Claim Representative Resume Sample
Grady Christiansen
374 Torrey Mountain,
Houston,
TX
+1 (555) 865 8013
Work Experience
Senior Claim Representative
10/2017
-
PRESENT
Chicago, IL
- Reserving/Reporting - In accordance with Westfield’s reserving philosophy, establishes and reviews proper reserves for each claim based upon thorough investigation, evaluation, and experience. Completes appropriate reports so that the current status of the claim is clearly documented at all times
- Five or more years worker’s compensation claims adjusting/industry related experience
- Previous experience handling worker’s compensation claims with exposure up to $75,000
- Valid driver’s license and a driving record that conforms to company standards
- Coverage/Investigation/Liability - Determines whether or not proper coverage exists for the type of claim assigned. Investigates thoroughly to obtain relevant facts concerning all aspects of the claim, such as coverage, liability, legal climate, potential exposure, and damages, and makes decisions, where appropriate, on claim resolution. Monitors ongoing case development for appropriateness
- Auto claims adjusting/industry related experience
- Previous experience handling auto claims with exposure up to $25,000
- Holds (or has ability to obtain) and maintains appropriate adjuster licensing and certification(s) in assigned territories
- Advanced proficiency in liability
Claim Representative
07/2012
-
07/2017
Detroit, MI
- Advanced proficiency in cargo damage assessment
- Advanced negotiation & settlement skills
- Interact with Senior Leadership Team, business partners and agents
- Excellent verbal and written communication skills, as well as customer service skills
- Establish the physical damage claims value of assigned losses. Prepare and document accurate home damage appraisals, Actual Cash and Replacement Value according to applicable regulatory and corporate guidelines
- Serve as “the face of The Hartford” as we deliver on the insurance promise and make a difference in our customers’ lives
- Achieve targeted performance goals to manage costs and support The Hartford’s industry-leading operational claims standards
- Willingness to learn, lead, be led, support your teammates, have fun and work hard in our Workers’ Compensation department
- Conducting electronic and telephone investigations along with assigning field appraisers/adjusters to assist with investigations
Liability Claim Representative
08/2007
-
02/2012
Detroit, MI
- Gathering and evaluating coverage information, taking recorded statements, police reports, repair estimates and other related documents
- Determining coverage and liability
- Evaluating property damage and bodily injury
- Negotiating and settling liability claims
- Attending vehicle inspections, depositions, trials and settlement conferences
- Manage the process for vendor assignment specific to engineers, CPA’s, salvors, etc. as needed per guidelines. Manage these vendors to ensure they meet FEMA guidelines
- Handles incoming calls and correspondence from insured’s, agents, mortgage companies and public adjusters regarding questions or problems associated with claims as well as internal staff
Education
Keiser University - Sarasota Campus
2002 - 2006
Bachelor's Degree in Business Administration
Professional Skills
- Demonstrates strong written, verbal and effective listening skills
- Excellent skills in planning and organizing
- Strong analytical and critical thinking ability with a desire to develop negotiation and conflict resolution skills
- Strong written, verbal and listening skills; and
- Strong critical, analytical and investigative skills
- Excellent computer and line of business technical software skills required
- Detail orientated and strong organizational skills
How to write Claim Representative Resume
Claim Representative role is responsible for customer, negotiation, training, listening, software, organization, analytical, travel, credit, litigation.
To write great resume for claim representative job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claim Representative Resume
The section contact information is important in your claim representative resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Claim Representative Resume
The section work experience is an essential part of your claim representative resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous claim representative responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular claim representative position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Claim Representative resume experience can include:
- 12 months of experience in current Long Term Care claims role or 3+ months of experience making Long Term Care claim payments
- Evaluates and negotiates the resolution of claims within authority levels while mitigating damages to achieve cost effective claims outcomes
- Experience handling casualty claims
- Experience handling high-exposure commercial P&C claims
- Significant experience working with Microsoft Office applications and electronic claim files is required
- Experience handling commercial general liability claims. Multi-line adjusters are encouraged to apply
Education on a Claim Representative Resume
Make sure to make education a priority on your claim representative resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claim representative experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Claim Representative Resume
When listing skills on your claim representative resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical claim representative skills:
- Strong analytical skills evaluating large amounts of information and drawing appropriate conclusions
- Demonstrates excellent judgment in the evaluation and handling of claims
- Effectively partnering with coverage and defense counsel
- 18 months of experience in Long Term Care claims or 3+ months of experience making Long Term Care claim payments
- Possess functional knowledge and skills that are reflective of fully competent claims professional
- Obtaining and reviewing evidence, reports, and medical records
List of Typical Experience For a Claim Representative Resume
1
Experience For Senior Claim Representative Resume
- Demonstrate a passion for providing exceptional customer service
- Conducting electronic and telephone investigations along with assigning field appraisers to assist with investigations
- Commit to learning and developing, including a better understanding of Hartford products and business lines, both as an individual and as part of the group
- Responsible for the investigation and file management of claims as well as assisting other claim professionals and our
- Effects settlements and reserves within prescribed time limits and submits recommendations to management on cases exceeding personal authority
- Investigates, evaluates, and resolves claims of varying complexity and severity
2
Experience For Claim Representative APD Resume
- Take ownership to ensure we go above and beyond to service each caller's needs, using every touch point as an opportunity to build value and The Hartford brand
- Serve as “the face of The Hartford” as we deliver on the insurance promise and make a difference
- Identify potential coverage issues and refer claims to senior leader as needed, determine liability and damages of all exposures related to the claim and document findings of investigation
- Experienced in using Windows applications and other office technology (e.g. letter writing, spreadsheets, databases, Outlook, video and audio conferencing, phone systems, etc.)
- Able to be flexible and open to change and quickly adapt when change is implemented
- Investigates and maintains commercial general liability, property and auto claims. Reviews and evaluates coverage and/or liability. Secures necessary information (i.e., reports, policies, appraisals, releases, statements or other documents) in the investigation of claims
- Works toward the resolution of claims files, and attends arbitrations, mediations or trials as necessary
- Investigates and maintains workers’ compensation claims. Reviews and evaluates coverage and/or liability. Secures necessary information (i.e., reports, policies, appraisals, releases, statements or other documents) in the investigation of claims
3
Experience For Liability Claim Representative Resume
- Investigate, evaluate, and resolve claims (litigated & non-litigated claims)
- Attend mediations, arbitrations, depositions, and trials as necessary
- Report to management, Corporate Claims, and others, as required
- Respond to inquiries from underwriters and producers
- Possible travel for vehicle inspections, depositions, trials and settlement conferences
- Investigates and handles casualty claims. Reviews and evaluates coverage and damages. Secures and analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records or other documents) in the investigation of claims
4
Experience For Associate Claim Representative Resume
- Investigates and handles claims. Reviews and evaluates coverage and damages. Secures and analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records or other documents) in the investigation of claims
- Monitors and facilitates medical treatment to ensure appropriate, cost-effective, quality care
- Secures and analyzes necessary information (i.e., expert reports, policies, appraisals, releases, statements) to properly investigate claims
- Conveys moderately complex information such as coverage determinations, liability decisions, and case outcomes, to all appropriate parties, while maintaining a professional demeanor
- Conveys complex information (coverage, decisions, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations
- Manage outside vendors and legal counsel, as necessary
- Investigates and maintains claims. Reviews and evaluates coverage and / or liability. Secures and analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, reports or other documents) in the investigation of claims
- Investigates claims. Reviews and evaluates coverage and / or liability. Secures and analyzes necessary information (i.e., policies, appraisals, releases, statements, reports or other documents) in the investigation of claims
- Handle a high volume of personal lines claims which include the investigation, adjudication and file management as well as assisting other claim professionals and our policy holders with multiple facets of the claims process
5
Experience For Senior Flood Claim Representative Resume
- Licensing is required. The licensing portion is conducted during the first two weeks of training
- Reviews and evaluates coverage, compensability and / or liability
- Service claims of various complexity
- The employee is frequently required to stand, use hands to finger, handle or feel; stoop, kneel, crouch or crawl around vehicles in all kinds of weather
- Secures necessary information (i.e., reports, credit or financial reports, bond forms, agreements, releases, statements or other documents) to assist in the investigation of claims
- Retains and directs approved consultants and outside counsel. Responsible for managing litigation, including budget development, maintaining cost controls, overseeing the work of outside counsel, and development of litigation strategy in consultation with counsel
- Establishes and maintains timely and appropriate loss reserves and expense budgets
6
Experience For Claim Representative Auto Bodily Injury Resume
- Acquires and maintains applicable adjuster licenses in all states where required
- Investigates primarily 3rd party property damage, 3rd party bodily injury and occasionally 1st injury claims
- Reviews and evaluates coverage and/or liability
- Secures necessary information (i.e., reports, policies, appraisals, releases, statements, or other documents) in the investigation of claims
- Works toward the resolution of claim files
- Works within specific limits and authority on assignments of simple to moderate complexity
- Manage and control independent adjusters, experts, and outside counsel as necessary
7
Experience For Senior WC Claim Representative Resume
- Appropriate adjuster licensing and continued professional development is essential. The AIC, CPCU, SCLA, and other insurance related designations are highly regarded
- Investigates and maintains commercial property claims
- Continued professional development is required
- Works toward the resolution of claims files, and attends arbitrations, mediations, settlement conferences or trials as necessary
- Investigates and maintains workers' compensation claims
8
Experience For Material Damage Telephone Claim Representative Resume
- Evaluate investigation results and make determination as to extent of company’s liability, if any
- Negotiate and resolve claims in a fair and equitable manner, within designated authority level, in compliance with company’s settlement practices, policies and procedures and conferring with management for any recommended settlement outside authority level
- Responsible for Litigation management
- Verification of coverage and its application to the specific loss
- Investigation of coverage, liability and damages
- Investigative activities to include written and oral statements
- Investigate and resolve property claims
- Provide service to policyholders in response to notice of loss. Service includes prompt contact, investigation, coverage and liability analysis, damage verification, estimating, negotiation and timely settlement
- Work onsite in Aurora office
9
Experience For Senior Service Center Property Claim Representative Resume
- Investigates and directly handles liability claims
- Works toward the resolution of claims and attends arbitrations, mediations, dispositions or trials as necessary
- Audits third party administrators (TPAs) or pool’s in-house claims files
- Investigate and maintain commercial auto and general liability claims
- Investigates and handles property claims. Reviews and evaluates coverage and damages. Secures and analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records or other documents) in the investigation of claims. Demonstrates excellent judgment in the evaluation and handling of claims
- Drafts coverage position letters with moderate supervision
- Manages litigation; attends mediations, arbitrations, depositions, and trials as necessary
- Sets reserves within prescribed authority and submits written recommendations for reserves outside authority
- Responds to inquiries from underwriters and producers
10
Experience For Catastrophe Claim Representative Resume
- Reviews claims; confirms and evaluates coverage
- Contact appraisers and act as a liaison between shops and claims
- Monitors, controls and negotiates claim settlements with insureds and body shops
- Ensures that reserves and payments are issued in a timely and accurate manner
- Investigates and evaluates recovery potential. Performs recovery activities as needed
- Knowledge of commonly used insurance coverages, concepts and practices
List of Typical Skills For a Claim Representative Resume
1
Skills For Senior Claim Representative Resume
- Utilize organizational and communication skills to have effective resolution of assignments, manage claim deadlines, and appropriately manage vendors
- Strong organization / time management / conflict resolution skills
- Strong skills in customer service, verbal and written communications, and the use of technology
- Proficient typing/computer skills
- Bodily injury claims experience and advanced coverage analysis experience is required
2
Skills For Claim Representative APD Resume
- Experience in using Windows applications (e.g. letter writing, spreadsheets, databases)
- Commercial transportation or trucking liability claims handling experience is desired
- Claim handling experience
- Effective ability to manage a high volume of claims in a fast-paced environment using dual monitors and multiple programs
- 18 – 24 months of experience in adjudicating claims
- Property claims handling experience. Multi-line adjusters are encouraged to apply
- Valid driver’s license with a level of financial responsibility required by the Club in an acceptable motor vehicle driving record required
- Min of 1 year experience handling Property Claims
3
Skills For Liability Claim Representative Resume
- Automobile claims handling experience required
- 6 months to 5 years of experience handling commercial general liability claims. Multi-line adjusters are encouraged to apply
- Multi-task, prioritize a diverse workload and maintain timely follow up/responses
- Negotiate skillfully in challenging situations with internal and external groups
- Casualty claims handling experience
- Desire to assume significant responsibility and work in a fast-paced, multiple priority environment
- Demonstrate ability to influence outcomes
- A proven knowledge of medical terminology, anatomy and physiology, disease processes, medications and interpretation of lab results
- Proven engaged excellence in customer service which include: written and oral communication
4
Skills For Associate Claim Representative Resume
- Proven ability to manage a desktop of high volume, fast paced work
- 6 months to 3 years of related experience
- Demonstrated negotiation aptitude
- Negotiation experience required
- Significant litigation management and negotiation experience required
- Experience in physical damage claim investigation and evaluation
5
Skills For Senior Flood Claim Representative Resume
- Interpreting medical reports, reviewing medical billing, evaluating claim value and managing claims process to ensure efficient resolution
- Providing high quality customer service by responding to and researching and resolving customer inquiries related to fraud claims
- Drafting coverage position letters including reservation of rights and declination letters
- Instructing, monitoring and coordination of outside adjusters and vendors
- Setting appropriate reserves within personal authority and making recommendations for reserves in excess of authority
- Adjusting license required in one or more of the following jurisdictions: NY, NJ, CT, MA, PA, NH, VT, ME, RI and or DE
- Interacting with customers via correspondence and telephone to determine the source of the claim and correcting errors
- Investigating losses and identifing coverage issues
- Assuming handling of injury claims and work to conclusion
6
Skills For Claim Representative Auto Bodily Injury Resume
- Obtaining all official reports from State and Federal government sources
- Identifying third party contribution and recovery opportunity
- Maintaining timely, professional documentation of claim activity
- Traveling up to 20% of the time
- Taking statements from insureds, claimants, and witnesses
- Negotiating settlements with claimants and claimant’s attorneys
- Estimating cost of treatment or compensation for those injured in accidents
- Negotiating with claimants and attorneys to settle bodily injury (BI) claims
7
Skills For Senior WC Claim Representative Resume
- Obtain the required property and casualty licensing. The licensing portion is conducted during the first two weeks of paid training
- Maintains necessary adjuster licenses, including completing required continuing education
- Develops a basic understanding of the insurance industry and the organizational relationships of the company such as Policy Ops and Marketing
- The Hartford provides training and pays for the cost to obtain and maintain state licensing
- Reviews and analyzes coverage and liability; including issuing coverage and liability correspondence
- Complies with applicable company procedures and policies, statutes, regulations, and other legal requirements governing claims handling
- Principles and concepts for providing customer service
8
Skills For Material Damage Telephone Claim Representative Resume
- Develop an understanding of the types of policies written by the company
- Continued Education and maintenance of licensing
- Investigate employee and third party accidents and injuries with the objective of resolving claims when appropriate without attorney involvement
- Work M-F, between the hours of 8am - 6pm (Working an 8 hour shift)
- Properly assess the indemnity and expense exposure, along with settling total loss claims in line with state jurisdictions
9
Skills For Senior Service Center Property Claim Representative Resume
- Documents and maintains all systems and manual records necessary for proper claim handling
- Conveys information (coverage, recommendations, decisions, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations
- Willingness to cross train in multiple lines and become licensed in all states requiring an adjuster’s license is a necessity
- Successful completion of required licensing exams
- Continued professional development and licensing is required. The AIC, CPCU, SCLA, and other insurance related designations are highly regarded
- Verification and evaluation of damages, while properly managing expense
- Communication of loss prevention information to appropriate underwriting personnel
- Proficient with interpreting coverage on standard ISO personal auto and homeowner’s policies
- Manage conflict during difficult or emotional situations
10
Skills For Catastrophe Claim Representative Resume
- Willingness to travel, including overnight travel as needed, is required
- Conveys complex information to all appropriate parties, maintaining a professional demeanor in all situations
- Coordinates the claims material damage direct repair program including vendor/shop selection
- Services the claim needs of our customers, including insureds, claimants, agents and other Great American personnel in a prompt and courteous manner
- Convey moderately complex information (coverage, decisions, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations
- Identify relevant information and understand it’s impact
- Properly document investigation findings in accordance with internal and external laws and procedures
- Investigates the facts of loss, determines and verifies coverage and liability, evaluates settlement value and settlement options and negotiates material damage claims at the direction of manager and/or mentor. Claims involved are subject to standardized procedures which lead to a settlement with limited exercise of discretion
List of Typical Responsibilities For a Claim Representative Resume
1
Responsibilities For Senior Claim Representative Resume
- Operate in team environment
- Customer Service and Fair/ prompt processing of claims
- Continued professional development of our employees is required
- Confirms and evaluates coverage and/or liability on low to medium exposure cases. Secures and analyzes necessary information (i.e. expert reports, policies, appraisals, releases, statement, and other necessary documentation) in the investigation of claims
- Investigate and maintain claim files
- Review and evaluate coverage and / or liability
- Secure and analyze necessary information (i.e., reports, policies, appraisals, releases, statements, reports or other documents) in the investigation of claims
- Work toward the resolution of claim files
- Ensure claim payments are issued in a timely and accurate manner
2
Responsibilities For Claim Representative APD Resume
- Ensure claim handling is conducted in compliance with applicable statutes, regulations and other legal requirements and that all applicable company procedures and policies are followed; and
- Investigates and maintains casualty, primarily commercial auto claims, and some general liability. Reviews and evaluates coverage and/or liability. Secures necessary information (i.e., reports, policies, appraisals, releases, statements or other documents) in the investigation of claims
- Familiarity with relevant terminology
- The position has not specific start date at this time
- Typically the work schedule falls between regular business hours
- Plan, recommend, reserve and execute the investigation, control, valuation and final disposition of small to medium dollar total loss (majority) with the occasional high end or specialty vehicle total loss
- Support other team members to enhance overall team productivity
3
Responsibilities For Liability Claim Representative Resume
- Use active listening and critical thinking skills to quickly analyze and clearly understand a specific request or customer need, and then leverage the knowledge and resources to provide solutions
- Act as a liaison with other departments to resolve problems
- Utilize active listening and critical thinking skills to quickly analyze and clearly understand a specific request or customer need, and then leverage knowledge and resources to provide the appropriate solutions
- Take ownership to ensure that we go above and beyond to service each caller's needs, utilizing every touch point as an opportunity to build value and The Hartford brand
- Operate under the mindset of The Hartfords Behaviors: Deliver Outcomes, Operate as a Team Player, Build Strong Partnerships and Strive for Excellence
4
Responsibilities For Associate Claim Representative Resume
- Studies and successfully completes the Claims Training Program
- Develop technical and jurisdictional expertise, including knowledge of independent adjusters, contractors, vendors, etc
- Act as a liaison with other departments to revolve problems
- In-depth knowledge of products, services, terminology, procedures and systems related
- Build Strong Partnerships – Establish and maintain strong relationships with customers, and other business partners. Build credibility and gain trust while operating with integrity
- Deliver Outcomes - Achieve results in support of The Hartford’s industry-leading claims standards
- Learn and Grow – Receive technical training to master your role, and develop leadership competencies to build a career
- Investigate Claim Facts – Investigate and manage claim files
- Provide high-quality customer service consistently
5
Responsibilities For Senior Flood Claim Representative Resume
- Properly assess the exposure of assigned claims
- Set appropriate and timely file reserves
- Identify and properly manage mitigation, subrogation, salvage and other recovery opportunities
- Identify fraud indicators and initiate investigation
- Always demonstrate professionalism and establish credibility when interacting with customers; personally enhance The Hartford’s reputation in the marketplace
- Development and implementation of claim handling strategy
- Consistent adherence to claim handling protocols
6
Responsibilities For Claim Representative Auto Bodily Injury Resume
- Team work measured by standards of performance for department
- Exhibit professional behavior
- Licenses required TX, OK, NM, CO
- Licenses required TX, OK, NM
- At The Hartford, our compensation philosophy is simple: we pay competitive base salaries and reward performance
- The position is scheduled to begin in June 2018
7
Responsibilities For Senior WC Claim Representative Resume
- Timely and documented work
- Communications are professional and courteous
- Work Product-Proficient with coverages for all product lines and regulations
- Knowledge of Microsoft Office products and telephone protocol
- Deal with problems in a variety of circumstances
8
Responsibilities For Material Damage Telephone Claim Representative Resume
- Coordinate case handling closely with Health Services staff to implement aggressive and comprehensive medical case management, rehabilitation, and work hardening programs to meet the objective of returning injured employees to gainful employment
- Identify and preserve evidence from investigations and claims to prevent spoliation actions and ensure/protect appropriate facts for a proper defense of litigation
- Negotiate settlement of claims within limits of authority or with authority granted by supervisor. Drafts and prepares settlement release and other required settlement documents for approval. Effects collection of monies due to company as the result of accidents
- Confer on a regular basis with department managers to assess status of cases and current department objectives and goals, with periodic review of all activities
- Recommend strategies for the negotiation of claim settlements
- Counsel defense and prosecution attorneys contracted to defend the company in personal injury and property damage lawsuits brought for, or against, the company
9
Responsibilities For Senior Service Center Property Claim Representative Resume
- Represents the company in court in injury and damage suits
- Authorize medical payments for injured employees to providers upon determination of the correlation of the treatment to the injury
- Coordinate with internal CP witnesses and defense attorneys in preparation of claims and/or participates in pre-trial negotiations to minimize costs and settlements
- Responsible for maintaining and growing a relationship between NGIC and current policyholders. Also responsible for focusing on the needs of loss participants. Identifies customer needs and works to meet those needs using appropriate customer service skills
- Develop a basic understanding and knowledge of state laws and regulations applicable to claims handled, including state unfair claim practice laws, and exhibit the basic ability to apply these laws and regulations as it relates to handling of material damage claims assigned
10
Responsibilities For Catastrophe Claim Representative Resume
- Evaluates settlement value and settlement options and summarizes findings and action plan and submits to manager for approval
- Makes appropriate contacts to discuss a settlement or disposition of PIP and / or Med Pay claims; extends an offer to appropriate party; documents all file activity and payments. Payment information in file notes clearly outlining basis for settlement
- Determines subrogation or fraud potential and makes referral to appropriate claim unit for further handling
- Performs other projects and assignments as directed by manager
- Interpret and evaluate medical reports to determine if applicable to claim; medical billings and investigates for proper charges and pays accordingly
- Build rapport and provide support to local agents
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