce
5
years
at this job
HS
High School Diploma
10

Claims Adjuster

  • Within approved limits, applies claims settlement procedures to process claims, initiate claim payment process and close files assigned by Auto Claim Management and/or electronic assignment
  • Communicates with team members, business partners, and external customers which may require contact by telephone, by correspondence or in person to assist in processing claims
  • Uses various electronic resources for claim processing
  • Licensed adjuster in 9 states (SC, VT, TX, DE, NH, OK, WY and CT)
Candidate Info
5
years in
workforce
3
years
at this job
Business Administration

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