Claims Consultant Resume Sample
Albin Sipes
2140 VonRueden Cliff,
San Francisco,
CA
+1 (555) 704 4628
Work Experience
Senior Claims Consultant
11/2015
-
PRESENT
Detroit, MI
- Insurance claims management experience, with a heavy focus on Property & Casualty (P&C) claims
- General familiarity with handling high volume of work
- Confer with client and broker to tailor the policy language and program design to meet the client’s needs
- Monitor the performance of clients’ insurer/TPA claim services
- Working knowledge of major lines of liability insurance coverage
- Working knowledge of Workers’ Compensation coverage and cost containment practices
- Knowledge of laws, legal codes, procedures and processes involving insurance and insurance claims
Claims Consultant
04/2012
-
09/2015
Chicago, IL
- Licenses/Designations: State licensing where required. Successful completion of required/applicable claims certification training/classes
- Experience in best practices or business process improvement; demonstrated project management skills; excellent interpersonal and written communication skills
- Familiarity with state and government regulations which relate to the Claims Department
- Demonstrated ability to deliver high caliber customer claim service
- Advanced listening and negotiation skills
- Advanced knowledge and attention to detail in insurance coverage and contracts, investigating mid- level to severe claims, as well as setting timely and accurate reserves
- A personal commitment to superior performance that adds value to our company
- The ability to multi-task along with strong time management and organizational skills
- Experience in Disability Claims assessment and ongoing claim management including rehabilitation
Assistant Claims Consultant
09/2005
-
12/2011
Dallas, TX
- Advocating for clients to protect their interests in the claims process
- Obtaining claims details, triaging and reporting claims to insurers
- Guiding clients on preparing their claim
- Discussing policy coverage on behalf of Aon clients
- Handling administration of claims to include following up on settlements/claim status, remitting settlements to clients and handling all necessary correspondence
- Monitoring large losses, attending loss sites and assisting clients in positive resolution of claims
- Preparing claims reports for clients and annual loss history reports as required
- Discussing aspects of coverage with insured and insurance company
Education
Duke University
2000 - 2005
Bachelor's Degree in Insurance
Professional Skills
- Strong communication, teambuilding, and collaboration skills; ability to prioritize effectively
- Excellent time management skills as well as organization skills
- Excellent interpersonal and strong negotiating skills
- Strong customer service, diplomacy, negotiation, and relationship-building skills
- Possesses excellent knowledge of coverage and analytical skills in policy interpretation
- Strong communication skills - both verbal & written, as well as effective time management and organizational practices
- Good computer skills with proficiency in email, word processing and spreadsheet software as well as working knowledge of presentation software
How to write Claims Consultant Resume
Claims Consultant role is responsible for customer, interpersonal, organizational, software, insurance, negotiation, word, training, retail, litigation.
To write great resume for claims consultant job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claims Consultant Resume
The section contact information is important in your claims consultant 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 Consultant Resume
The section work experience is an essential part of your claims consultant 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 consultant 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 consultant position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Claims Consultant resume experience can include:
- Strong communication negotiation and presentation skills. Ability to effectively interact with all levels of CNA's internal and external business partners
- Proven experience in the evaluation of the accuracy of property and casualty claim reserving practices
- Significant computer skills, including, but not limited to, Microsoft Office Suite to include: Excel, Word and PowerPoint
- Exceptional customer service skills and enjoy working in a team environment
- Effectively present to clients and prospective clients your claims expertise
- Previous proven track record of technical /large loss claims handling experience in liability claims
Education on a Claims Consultant Resume
Make sure to make education a priority on your claims consultant resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claims consultant 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 Consultant Resume
When listing skills on your claims consultant 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 consultant skills:
- Excellent influencing, negotiation, presentation and communication skills
- Excellent verbal and written communication in order to convey information effectively
- Excellent customer service skills and a high attention to detail
- Strong time-management skills and the ability to work on many projects at once
- Good interpersonal skills and the ability to develop and maintain relationships with internal and external business partners
- Proven experience interpreting and applying the Code of Practice and other relevant legislation and regulations
List of Typical Experience For a Claims Consultant Resume
1
Experience For Senior Claims Consultant Resume
- Strong exposure to Claims involving the Local Health District
- Create effective presentations and present cases
- Management of client’s claims in order to create efficient, effective, and proactive strategies to reduce claim costs and mitigate exposures
- Has 3-5 years of claims experience in liability lines of coverage
- Analyzes medical evidence and submits when appropriate. Researches and identifies reference material to support case development and documentation
- Extensive experience within Corporate Claims
2
Experience For Claims Consultant Hartford Financial Products Resume
- Lead experience OR,
- Management of client’s claims in order to create efficient, effective, and proactive strategies to reduce claim costs and mitigate exposure
- Arranging programmes, events by arranging for facilities and caterer, issuing information or invitations, coordinating speakers
- Building and developing external business relationships with loss adjusters, Engineers & Building consultants
- Managing Complaints and negotiating resolution
3
Experience For Technical Claims Consultant Resume
- Negotiating through the determination and/or settlement process with Claimants, Brokers and Insured’s
- Acting as a point of referral on complex claim matters for Customer Service Officer/s and Claims Consultant/s
- Using the appropriate medium, negotiate a fair and reasonable settlement of the Third Party claim
- Taking full ownership for your customer to get the right outcome for them on that first call whenever possible
- Support service delivery through data/cycle uploads and processing, developing new insights and presenting results to clients
- Commitment to ongoing learning and professional development including insurance courses/certifications/designation
- A management team that is truly passionate about your career development offering coaching and mentoring programmes
- Assist in developing programs that reduce corporate exposure including the development and presentation of educational material
- Assume temporary responsibility for the portfolio and team during the absence of Manager and assist during the temporary absence of other team members
4
Experience For Associate Claims Consultant Resume
- Communicate with various personnel regarding the ongoing claim process and assist field personnel with any follow-up issues
- Work with accounts to ensure efficient, prompt and smooth flow of handling of all claims, ensuring that established processes are followed
- Works with attorneys, account representatives, agents, and insureds regarding the handling and/or disposition of highly complex claims
- Assist Underwriting and Products in the review and development of new or existing policy language
- Have access to the best in the industry training opportunities including career development, study benefits and support
- Where required represent DLG on industry bodies or review groups providing technical input, and reporting to Claims Management as required
- Lead by example, adopting best estimating practices and processes that can be implemented across the team
- Supports team through mentoring and training
- Self-motivated to create training plans and assist departments with training needs
5
Experience For Reinsurance Accounting / Claims Consultant Resume
- Comfortable with decision making with innovative problem solving ability
- Proficient using Claims systems (i.e. CSS PMS etc.)
- Basic knowledge of reserving practices
- Analyze new claims identifying potential compensability or legal concerns
- Interpret policy wordings and applying accurately
- Interpret and understand building contracts and application to claims
6
Experience For Litigated Claims Consultant Resume
- Interpret public liability and professional indemnity policy wordings and applying accurately
- Provides consultation and advocacy to clients in managing their claims program and develops service plans as appropriate
- Reviews loss history, providing verbal and/or written recommendations
- Plans and administers peer coaching
- Work with current computer software including Microsoft Office applications, as well as hardware technology, with little instruction
- Ensures filing dates and retroactive benefit eligibility are met
- Participates in training sessions and demonstrations
- Assist, on an as needed basis, with claims specialist job functions. Including, but not limited to, phone intakes, appeals, ADLs, etc
7
Experience For Quantum Claims Consultant Resume
- Work on special projects (presumptive report, protective filing, etc.)
- Assess and investigate all Personal Accident/Illness claims, constantly liaising with clients, insurers, claimants, Brokers and external providers
- Make recommendations to underwriters regarding risk management based on claims
- Possess a thorough understanding of all major classes of insurance which the Company offers to its clients
- Proactively manage assigned Casualty/Liability Claims in accordance with XL Catlin’s Claim Handling Principles
8
Experience For Specialty Claims Consultant, MPL Resume
- Drive the settlement negotiation process whilst negotiating on behalf of client; and
- Prepare routine and ad hoc reports including claims trends analysis
- Support the development of the new claims benchmarking product for Willis Towers Watson
- Manage client relationships, supporting their requirements, technical issues and legal/contracts
- Attract new clients and identify opportunities with existing clients to cross sell our ICT services
- Review and recommend solutions to coverage, quantum and claim handling management issues
9
Experience For Liability Claims Consultant Resume
- Manage own portfolio of high value injury/complex claims in accordance with personal delegated handling authority
- Identify, own and manage the risks involved in running our business appropriate to the role, in line with the DLG risk framework
- An in depth knowledge of common law and legislation affecting Liability insurance
- Manage a portfolio of high value catastrophic injury/complex claims in accordance with personal delegated handling authority
- Conduct internal educational seminars and training
- Build and prepare presentations using Power Point, Prezi, or other software
- Capable of working in a team
10
Experience For Specialty Claims Consultant, LPL Resume
- Success in managing projects and initiatives
- Attractive remuneration packaging and discounted memberships
- Evaluates the claim to determine claim value, negotiate settlement and moves to settle claims while adhering to company best claim practices
- Coordinate and lead inter-departmental projects and training
- An innovative mind to look at ways to improve and find better client outcomes rather than just accepting the status quo
List of Typical Skills For a Claims Consultant Resume
1
Skills For Senior Claims Consultant Resume
- Strong interpersonal skills with a strong customer focus
- Previous proven track record of technical /large loss claims handling experience in motor and/or liability claims
- Typically has 6-10 years professional experience, with 2-5 years experience handling Employment Practices Liability claims
- Exceptional customer communication skills and an ability to engage with stakeholders at all levels
- Work effectively with insured’s, defense counsel, other carriers, and agents and brokers in the management of accounts
2
Skills For Claims Consultant Hartford Financial Products Resume
- Possess intermediate/ advanced excel skills
- A proven performer with strong technical knowledge of commercial claims
- Ten or more years of claims experience in an insurance company, TPA, in-house claims department or brokerage environment, or equivalent experience
- Customer focused service skills
- Prior experience in claims consultation with larger risk accounts
3
Skills For Technical Claims Consultant Resume
- Strong end-to-end claims experience within Motor claims (essential)
- Strong end-to-end claims experience
- Prior litigation management experience in multiple jurisdictions is desired
- Knowledgeable in customer service procedures and skills
- Well-rounded communication and interpersonal skills
- Claims experience and at least 1 year of lead experience
4
Skills For Associate Claims Consultant Resume
- Providing claims service that is quick, fair, consistent and cost effective
- Providing strong administrative support to the claims team
- A solid understanding of operational impacts resulting from initiative work, including reporting, KPIs and workflows
- Perform and/or direct claim/accident investigation gathering and preserving evidence
- Regularly and consistently demonstrates the client Values and Guiding Behaviors
5
Skills For Reinsurance Accounting / Claims Consultant Resume
- Experience writing reservation of rights and denial of coverage letters
- Public sector experience including knowledge of public procurement, would be desirable
- Previous customer service experience managing customer queries either face to face or in a phone-base environment
- Immediate MS Word, Excel and experience using a claims management system or similar application
- Typically has 6-10 years' experience handling General Liability and Litigation
- Easily adapts to new or different changing situations requirements or priorities
- Strong attention to detail and pride in being thorough
- Experience interpreting legislation and insurance policies
- Good working knowledge of MS Word, Excel, PowerPoint and databases
6
Skills For Litigated Claims Consultant Resume
- Good working knowledge of Risk Management Information Systems (RMIS) and insurer claims systems
- Become part of a global leader that has one of the strongest reputations in its industry – ‘Large Broker of the Year’ 2015
- Undertake all necessary investigations, with assistance of experts where required, to ensure all large loss claims are fully validated
- Advanced technical and product specific expertise, claims resolution skill, and knowledge of insurance and claims principles, practices and procedures
- Experience in a similar role with exposure to motor and heavy haulage insurance products
- The ability to build strong relationships with our clients and brokers
7
Skills For Quantum Claims Consultant Resume
- Experience with Microsoft Excel and other Microsoft Office packages
- Previous experience in a sales or team support role is ideal
- Professional and an effective communicator
- Provides structured data for the business to use to provide excellent service to our clients
- Deliver Outcomes – Demonstrate a bias for speed and execution that serves our
- Claims experience in property damage and personal injury (required)
- Claims experience in professional indemnity (desirable)
8
Skills For Specialty Claims Consultant, MPL Resume
- 12 months claims experience
- Claims experience in public liability and/or professional indemnity Industry specific ANZIIF qualifications (desirable)
- Post-secondary education and/or relevant work experience
- General knowledge and/or experience with multiple lines of insurance coverage with detailed knowledge in specialized coverage lines considered an asset
- Results oriented with strong client service emphasis and focus
9
Skills For Liability Claims Consultant Resume
- Professional maturity and proven track record of adherence to professional standards and ethics
- Strong legal background within Liability
- Commercial insurance experience required
- Previous travel, accident and/or health claims experience
- Overall claims knowledge, pre-litigation experience and
- Claims Experience 5-10 years (> 5 years of BI) and sustained technical performance
10
Skills For Specialty Claims Consultant, LPL Resume
- Experience with Macro’s and VBA
- Clinical experience as an Occupational Therapist
- Insurance claims assessment experience
- Life insurance experience of all major benefit types
- Demonstrated ability to work with complex medical and financial information
List of Typical Responsibilities For a Claims Consultant Resume
1
Responsibilities For Senior Claims Consultant Resume
- Builds and maintains effective relationships with clients to provide the best possible service in a timely manner
- Working towards a professional insurance qualification
- Preparing various client targeted reports
- Maintain the integrity, accuracy and thoroughness of claim files providing legally supportive file documentation
- Comply with all policies, rules, and regulations of the company including all applicable safety rules, regulations and procedures
- Management of a portfolio of travel ,salary continuance, and financial lines claims and reporting to Insurers
- Proactive customer service focused attitude
2
Responsibilities For Claims Consultant Hartford Financial Products Resume
- An energetic self starter able work as part of a team
- Makes recommendations on claims processes and resolution strategies to management
- Analyzes claims activities; prepares and presents reports to management and other internal business partners and clients
- Execute claim strategies for large accounts to manage claim exposures in conjunction with
- Negotiate settlements mitigate losses and control expenses on our company’s largest losses
- Thinks critically and anticipates recognizes identifies and develops solutions to problems in a timely manner
- Proficient in MS Office Excel Word Internet etc
- Negotiate settlements, mitigate losses and control expenses on our company’s largest losses
3
Responsibilities For Technical Claims Consultant Resume
- Respond to RFI’s from site personnel
- Manage claims to conclusion
- Knowledge of legal processes
- Basic knowledge of loss control and risk reduction techniques
- Basic knowledge of Workers’ Compensation law
- Technical knowledge of claims management process for workers’ compensation
- Monitor carrier/TPA claim handler’s plan including notes, action plans, reserving strategy, investigation, collection and evaluation of documentation and evidence preserving chain of custody, coverage analysis, liability/compensability determination and damages
- Maintain general knowledge of individual federal, state and local laws and regulations
- Provide location management guidance and advocacy support
4
Responsibilities For Associate Claims Consultant Resume
- Evaluate, select and communicate with insurance adjusters, attorneys, experts, medical providers, associates, etc
- Establish and maintain business partnership with those involved with each claim to assure clear understanding of corporate objectives, goals, policies and procedures
- Participate in all aspects of litigation management including selection and retention of defense counsel, discovery preparation, mediation and trial
- Authority to approve reserve and settlement recommendations up to $50,000 and negotiate appropriately
- Evaluate claims for risk control intervention and assist with the development of appropriate loss and risk mitigation programs. Recognize exceptions as they occur and seek assistance to resolve problems of varying scope and complexity
- Participate in claim review sessions
5
Responsibilities For Reinsurance Accounting / Claims Consultant Resume
- Identify and pursue loss recovery opportunities
- Extensive use of various claims/risk information systems to monitor and manage claims
- Work as necessary for task completion
- Manages highly complex investigation of claims, including coverage issues, application of policy language and coordination of such claims with other claim professionals, clinicians or claim examiners. Effectively manages financial and reputational claim risk through application of claim processes and industry best practices
- Authorizes payment within scope of authority, settling claims in most cost effective manner and providing necessary oversight to ensure timely issuance of disbursements
6
Responsibilities For Litigated Claims Consultant Resume
- Works with attorneys, account representatives, providers, physicians, and insureds regarding the handling and/or disposition of highly complex claims
- Evaluate exposure presented to determine appropriate policies
- Ensure customer service standards are adhered too
- Manage liability claims end to end, attend and run settlement conferences
- Comply with legislation such as Insurance Code of Practice and other relevant legislation / regulations and policy requirements
- Identify potential fraud / recovery indicators for claims where applicable
- Serves as a strong client claims advocate in individual claim situations, while respecting Lockton’s relationships with our insurance carrier, third party administrator, and vendor partners
- Monitors claims activities and results, and facilitates the resolution of claims occurring on assigned accounts by acting as a liaison between clients and insurance carriers
7
Responsibilities For Quantum Claims Consultant Resume
- Presents narrative information to client's decision makers, representing Lockton in the highest professional manner
- Participates with other Lockton Associates in formal presentations to prospective and current clients
- Coordinates and attends scheduled claim reviews and coordinates other claim related meetings
- Develops, coordinates and participates in claim audits.Summarizes findings and calculations with a written report, and leads wrap-up meetings at the conclusion of the audit
- Attends staff meetings, unit meetings, educational workshops, insurance carrier functions, and other business related social functions as needed
- Proficiency in the evaluation, interpretation and communication to the client of property and casualty insurance coverage
- Professionally interact with business persons of all levels and succinctly communicate information and strategies
- Substantial knowledge of the practices and procedures of Insurance Carriers and Third Party Administrators, and the skill to effectively develop long term partnerships that meet client needs and expectations
8
Responsibilities For Specialty Claims Consultant, MPL Resume
- Reviews new claims to Allsup and resolves discrepancies as necessary prior to submission to Social Security. Also reviews work of other team members before submission to SSA/DDS/ODAR if requested
- Research and identify reference material to support case development and documentation
- Cultivates and maintains a professional rapport with claimants, SSA, DDS, and client companies
- Accurately and thoroughly document system notes of all conversations and actions
- Maintains technical knowledge of all SSA programs and procedures
- Reviews claims for viability and closure. Contacts claimant/clients to review and discuss
9
Responsibilities For Liability Claims Consultant Resume
- Mentor peers and support staff
- Claims assessment and management of Individual Life (Facultative and Automatic) and Group business claims for the South African operation
- To carry out external audits as required
- To participate in the analysis of results and provision of statistics
- Perform ad-hoc client facing activities such as training, facilitating workshops and meetings and creating the technical material that would be the foundation of these activities
10
Responsibilities For Specialty Claims Consultant, LPL Resume
- Manage a portfolio of liability claims end to end, including public and products liability and professional indemnity claims
- Provide advice to insurer clients on indemnity, liability, quantum, reserving and settlement
- Liaise with various third party providers including solicitors, loss adjusters, brokers and barristers
- General administrative matters including data management
- Management of a portfolio of travel claims and financial lines incident reporting to Insurers
- Interpret public liability policy wordings and applying accurately
- Manage payments to claimants in accordance to respective policies
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