Claims Representative Resume Samples

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Claims Representatives are intermediaries between insurance companies and customers and assess customer situation to determine if the claim is valid and how much compensation should be given. A lot of research is needed, and Claims Representatives need to gather information from various third parties to determine if the claim can be accepted. The most successful Claim Representative resume samples underline a complex skillset, including research and investigation skills, negotiation abilities, attention to details, and being results-oriented. A high school diploma or even a college degree in business or insurance studies should be showcased in a successful Claim Representative resume.

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1

Claims Representative

Held the highest referral rate on team to Premier Service Provider program in first 6 months

  • Made over 550 outbound calls in January, 59% greater than team average
  • Selected 2013 February Employee of the Month
  • Conducted and investigated claims, interpreted laws and regulations, rendered insurance decisions from onset to closing
Candidate Info
7
years in
workforce
5
years
at this job
BBA
Marketing
2

Claims Representative

Managed the investigation and adjustment of bodily injury and property damage
insurance claims

  • Caseload of up to 227+ files and $2,175,007 in reserves
  • Trained in the use of bio-mechanical (low impact), comparative negligence and injury evaluation techniques and software
  • Led as a Technical Specialist/Team Lead in staff management and training; Participated in the computer system user group and process improvement projects; duties included risk management, large exposure claims, concurrent coverage investigation and initiating a forms library
Candidate Info
25
years in
workforce
11
years
at this job
BS
Journalism
3

Claims Representative

Process life claims up to $50,000, provide customer support to clients. Perform numerous administrative tasks, process medical records, perform investigations as needed.

  • Recognized for consistency of 98% plus, accuracy in claims processing.
  • Took on international claims to relieve the workload of others.
  • Maintained exemplary work record completing work to meet goals to compensate for any variance of schedule.
  • Provided assistance to others as needed assuring goals of department
  • Responded effectively to increased workloads, increasing knowledge and expertise as required while meeting targeted goals.
Candidate Info
12
years in
workforce
4
years
at this job
AS
Medical
BS
Bachelor of Science
4

Claims Representative

Investigated, evaluated, and negotiated settlement of commercial property and casualty insurance
claims. Settled claims both in the field (with a territory) as well as from the office handling several
states. Hired independent adjusters for field inspections when needed. Settlement authority level
varied from $25,000 to $50,000.

  • Conducted agency visits as a territory field adjuster that established rapport and cultivated relationships with agents, resulting in increased business.
  • Consistently received "Green Flag" recognition for receiving top ratings on customer
  • Analyzed policy coverage accurately including from complex commercial property
  • Reported all hazardous and poor property conditions to the risk underwriter who would
  • Reduced claim expenses the past two years during a concerted expense reduction effort by making personal inspections when possible to minimize the use of independent
Candidate Info
39
years in
workforce
15
years
at this job
BBA
Bachelor of Business Administration
5

Claims Representative

Responsible for investigating claims for file recoveries.

  • Handled approximately 100-125 inbound and/or outbound calls daily.
  • Reviewed 1400 files and notified the responsible party.
  • Provided documentation of the damages, costs, and facts.
  • Planned, prioritized, and organized files for attorneys.
  • Reviewed documents, correspondence, and reports.
  • Handled case files and deposition calls.
  • Maintained calendars and prepared and filed pleading packages.
Candidate Info
18
years in
workforce
18
years
at this job
AS
Accounting
BA
Busines Addministration
6

Claims Representative

Prepare insurance claim forms or related documents and reviewed them for completeness.

  • Performed adjustments, invested claims, and provided telephone coverage
  • Transmit claims for payment or further investigation
  • Processed and adjudicated medical claims according to health plan polices
  • Contact insured or other involved persons to obtain missing information
  • Closely coordinated with all departments to ensure smooth day to day operation
Candidate Info
3
years in
workforce
2
years
at this job
HS
High School Diploma
Medical
7

Claims Representative

Handled incoming calls from insured, claimants, attorneys or agents regarding first notice of claims or any other claim related questions.

  • Conducted recorded interviews with insured, claimants and witnesses to determine liability.
  • Addressed diaries, emails and voicemails within company timeframe.
  • Sent correspondence and completed actions to satisfy department of insurance and/ or state specific regulations.
  • Provided efficient and courteous service to internal business partners and external customers concerning investigation and resolution of claims.
Candidate Info
10
years in
workforce
5
years
at this job
Advertising And Marketing Communications
Business Administration
8

Special Claims Representative

Worked as property and casualty claim representative handling auto liability, commercial, and homeowner general liability claims.

  • Evaluated, negotiated and settled bodily injury claims with attorneys or claimants.
  • Assisted in the defense of the Insured on litigated files.
  • Conducted extensive coverage and liability investigations applying relevant state statues and policy language.
  • Responsible for making sound financial decisions that are in the best interest of the company and its clients.
  • Conducted scene investigations in the field.
Candidate Info
15
years in
workforce
11
years
at this job
BS
Communication Arts
9

Claims Representative

Highly productive commercial claims processor that negotiated and adjusted physician and facility
claims to allow proper benefit determinations.

  • Proactively generated solutions to solve complex problems regarding systems issues.
  • Isolated coding discrepancies reducing cost containment measures.
  • Reduced rework and appeals by effective research and analysis.
  • Minimized roadblocks and improved the consumer and provider experience.
  • Re-wrote policy provisions in Standard Operations Procedures (SOPs) to ensure proper eligibility
Candidate Info
8
years in
workforce
3
years
at this job
C
Paralegal Studies
BS
Criminal Justice
10

Claims Representative

Adjusted auto insurance claims for a high volume regional claims office

  • Investigated coverage and liability for non-injury property damage claims, which include multi car accident claims, liability disputes, and commercial vehicle claims
  • Resolved claims in a timely manner, including a majority of total loss claims within 7 days of report
  • Provided a high level of customer service with multiple customer service awards
  • Wrote estimates and negotiated with auto body shops, and monitored vehicle repairs and rental
Candidate Info
12
years in
workforce
8
years
at this job
AA
Arts And Liberal Arts
BA
Communication Studies

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