Claims Examiner Resume Samples - Page 3

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Claims Examiners contribute to the final decision on covering losses from accident or illness. Key activities mentioned on a Claims Examiner resume are preventing insurer financial loss, assessing insurance claim validity, reviewing investigator findings, checking documentation, and making sure company guidelines are being followed. Based on our collection of resume samples, the ideal candidate should demonstrate insurance claim expertise, attention to details, strong communication abilities, report writing skills, and computer competencies. Most Claim Examiners hold a Bachelor's Degree in a legal or business related field.

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21

Claims Examiner

Claims Examiner

  • I am currently working a minor property damage claims desk for a national account specializing in Home Improvement retail.
  • I investigate each claim through initial contacts, documentation and evidence that is available. If liability is determined, appropriate reserves are set and settlement is issued.
  • First party claims are investigated and set to a subrogation department for recovery.
  • Product claims are tendered to the manufacturer.
  • Installed sales claims are tendered to the subcontractors insurance carrier and payments are coordinated with the other carrier.
  • I have also worked on a fast track property claims team working to quickly resolve minor property damage claims while delivering customer service.
Candidate Info
15
years in
workforce
10
years
at this job
Liberal Arts
22

Claims Examiner

  • Participated in the transition of over 5,000 open workers' compensation claims transferring from one TPA to Frank Gates.
  • Responsibilities encompassed specialization in initial claim investigations, identification of subrogation issues, oversight of surveillance and overall management of claims practices and reserving policies.
  • Attended multiple Serious Case Reviews to specifically address legal issues and staff aggressive plans of action.
  • Responsible for ongoing management of appropriate claims reserving and constant communication with nationwide account related financial issues impacting loss ratios.
  • Participated in the implementation of MPN Network and roll out with multiple facilities.
  • Worked diligently the on-site nurse case managers to strictly enforce ACOEM guidelines.
  • Member of 2 investigation teams, which included development of a litigation plan, taking recorded statements, identifying subrogation issues, and management of subrosa and investigations.
  • Worked closely with attorneys, vocational rehabilitation counselors, underwriters, bill review representatives, and nurse case managers.
  • Assisted in training and was appointed to several committees for the educational expansion of employees and employers.
Candidate Info
6
years in
workforce
3
years
at this job
Workers Compensation
Workers Compensation (ce Current Through 2017)
Education
23

Claims Examiner

Administers all Medicare UB claims adjudication processed in accordance with contractual guidelines along with [company name] guidelines.

  • Retrieve Medicare UB claims in accordance with departmental guidelines and adjudicate based on contractual guidelines wile applying all relevant policies and procedure.
  • Research pended Medicare UB claims in accordance with departmental policies and procedures.
  • Determine payment or denial of Medicare UB claims while applying appropriate codes as necessary for denied claims.
  • Maintain production and quality goals.
Candidate Info
14
years in
workforce
2
years
at this job
BS
Information Management
24

Workers' Compensation Claims Examiner

Responsible for management of up to 120 claims for dedicated unit

  • Coordinated management requirements with client guidelines
  • Management claimant benefits and issued required benefit notices
  • Resolved litigated and in pro per claims and resolved liens
Candidate Info
9
years in
workforce
7
years
at this job
BA
History
25

Claims Examiner

Process general, product, and auto liability claims for all Masco business units

  • Work closely with the Business Unit Financial personnel managing their claims and risk
  • Delegate and supervise the investigation of all assigned claims
  • Review insurance policies for coverage determination
  • Communicate effectively with claimants, insurance companies, and attorneys
  • Negotiate settlement of all assigned claims
Candidate Info
18
years in
workforce
14
years
at this job
BS
Business Administration
26

Claims Examiner

  • Review policy file to determine correct beneficiary and establish available death benefit options.
  • Analyze completed claim forms, and other documents submitted with claim such as death certificates, letters testamentary and determine when claim is available for payment, in compliance with policy provisions, state and federal regulations.
  • Maintain working knowledge of claim practices, policies and procedures.
  • Identify and escalate complex related claims and research items to Claims Risk Management team for further handling.
  • Developed and implemented Quality Assurance metrics for Annuity Claims Department.
Candidate Info
3
years in
workforce
1
year
at this job
BA
Liberal Studies, Pre-law
MA
Master of Arts
27

Claims Examiner

Preparing Medicare beneficiary documents for Qualified Independent Contractor evaluation

  • Keying paper insurance claims for verification
  • Evaluating and correcting on-line Medicare claim errors
  • Accessing and applying on-line instructions for the proper resolution of claims suspensions
  • Manually pricing and adjudicating suspended claims
Candidate Info
7
years in
workforce
4
years
at this job
BA
Psychology
28

Claims Examiner

Process complex Medicare, Medicaid & private insurance claims

  • Investigate and code member submitted claims
  • Investigate DME claims up to 5 years back
  • Resolve pending claims & process adjustments
  • Knowledge of ICD-9 codes and CPT Modifiers
  • Contact providers office for additional information
Candidate Info
7
years in
workforce
10
months
at this job
AS
Arts
29

Claims Examiner

Validate claims based on claim department workflows

  • Monitor claims based on compliance regulation and timeframes
  • Perform manual data entry of claims with appropriate information as required
  • Maintain quality and productivity standards as set by management
  • Review the rejected claim file received from vendors to determine appropriate course of action
  • Assist Supervisor in monitoring claim turnaround time (TAT)
  • Responsible for sending misrouted claims to the appropriate group within 10 (ten) business days
  • Update and prepare reports for management team as assigned
Candidate Info
13
years in
workforce
2
years
at this job
30

Claims Examiner

  • Familiar with standard concepts, practices, and procedures within a particular field.
  • Examines claims material to ensure insurance coverage and validity.
  • Has contact with agents, claimants, and policy holders.
  • Reviews, evaluates and processes disability insurance claims according to procedure and practice.
  • Examines claims material to ensure insurance coverage and validity.
Candidate Info
8
years in
workforce
2
years
at this job
BS
Bachelor of Science

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