Claims Resume Sample
Garry Weissnat
965 Collins Groves,
Philadelphia,
PA
+1 (555) 437 4190
Work Experience
Claims Director
07/2017
-
PRESENT
Houston, TX
- Customer status reporting on projects, change requests, defects and new releases
- Work with client to review the upcoming pipeline and prioritize the work on a weekly basis
- Manage customer’s expectations on Xerox’s abilities to deliver by keeping the workload and work priority real
- Work with client and account manager to ensure adequate staffing are aligned with both billable and regular operational work
- Constantly look for the opportunities for improvement in the current process and make a proposal for the customer buy-in and implementation
- Establish and manage an effective client communication with their IT as well as operations organization
- Develop relationship with client to negotiate and influence critical decisions
- Work in team environment with senior IT professionals
Claims
06/2012
-
03/2017
Dallas, TX
- Treat all people right and with respect: Respects everyone’s unique voice and differences and is actively seeking out opportunities to attract, hire and leverage diversity on team
- Deal with ambiguity: Has the skill to lead others through change with professionalism. Manage crisis situations effectively and efficiently
- Manage the client’s expectations (internal and external)
- Ensure that the Claims Division’s strategic approach and procedures are clearly communicated as required and that adherence within the Regions is appropriately monitored and reported on
- Take responsibility for own and team’s continual professional development
- Coordinates activities of unit to meet budget and deadlines and resolves conflicting demands
- Handle various administrative tasks including, but not limited to, file opening and document management
Claims Intern
11/2007
-
12/2011
Phoenix, AZ
- Learn new applications needed and/or enhancement to existing applications using Java, ETL tools, Oracle Database, various UI Frameworks
- Opportunity to collaborate with various teams/groups to achieve the given task
- Learn and apply new ideas, algorithms, and design patterns to solve various real time applications issues
- Analyzes and processes claims by investigating, gathering and obtaining information to make claim determinations
- Conducts interviews with external stakeholders (e.g. physicians, claimants, and/or lawyers) on standard claims
- Makes FML claim determinations
- Negotiates settlement of FML claims up to designated authority level and makes claims payments
- Analyzes claimants coverage contracts to determine payment eligibility is met
- Technical consulting on compliance issues and adherence to procedures and process improvements
Education
University of Phoenix - Chattanooga Campus
2001 - 2006
Bachelor's Degree in Business
Professional Skills
- Strong organizational skills, ability to prioritize, and time management skills
- Excellent verbal, written and interpersonal communications skills, analytical and organizational skills
- Detailed oriented, organized with strong analytical skills, problem solving and negotiating skills
- Excellent oral and written communication skills, including the ability to effectively communicate with internal business clients and outside of the company
- Strong time management skills and ability to prioritize daily assignments
- Outstanding interpersonal skills and the ability to deal effectively with support staff, claims staff, underwriting peers, policyholders and senior management
- Strong people skills, effective at coaching and motivating staff. Serves as a role model in building effective relationships
How to write Claims Resume
Claims role is responsible for interpersonal, analytical, leadership, organizational, customer, claims, technical, organization, business, presentation.
To write great resume for claims job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claims Resume
The section contact information is important in your claims 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 Claims Resume
The section work experience is an essential part of your claims 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 claims responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular claims position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Claims resume experience can include:
- Technical experience includes 7-10 years of claims handling, strong organizational skills, planning and delegation
- Demonstrate the knowledge and skills to deliver effective performance management, communication, relationship building, decision making, and customer service
- Technical experience includes 7 to 10 years of casualty claims handling, strong organizational skills, planning and delegation
- Influence, to interact effectively, and coach others on interacting effectively, with internal or external customers and act with empathy
- Demonstrated effective performance, feedback, and coaching skills
- Demonstrated personal initiative and excellent follow-through skills
Education on a Claims Resume
Make sure to make education a priority on your claims resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claims 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 Claims Resume
When listing skills on your claims 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 claims skills:
- Strong communication skills needed as well as excellent interpersonal skills
- Strong record of results from prior roles. Strong written and communication skills, including ability to facilitate meetings with senior leadership
- Excellent MS Office skills and presentation skills
- Effective communication skills and presentation skills to both staff and management
- Effective organizational skills to accommodate large volume of reference materials combined with time management skills to achieve accessibility to callers
- Strong technical claims knowledge. Experience and demonstrated success in claims adjudication functions, including negotiation skills
List of Typical Experience For a Claims Resume
1
Experience For Claims Director Resume
- Good written, verbal and interpersonal communication skills. Demonstrated ability to effectively communicate with internal and external customers
- Strong interpersonal/people skills, proven record of dependability
- Strong oral and written communication along with good presentation skills
- Strong communication, good planning and analytical skills and of course accuracy and attention to detail
- Strong application skills including Excel, Word, and PowerPoint
- Strong numeracy and literacy skills, including Grade C or above in GCSE Maths and English or equivalent
- Excellent negotiation skills, able to resolve large exposure cases through direct negotiation, mediation or arbitration
2
Experience For Director of Claims Resume
- Solid organizational skills with attention to detail and follow through
- Excellent data entry skills and the ability to multi-task
- Work with a large volume of claims and effectively prioritize the workload
- Strong leadership and management skills
- Clear communicator with excellent interpersonal skills
- Organizational skills – attention to detail, time management, focus on priorities, thoroughness, follow up
- Planning and Organization Skills/Time Management
- Experienced in multi-tasking and prioritizing various tasks being requested by Department staff
3
Experience For Claims Adjudicator Resume
- Effectively plan each audit including audit date range and communicating audit scope to appropriate parties
- Define global talent requirements including skills, training and certifications
- Assess claim volume and staffing needs to identify and effectively address staffing gaps and surplus
- Maintain, effectively communicate and teach a thorough understanding of business vision, strategies and plans for achieving business goals
- Evaluate claims prior to the hearing and obtain settlement authority from the claims adjuster or manager prior to the hearing
- Average to above average keyboarding and PC skills, including familiarity with shortcut key functions
- Average to above average problem-solving and decision making skills
- Strong experience in building reports and providing Data that Supports Department Projects
- Advanced reading, writing, and arithmetic skills required
4
Experience For Director, Claims Resume
- Prior medical billing and coding experience desirable
- Basic reading, writing and mathematic skills
- A demonstrated logical approach to prioritising and problem solving
- Proven record of effective leadership mentoring and training
- Participation in Toastmasters to develop communication and public speaking skills
- Performance and objective skills setting
- Proficient problem solving, time management and organizational skills
- Effectively manage internal and external partner relationships including outsourced & offshored function and call center claim operations
5
Experience For Team Lead, Claims Resume
- Experience in training or equivalent combination of education experience
- A formal on-the-job training program designed to teach basic claim skills, medical knowledge, & procedural processes
- Implement and manage a ‘right resource, with right skills, at right time’ training approach
- Average to above average reading comprehension and communication skills
- Prior dispute resolution experience and training
- Previous experience within Property/ Commercial claims handling experience
6
Experience For Claims Intern Resume
- Highly advanced problem solving skills to continuously improve business outcomes
- Problem solving skills in a customer focused environment
- Experience in insurance or working experience in hospital
- Language skills to include interpreting payor and provider contracts and regulatory documents
- Over 7 years and up to and including 10 years of proven management experience in claims
- A proven track record, 5-10 years experience in the handling of General Liability claims
7
Experience For Director, Claims Qual-lynx Resume
- Critical thinking skills and ability to discover and outline systems related issues independently and within a team to provide resolution to work problems
- Efficiently apply problem-solving and analytical skills
- Can effectively lead change
- Demonstrated experience gathering, interpreting and presenting data from various sources
- Claims experience, preferably medical malpractice, with some management experience
- Leadership and supervisory skills to manage and develop Team Managers and future leaders within the departments
- In management with demonstrated progressive management experience
- Demonstrated ability to build and lead a strong, motivated team
- Customer service skills including phone intensive follow up
8
Experience For Claims Adjustor Resume
- Experience: 5-7 years of claims management experience or similar background in insurance industry
- Polished and professional written and verbal communication skills. The ability to read and write English fluently is required
- Advanced ability to effectively communicate with both business and technology audiences
- Communicate effectively with Executive Leadership
- Proficiency with data entry skills and Microsoft Office products
- Proven track record of effectiveness in a matrixed organization
- Professional Liability experience or the equivalent combination of education and experience required
- Able to communicate effectively and sensitively with vulnerable customers
9
Experience For Claims Processing Specialist Resume
- Coverage/extra contractual litigation experience with experience in insurance industry
- Financial skills, to analyze and evaluate various coverage, liability, exposure and damage issues
- Develop skills to manage national medical management programs
- Effectively utilize the iVOS System to manage all claims electronically
- Demonstrated analytical and technical skill strength
- Demonstrated verbal and written communication skill strength
- Experience in a property and casualty claims department or related experience in an insurance agency as underwriter or assistant
- Identifying process issues which impact on customer experience or indemnity spend and making recommendations to resolve
10
Experience For Claims Team Manager Resume
- Providing direct support to the Customer Service Management team, allowing the team of legal claims administrators to operate with optimum efficiency
- Broad range of leadership competencies, from direction and pace setting to coaching and effective listening
- Strong leadership abilities and capability of maintaining a high level of respect from subordinates through leader mentoring and training
- Demonstrated results with simplifying, automating and innovating complex processes
- Direct experience claim inventory management, capacity planning, transactional processing and reporting
- Competent at claims handling, reserving, settlement, assignment, lean claims filing processes and negotiation experience with vendors for price agreements
List of Typical Skills For a Claims Resume
1
Skills For Claims Director Resume
- It is essential that this individual has a good standard of education with excellent communication skills including letter writing skills and telephone manner
- Excellent organizations skills with the ability to plan, organize and delegate effectively in a fast paced environment
- Good verbal and written English and French communication skills to effectively communicate with internal and external customers/partners and vendors
- Technical experience includes 7 to 10 years of claims handling, strong organizational and time management skills, planning and delegation
- Demonstrates essential business communication/writing skills; effective email management
- Solid organizational skills, ability to manage multiple and often competing priorities
- Effectively handle and resolve consumer complaints and be able to effectively address adjusters who are the source of the complaint
- Demonstrate effective leadership and management skills
- Demonstrates strong written and verbal communication skills; promotes and facilitates free and open communication
2
Skills For Director of Claims Resume
- Strong organizational and time management skills with emphasis on an ability to prioritize
- Prioritizing and organizing team’s workloads, work effectively in the face of ambiguity
- Typing and 10-key skills (40 wpm and 100 spm) and CRT experience
- Demonstrates significant claims handling skills on assigned files incorporating the Claims Adjuster Lead Job Description for claim handling
- Excellent communication skills, including listening, writing and relationship development at all levels of an organization
3
Skills For Claims Adjudicator Resume
- Excellent writing and speaking skills. Ability to deliver clear guidelines to all levels of management, including the MPIE board of directors
- Demonstrates or is working toward core commercial loss scoping and estimating skills
- Demonstrated creative problem solving and critical thinking/decision making skills
- Effective presentation skills, including public speaking
- Demonstrated skills in customer service, mentoring, leadership, organizational, problem-solving, and claims case management required
- Decision making, problem solving, organization, prioritization, verbal, and written skills
- Operate effectively in a fast paced matrix environment managing up, down and cross-functional
4
Skills For Director, Claims Resume
- Demonstrated success in problem solving and organizational skills
- Demonstrated track record of accelerated learning capability to effectively lead
- Accurate keyboarding and strong computer skills with intermediate or better knowledge of Word and Excel
- Excellent communication skills (written and, verbal, presentation, training)
- Strong interpersonal skills and ability to maintain superior working relationships
- Demonstrated leadership behaviors and skills in achieving department objectives and plans
- Effective coaching and delegation skills
5
Skills For Team Lead, Claims Resume
- Proactive and can-do attitude with good analytical and problem-solving skills
- Possess analytical and critical thinking skills; knowledge of medical terms, excellent time management abilities
- Proven experience leading a team, preferably in a claims arena. Commercial Property experience is desirable
- Strong organization skills, planning and delegation
- Strong leadership skills, with ability to make sound decisions based on deductive reasoning
6
Skills For Claims Intern Resume
- Multi-tasking abilities with excellent documentation and follow up skills
- Strong organizational, planning, delegation, communication (oral and written), and interpersonal skills are desired
- Self-starter with excellent problem-solving capabilities, judgment, communication and interpersonal skills
- Time management, prioritization and organizational skills are
- Average to above average organization and prioritization skills
- Manage telephone calls professionally, efficiently and with good communication skills
7
Skills For Director, Claims Qual-lynx Resume
- Effectively organizes and prioritizes daily responsibilities to ensure adherence to standard time frames for all work
- Excellent oral and written communication skills; Ability to communicate with different levels of internal and external customers
- Strong written and verbal communication, presentation, interpersonal, analytical and research skills
- Demonstrated partnership and collaboration skills
- Proven ability to partner effectively with senior management
8
Skills For Claims Adjustor Resume
- Demonstrated experience with independent decision making to include effective problem resolution
- To effectively manage/control the Home team’s tasks and priorities
- Excellent written and verbal communication skills with an ability to handle written and telephone inquiries of a sensitive nature
- Solid PC skills with knowledge of Word and Excel
- Strong communication skills (written and oral) including the ability to influence and negotiate
- Strong client relationship skills and a client centric mindset
- Good customer centric interpersonal skills, and ability to communicate to maintain relationships with our contractors
- Proven skills in staff development and the ability to meet deadlines under pressure
9
Skills For Claims Processing Specialist Resume
- Excellent verbal, written and leadership skills are required
- Good interpersonal communication skills and ability to lead others
- Excellent communication skills at both and executive and process level
- Possess excellent client relation’s skills
- Effective verbal, writing and interpersonal skills
10
Skills For Claims Team Manager Resume
- Demonstrated competency in organizational skills and multi-tasking
- Strong computer skills in, especially with Databases and report crEation
- Strong numeracy and literacy skills to include GCSE Maths and English at Grade C or above (or equivalent)
- Proven ability to work effectively, mentor others, and exercise leadership in a team environment
- Developing decision-making skills
List of Typical Responsibilities For a Claims Resume
1
Responsibilities For Claims Director Resume
- Good decision making skills; good multi-tasking abilities
- Excellent time management, organizational, reading comprehension, analysis, and math skills
- Highly developed skills in negotiating, mediating and/or arbitrating claims
- Sharp analytical skills to help develop better executive and department reporting to help drive result, reduce risk
- Effectively oversee/participate with the management team in employee recruitment to ensure appropriate staffing
- Customer service or data entry experience or closely related experience
- Experience of leading change, and motivating others
- Configuration, claims adjudication, pricing/benefits setup, or contracting experience
2
Responsibilities For Director of Claims Resume
- Proven track record for consistently meeting or exceeding qualitative, as well as any relevant
- Claims processing experience in managed care setting
- Experience in directing/managing regulatory compliance audits
- Strong grasp of technical and operational processes and ways to improve those processes, with an eye on achieving client satisfaction and driving for results
- Capable of balancing competing priorities
- Experience in writing and filing Arbitration contentions through Arbitration Forums or
3
Responsibilities For Claims Adjudicator Resume
- Demonstrates a base understanding of the Marine and Inland Marine classes of business, including the nationwide definition of Inland Marine
- Claims function operating effectiveness and efficiency
- Experience of leading teams in a fast paced operational environment (preferably financial services) to deliver to agreed service levels and KPI’s
- The ability to build and maintain strong working relationships with a variety of customers and stakeholders, both internal and external
- Easily adapts to changing situations requirements or priorities
- Excellent understanding of internal process/procedure/practices
- Commercial experience and shipping knowledge, claims and legal expertise
- Previous experience in shipping industry is an advantage
- Maintians a good working relationship with all PKI employees
4
Responsibilities For Director, Claims Resume
- A thorough knowledge of adjusting principles/standards/insurance policy interpretation through accreditation or related experience
- Work in partnership with defense counsel and field adjusters to bring about a timely cost effective conclusion
- More highly skilled at handling multi-line claims in a specific venue
- Previous management/coaching experience
- Demonstrates leadership ability by encouraging positive behavior and professionalism
- Adaptability to changing work priorities and client demands
- Previous claim processing experience required
5
Responsibilities For Team Lead, Claims Resume
- Determine and resolve workload and assignment issues to ensure effective claims processing, expense management, and claims disposition
- Evaluates the effectiveness of the inventory management processes and recommends ongoing improvement efforts
- Progressive business experience in financial services, either underwriting or claims
- Identify and implement staff development and training need to support an effective succession plan
- Technical experience includes 7 to 10 years of claims handling
- Experience with General and Professional Liability, Healthcare Professional and Workers Compensation lines
- Extensive customer service knowledge and background with the ability to create and deliver exceptional customer experiences
6
Responsibilities For Claims Intern Resume
- Able to multi-task and prioritize in a busy insurance and health care environment
- Delivering targets through developing, leading and managing a high performing team, ensuring productivity, quality and customer service goals are maximised
- Developing and managing teams to deliver against specified targets, including taking action to address performance issues
- Receiving, date stamping, logging and acknowledging new claim submissions
- Monitoring key performance indicators, assessing team performance against targets and implementing improvement plans
- Embedding employee engagement, building robust and ongoing plans to continuously achieve a highly motivated and committed team
- Monitoring Employee’s process accuracy and providing technical feedback and service feedback, working in conjunction with the Leader, in a timely fashion
- Scanning, filing, sending of letters and emails etc
- Training on specialised documentation review resulting in knowledge of all the various product structures we administer in Issuer Services
7
Responsibilities For Director, Claims Qual-lynx Resume
- Processing and adjudicating medical claims
- Limiting exposure through consistent auditing and observations
- Managing and servicing a portfolio of NPE & NPL SME claims
- Managing key claims handling enquiry; coverage determination, quantum analysis and legal liability assessment, where appropriate for complex claims
- Driving continuous improvement practices in an ongoing effort to improve claims services
- Supporting and counseling the claims department about coverage issues, strategies, and coverage positions
- Looking for a hardworking, enthusiastic and flexible person who wants to be a part of a close and professional team
- Assisting in monitoring capitation agreements and hospital services rendered
8
Responsibilities For Claims Adjustor Resume
- Leading projects, implementation, and special engagements; conducts training as necessary
- Driving customer satisfaction and first contact resolution
- Optimising the performance of your team to ensure delivery of KPI
- Auditing a predetermined number of Brokerage Back Office Claim and Check Fraud Detection cases per associate per month
- Auditing a random sample of Brokerage Back Office Claim and Check Detection cases to confirm completeness and accuracy of process
- Performing quality call reviews or other internal audits determined by LOB
- Managing the allocation of claims within the team of adjusters
- Providing a technical referral point for team members and manage performance
- Keeping the Cluster (LOB) Team Manager advised of key Complex loss developments and wider Complex trends
9
Responsibilities For Claims Processing Specialist Resume
- Executing strategic initiatives within their Complex team
- Ensuring claims are accurately assessed and proactively reserved within agreed service levels
- Embedding use of balance scorecard/KPIs within team
- Operating on a holistic, multi-disciplinary risk management platform philosophy, identifies and analyzes critical issues and implements or recommends solutions
- Loading claims onto the system as advised by the Medical Claims Assessors
- Liaising with members, brokers and providers via telephone and email to obtain further information if required for assessment
10
Responsibilities For Claims Team Manager Resume
- Ensuring proper set up or update of benefit groups/codes, provider profiles, contract rates and fee schedules
- Demonstrating the ability to make decisions, takes appropriate action and follows tasks
- Working knowledge of MS-Office and other database program
- Managing complex escalations from business partners
- Earning the preeminent claims designation, the Associate in Claims, from The Institutes
- Develop direct reports by fostering and supporting career development, motivating, engaging and capitalizing on employee strengths
- Responsible for developing training materials as needed based on audits results as well working with the Training Team to update training materials
Related to Claims Resume Samples
Claims Rep Resume Sample
Work Experience
• Has the authority to make payment of assigned claims within prescribed limits, with supervisory review and approval
• Inspects damaged property and vehicles, and determines claims related damage
• Personal contacts are a major part of activity and include policyholders, claim...
Professional Skills
• Experience prior experience as a Claims Ex...
• Proficiency in general computer skills needed
• Claims experience (ICD, Coding, Billing, e...
Claims Specialist Resume Sample
Work Experience
• Coordinate with in-house risk management team on detailed incident investigation and gathering all necessary elements to successfully resolve a claim
• Conduct follow-up investigation as required by complexity or severity of incident
• Determine liability and total value for ...
Professional Skills
• Demonstrated strong verbal and written com...
• Demonstrate strong written and verbal comm...
• Excellent interpersonal skills including s...
Manager, Claims Resume Sample
Work Experience
• Coordinates activities of unit to meet budget and deadlines and resolves conflicting demands
• Lead the work activities of our Risk Management department. Manage the team that handles our general liability, workers’ compensation and property claims
• Deliver on our brand prom...
Professional Skills
• Proven ability to establish and manage key...
• Proven experience of working independently
• Superior analytical skills are needed to a...
Call Resume Sample
Work Experience
• Configuration, setup and maintenance of Genesys routing logic for Chase Toll-Free numbers and Multi-Site Call Routing
• Administration and documentation of the Chase Call Routing Platform (Carrier, Genesys, PBX)
• First Level 24x7 on-call support for call routing issues
...
Professional Skills
• Good communication skills and the ability ...
• Proven ability to work under pressure & pr...
• Excellent communication & writing skills
Document Processing Resume Sample
Work Experience
• Modify and maintain tools to support operations and business process creation using Adobe Acrobat, SharePoint, Excel and Access capabilities
• Monitor and create control reporting to track the performance of system and process integrity, vendors, internal workflows and SLAs
• ...
Professional Skills
• Experience using imaging equipment, a pers...
• Prior loan operations experience in a bank...
• With good leadership and people management...
Enrollment Services Resume Sample
Work Experience
• Serves as principal and first source of information regarding DCE programs and schools for prospective and current students
• Coaches and advises students one-on-one through the inquiry, registration, and admissions process
• Responsible for advising students on enrollment se...
Professional Skills
• Demonstrates effective coaching skills and...
• Superior attention to detail, organizing a...
• Excellent organizational, problem solving,...