Claims Specialist Resume Samples

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Claims Specialists usually work in the medical field and are responsible for reviewing insurance claims. Main job duties seen on a Claims Specialist resume sample are examining insurance claims, collecting and analyzing patient data, making sure that filling procedures have been completed correctly, and eventually approving or denying claims based on their findings. A well-written example resumes for Claims Specialist should mention skills such as knowledge of claim filling procedures, confidentiality, attention to details, effective communication, time management, integrity, and computer competences. Some employers require college education to Claims Specialists, while others are satisfied with a high school diploma.

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1

Claims Specialist

  • Assisted claim adjusters by timely and accurately recording and processing over 500 property damage claims per month
  • Provided on-going customer support for dealers and customers, resulting in increased satisfaction and retention
  • Supported internal insurance agents by managing telephone inquiries, processing outbound mail, maintaining customer records, and administering to customer and dealer requests
  • Tracked and maintained theft histories and recoveries, resulting in 1M annual recovery proceeds of stolen equipment
Candidate Info
13
years in
workforce
7
months
at this job
AS
Information & Office Technology
BS
Psychology
2

Claims Specialist

Audited claims in NextGen database, ensuring that claims were processed correctly according to state guidelines

  • Assisted adjusters in making expense payments on EagleView invoices
  • Conducted outbound calls to customers to recover overpayment and resolve duplicate payments; processed PCR reports in NextGen to make sure the claims were properly handled
  • Researched unpaid and duplicate payments made to EagleView, identified situations where claims need to be paid or refunded
Candidate Info
3
years in
workforce
7
months
at this job
Computer Science
3

Claims Specialist

  • Administered a high volume of NY No-Fault claim files by utilizing daily diary systems to prepare and release all state mandated forms and letters.
  • Recognized the potential of possible fraudulent claims; submitting to the special investigations unit with close monitoring.
  • Analyzed bills for authorization of delay, denial or payment; opening reserves on the file to reflect the extent of injuries.
  • Negotiated and prepared claim files for arbitrations, suits, summons defense.
  • Calculated loss wages and essential services while keeping current on the NY No-Fault Fee Schedule, CPT book and ICD-9 coding specific guidelines.
  • Handled heavy volume of phone calls from medical providers and attorneys' offices; maintaining constant communication with the injured parties throughout the life of the No-Fault claim.
  • Ordered, reviewed police reports, DMV checks and CIB reports; resolved and defended billing allowances and reductions.
Candidate Info
11
years in
workforce
3
years
at this job
BS
Business Administration
4

Claims Specialist

  • Streamlined insurance processes and introduced process improvements to enhanced productivity
  • Served as a team leader to provide procedural direction and guidance to new team members
  • Achieved success assisting clients face to face, over the phone and electronically to resolve questions and concerns while explaining products and services to help settle property claims
  • Developed new business opportunities through target marketing and maintaining strong relationships
Candidate Info
4
years in
workforce
3
years
at this job
BS
Chemistry
MA
Insurance Management
5

Intermediate Claims Specialist

  • Set up an average of 85 reported life and health insurance claims per day.
  • Generated daily status letters to beneficiaries, concluding with claims forms obtained on 90% of pending claims, within 6 months of claim notice.
  • Trained and mentored two claim specialists.
  • Administered departmental outlook mailbox and acted on claims documentation within a business day.
  • Responded to internal and external customer service requests.
Candidate Info
19
years in
workforce
3
years
at this job
BBA
Finance And Marketing
6

Claims Specialist

  • Diligently assessed customer problems and created claim resolutions
  • Effectively improved customer retention by issuing credits on damaged orders
  • Thoroughly provided customers with detailed information on their claims by referencing the terms of use and the policy information
  • Independently made claim decisions within authority based on the information given by the customer
Candidate Info
6
years in
workforce
3
months
at this job
HS
High School Diploma
7

Claims Specialist

  • Received claims (workers' compensation, commercial property, auto, and liability) and prioritized their urgency by analyzing case information.
  • Developed process for state form filings, reducing compliance fines and increasing accuracy.
  • Interpreted individual state regulations in order to determine what filings needed to be submitted and what benefits were owed; contacted other departments and / or state agencies as required.
  • Utilized time management skills to ensure that all filings and requests from individual state agencies were completed in the allotted time frames.
Candidate Info
2
years in
workforce
2
years
at this job
HS
National
8

Claims Specialist

  • Conducted prompt and thorough investigations of bodily injury auto insurance claims.
  • Analyzed claims to determine the extent of Company's liability, make approval or denial decisions and negotiate fair settlements with claimants in accordance with policy provisions.
  • Provided optimum service to policyholders and claimants.
  • Established and maintained high level of positive working relationships with internal and external customers, ensuring satisfaction with company services.
  • Recognized for supporting company, business unit, and department's vision and mission.
  • Excelled at oral and written communication; time management.
Candidate Info
27
years in
workforce
24
years
at this job
BA
Sociology
9

Claims Specialist III

Performed managerial duties in the absence of the PIP manager. Evaluated policy coverage and processed payments for medical and commercial Personal Injury Protection claims. Reviewed and approved medical necessity requests. Recommend lifetime
reserves for catastrophic claims. Researched medical information and referred claims for PEER review.

  • Created training manual for processing commercial PIP claims.
  • Trained new employees hired into the unit and reviewed their work output.
  • Developed and suggested new procedures to enhance workflow with the team.
Candidate Info
25
years in
workforce
8
years
at this job
Medical
10

Claims Specialist II

  • Conducted one-on-one and classroom training sessions for new and existing employees
  • Reviewed and analyzed policy language and supporting documentation in order to accurately adjudicate accident claims
  • Adhered to HIPAA guidelines and privacy rules while consistently exceeding quality and production metrics
  • Provided guidance to internal and external customers through verbal and written communication
  • Routinely assisted with hospital indemnity claim processing
Candidate Info
9
years in
workforce
3
years
at this job
BA
Leadership And Professional Communication

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