Claims Representative Resume Sample
Dino Heaney
237 McLaughlin Canyon,
Los Angeles,
CA
+1 (555) 542 0007
Work Experience
Senior Claims Representative
10/2015
-
PRESENT
Detroit, MI
- Works under direct supervision. Relies on others for instruction, guidance, and direction
- GTreasury experience or similar Treasury workstation
- CTP (Certified Treasury Professional) designation required or to be completed within 18 months of hire date
- The position requires a high level of integrity, a high level of service orientation, and ability to multi-task
- Inspects damaged property and vehicles, and determines claims related damage
- Personal contacts are a major part of activity and include policyholders, claimants, agents, witnesses, repair facilities, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and all other persons’ incident to the investigation and processing of claims
- Ensure accurate logging of incoming customer claims in the following areas: shipment claims, refusals, returns and invoices
- Adhere to all customer claims policies and procedures
Claims Representative
04/2009
-
07/2015
Philadelphia, PA
- Cognizant is an Equal Opportunity Employer M/F/D/V
- Carrying up to 20 lbs
- Seeing Writing (English)
- Responsible for coordinating tasks of other individuals within the department related to TPL to be able to perform functions in another’s absence
- Knowledge of no-fault regulatory requirements for the state of Michigan (MI)
- Possess 1 years of experience as a material damage estimator either in the insurance industry or the collision repair industry
- Pursuant to Company lines of business strategies and good faith claim settlement practices: investigates, negotiates and settles (within authorized limits) assigned claims
- Establishes and maintains positive relationships with both internal and external customers providing excellent customer service
- Provides assistance with developing/mentoring newer claims associates
Assistant Claims Representative
05/2005
-
12/2008
Houston, TX
- Feedback to customers and internal stakeholders about resolution claims
- Develop positive relationship with Customers, Sales, Finance, Nike Distribution Centre and Carriers
- Assist Business Analyst,Team Leaders, and Customer Service Manager in identifying and supporting the analysis of process areas that require improvements
- Resolve discrepancies on weekly basis
- Document thoroughly queries and use correct steps in customer care tool
- Personal contacts are a major part of activity and include policyholders, claimants, agents, witnesses, repair facilities, contractors, police and fire departments, state and county fraud and arson personnel, special investigators, attorneys, expert witnesses, members of the medical profession and all other people’s incident to the investigation and processing of claims
- Conduct a thorough investigation by contacting injured workers, medical providers and locations/stores to determine if the claim is allowed under the applicable workers’ compensation statutes
- Has the authority to make payment of assigned claims within prescribed limits, with supervisory review and approval
- Self-starter, independent and resourceful
Education
University of Phoenix - Taylorsville Learning Center
2000 - 2005
Bachelor's Degree in Business
Professional Skills
- Excellent listening skills and problem-solving skills relative to customer inquiries
- Strong computer skills, desk management skills and accurate keyboarding
- Strong, proven customer service experience and skills
- Advanced planning recognition skills and interpersonal skills required
- Good computer navigation skills including excel and word, critical thinking skills
- Strong organizational and detail-oriented skills and ability to prioritize
- Excellent time management and organizational experience and skills required
How to write Claims Representative Resume
Claims Representative role is responsible for negotiation, computer, customer, organizational, interpersonal, research, software, training, claims, excel.
To write great resume for claims representative job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claims Representative Resume
The section contact information is important in your claims 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 Claims Representative Resume
The section work experience is an essential part of your claims 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 claims 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 claims representative position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Claims Representative resume experience can include:
- Strong analytical and problem solving skills to review and trouble shoot data, reporting and incentive claim processing and payment history
- Experience: 4 years claims experience; experience handling property claims; increasing levels of responsibility
- Strong leadership skills including the ability to coach, develop and lead team members towards successful attainment of goals and objectives
- Effective decision making and analytical skills
- Strong attention to detail with time management and decision-making skills but also described as someone with high energy and success-driven
- Strong organizational, critical thinking and communication skills
Education on a Claims Representative Resume
Make sure to make education a priority on your claims representative resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claims 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 Claims Representative Resume
When listing skills on your claims 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 claims representative skills:
- Excellent communication, negotiation and interpersonal skills to effectively interact with all levels of an organization both internal and external
- Strong time management skills, organizational skills and a high attention to detail
- High attention to detail, excellent oral and written communication skills, leadership qualities, and personal interaction skills are a necessity
- Comfortable in a fast paced environment and strong prioritization skills
- Excellent computer skills including MS Office, Outlook, AS/400, any service related ticketing software
- Strong negotiating, research and reading comprehension skills
List of Typical Experience For a Claims Representative Resume
1
Experience For Senior Claims Representative Resume
- Strong verbal and written communication skills. Interpersonal skills
- Management of claims so they are being prioritized and handled effectively and efficiently
- Strong telephone, letter writing and professional correspondence skills required
- Strong computer skills, proficient in MS Office products
- Typing (40-50 WPM) and computer skills - MS Word, Excel, Outlook
- Prior experience in reviewing scope of damages and estimates
- Experience working in an automated claim system environment Strong customer service
- Superior verbal and written communication and customer service skills and a commitment to consistently exceeding the customer's expectations
2
Experience For Liability Claims Representative Resume
- Knowledge of PC skills involving windows based software to include Microsoft Word, Excel, Power Point
- Up to 1 year of related work experience; or any combination of education and experience, which would provide an equivalent background
- Experience working with customers to surpass their expectations and ensure they are satisfied with their experience, regardless of the outcome
- Data entry skills with a knack for numbers
- Prior Claims and/or collections work experience is required
- Personal computer and math skills beneficial
- Effectively organizes work to meet business objectives
- Maintain working knowledge of Grange insurance policies and good faith claim settlement practices
3
Experience For Claims Representative Associate Resume
- Establish and maintain positive relationships with internal and external customers by providing excellent customer service
- Gain experience in determining minimal to moderate liability exposure
- Demonstrates the following competencies and behaviors
- Property and casualty claims handling experience
- Medical only file handling experience
- Basic personal computer knowledge with keyboarding proficiency is required. Previous user experience with Siebel (or similar systems)
- Workers' compensation claim handling experience required for New York claims
- Computer experience (MS Office, excel, word, etc)? Proficient using Claims systems (i.e. CSS, PMS, etc.)
4
Experience For Claims Representative Senior Resume
- Property and casualty claims handling experience
- Use good judgement and discretion when working with client private information
- Related claims experience with handling of disability related claims
- Demonstrated behaviors that support: fostering Confidence, Creativity and Collaboration; role model adidas Group behaviors and deliver results
- Proven capacity to efficiently manage a large claim workload with minimal supervision, adapt to changing conditions and work within time constraints
5
Experience For Senior Life & Annuity Claims Representative Resume
- CA claims handling experience
- ICD - 10 and CPT coding experience
- Previous claims adjusting experience within the IAA family of companies
- Experience in claims processing
- Claims processing experience in a managed care environment
- Previous experience working with Microsoft Excel to create and maintain spreadsheets
- Experience in claims processing (healthcare related)
- Experience working on a computer in Windows applications with the ability to learn other complex computer systems
- Experience processing medical, dental, prescription or mental health claims
6
Experience For PIP Claims Representative Resume
- Experience in claims processing (healthcare related)
- Previous processing medical health claims experience
- Experience working with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
- Experience working on a computer in Windows applications with the ability to learn other complex computer systems and dual monitor
- Experienced at interpreting contract to determine coverage
- Excellent problem - solving capabilities
7
Experience For Lead Claims Representative Resume
- Experience working with Automotive Dealerships is an asset
- Experience working in an automated claim system environment
- Previous experience in gaming/hospitality claims
- Experience in gaming/hospitality claims
- Worker’s Compensation technical file handling experience
- At least two years of experience in gaming/hospitality claims
- Workers’ Compensation experience in other states, including Kansas, Arkansas
8
Experience For Inside Claims Representative Resume
- At least 1year of experience in gaming and/or hospitality industry
- Experience working in an automated windows environment
- 6 months of experience in Long Term Care claims
- Experience in a similar environment
- Experience in the Insurance field
- Heavy premises liability experience
- The ability to prioritize your workload and perform multiple tasks at once is key
- Workers’ Compensation experience required, state of Missouri & Illinois
9
Experience For Senior Work Comp Claims Representative Resume
- In litigation management experience
- Previous insurance experience and/or coursework required
- Demonstrates timely responsiveness to customer requests
- Typically has 5 - 7 years of experience
- Claims adjustment or customer service experience in the insurance industry
- Claims experience
- Previous WC claim experience
10
Experience For PIP Claims Representative Trainee Resume
- Review all bills, estimates and Proofs of Loss prior to making settlement and payment of claim
- Providing high quality customer service by responding to and researching and resolving customer inquiries related to dispute/fraud claims
- Investigating and gathering information about claims by contacting all parties involved
- Achieving and maintain 95% production requirements per claim type utilizing departmental policy and procedures as established per Healthplan and Network. (20%)
- Gathering claim information and entering into 3rd party software
List of Typical Skills For a Claims Representative Resume
1
Skills For Senior Claims Representative Resume
- Strong Litigation Management skills, to effectively communicate with clients and defense counsel to guide and push to resolve claims
- Strong customer service skills, ability to effectively communicate with clients and vendors
- Good organizational, multi-tasking, and problem-solving skills
- Strong PC skills to include Word and Excel with the ability to navigate multiple applications during call handling
- Excellent listening, telephone etiquette, and customer service skills
- Able to effectively manage and execute multiple tasks, projects and priorities
- Excellent verbal and written skills necessary in order to communicate intricate job-related information to internal and external customers
2
Skills For Liability Claims Representative Resume
- Customer service experience and or skills
- Experience of Medicare/Medicaid Claims experience; or any combination of education and experience, which would provide an equivalent background
- Demonstrated ability to listen effectively and resolve disputes with tact, diplomacy and sensitivity
- Professional telephone, excellent interpersonal and communication skills
- Possesses excellent communication (both written and oral) and organizational skills
- Use computer and Windows PC applications, which includes strong keyboard and navigation skills and ability to learn new computer programs
3
Skills For Claims Representative Associate Resume
- Experience planning and prioritizing job tasks within deadlines
- Proactively addresses customer concerns via email and phone using professionalism, problem solving skills and exemplary customer service
- Claims processing experience in Managed Health Care/Insurance experience
- Serve clients, negotiate, effectively communicate verbally and in writing
- Interpersonal skills, including the ability to quickly adapt communication style and approach as appropriate
- Proficient and accurate typing skills – min. 35 wpm
- Pharmacy or medical claims processing experience and / or customer service experience
4
Skills For Claims Representative Senior Resume
- Prior medical claims processing experience
- MS Word, Excel and Outlook, typing skills
- Demonstrated experience in B2B negotiations
- Anthem claims experience; or any combination of education and experience, which would provide an equivalent background
- Proven ability to exercise strong initiative and use sound judgment in determining appropriate courses of action
- Experience and demonstrated ability to handle up to modestly complex PIP and MP claims
5
Skills For Senior Life & Annuity Claims Representative Resume
- Prior customer service experience with a goal oriented focus
- Negotiate and handle potential conflict effectively
- The ability to maintain a positive attitude and work effectively within a team environment
- Up to 1 year of related experience;or any combination of education and experience, which would provide an equivalent background
- Up to 1 year of related experience or any combination of education and experience, which would provide an equivalent background
- Experience in calculating insurance rates, analyzing trends and forecasting plan costs and new business growth
6
Skills For PIP Claims Representative Resume
- Experience working in team environments, and lending a helping hand when needed
- Customer service experience in solving customer problems in an office setting environment
- Billing/processing experience
- Billing / Processing experience
7
Skills For Lead Claims Representative Resume
- Successfully complete the UnitedHealth Group new hire training program and demonstrate proficiency through testing and practical application
- Knowledge of medical claims coding (CPT, ICD-10, etc) with experience of applying that knowledge in HealthCare Insurance industry
- Demonstrates a keen understanding of the following processes
- Auto damage estimating experience
- Experience in a life underwriting environment
8
Skills For Inside Claims Representative Resume
- Experience as a member of a cross functional team for product development and marketing release
- Analytical skill necessary to make decisions and resolve issues inherent in handling losses
- Experience adjusting auto property damage claims
- Experience working in an office production environment, e.g. data entry, math computations, computer applications, etc. is required
- Worker's compensation claim handling experience required
- Experience in using Excel create and maintain spreadsheets
9
Skills For Senior Work Comp Claims Representative Resume
- Experience in using MS word to create letters
- Customer service experience in solving customer problems
- Experience in using Microsoft Word to create letters
- Experience in using Excel - create and maintain spreadsheets
- ICD-9 and CPT coding experience
10
Skills For PIP Claims Representative Trainee Resume
- Recent total loss claims processing experience
- Experience working in the Healthcare Industry
- Strong sense of professionalism with dealing with all internal and external customers
- Experience in a customer service capacity, focusing on customer service excellence
- Casualty claims handling experience
- Experience processing medical, dental, prescription or mental health claims
- Five or more years of handling claims experience
- Thorough knowledge of client products, services, and coverages; along with a good understanding of applicable legal principles
List of Typical Responsibilities For a Claims Representative Resume
1
Responsibilities For Senior Claims Representative Resume
- Issue credit/debit memos for deductions proven valid. Work with the customer for repayment of deductions if proven invalid
- Excellent phone, computer, organizational and multi-tasking skills
- Demonstrates a depth and breadth of knowledge/skills in own area and is often able to apply this outside of own function
- Strong telephone and customer service skills. -
- Able to apply curiosity and good investigative skills to fully research and investigate each claim and complete it
- Able to manage time effectively, handle multiple tasks and priorities
- Experience prior experience as a Claims Examiner in an IPA, Medical Group or Health Plan
2
Responsibilities For Liability Claims Representative Resume
- Proven experience handling customers at varying levels of emotional duress, while maintaining professional decorum
- Intermediate to advanced proficiency with claims processing systems and intermediate Microsoft Office skills
- Recognizes need and utilizes negotiation skills to develop planning strategy to resolve matters within scope of authority
- Prior injury and litigated claims handling experience
- Develop the skills to be responsible for the verification or non verification of potential deaths
- Develop the skills necessary to verify that named decedents are insured by New York Life
3
Responsibilities For Claims Representative Associate Resume
- Exhibit research skills and utilize appropriate in house NYL systems ans well as TPA's
- Exhibit research skills and utilize appropriate in house NYL systems as well as TPA's
- Claims experience handling personal auto and homeowners’ litigation files involving serious injuries
- Insurance claims experience in commercial/auto transport/cargo & total loss handling
- Medical claims processing experience required
- Claims processing experience
- Exceptionally well organized & proven track record providing a high level of customer service
- Workers' Compensation claim handling experience
- Two or more years’ experience as a Claims Representative – Field (or the equivalent)
4
Responsibilities For Claims Representative Senior Resume
- Typically has 3 - 10 years experience
- Cultivates an environment of teamwork and collaboration? Operates with latitude for un-reviewed action or decision
- Possess and demonstrate ability to assess the information gathered and make appropriate decisions
- Use good judgement and discretion when workong wih client private information
- Developing proficiency in applicable technology and processing tools, proficiency in Word and Excel
5
Responsibilities For Senior Life & Annuity Claims Representative Resume
- Achieving and maintain 95% production requirements per claim type utilizing departmental policy and procedures as established per Healthplan and Network
- Working knowledge of computers including Microsoft Word and Excel
- Working knowledge of computers including Microsoft Office products
- Advising policyholders of the policy coverage and benefit triggers as well as gathering medical data and history
- Making decisions about reasonable expectations of benefit eligibility and obtaining agreement on how to proceed
- Ongoing training on current state/federal fraud and regulation updates
- Maintaining state compliance and decisioning claims for these products
- Notifying customer of rebuttals
- Working knowledge of medical terminology and ability to interpret medical reports
6
Responsibilities For PIP Claims Representative Resume
- Caring, compassionate attitude. In particular, with the elderly population
- Working knowledge of industry and customers
- Communicating with claimants or their representatives when they contact the call center to initiate a long-term care claim
- Continuing education is highly encouraged through achievement of a LOMA designation and/or the ICA Associate, Life and Health Claims designation
- Working knowledge of the insurance contract and relevant endorsements, statutes and regulations
- Working knowledge of human anatomy, types of injuries usually received in covered losses, diagnosis codes for those injuries and reasonable treatment regiments
7
Responsibilities For Lead Claims Representative Resume
- Understanding specific account profiles
- Preparing acknowledgements from carriers for claims
- PC proficiency in MS Word (Creating and editing documents) and MS Excel(Creating and editing spreadsheets, formulas)
- Responsibilities include investigating and settling Home losses with an emphasis in Dwelling claims
- Initial intake of mail and faxes, including scanning to claims processing system
- Conversant knowledge of insurance rating and underwriting and how claims activity and losses affect insurance pricing by line of coverage
- Provide high quality customer service by responding to inquiries relating to contract pricing rebates and promotional trade claims
- Complete on a daily basis all data entry required to document and communicate the status of claims as needed adhering to all reporting requirements
- Assists Team Leader in developing methods and improvements for handling claims
8
Responsibilities For Inside Claims Representative Resume
- Evaluate suspected manufacturing defect flooring claims and warranty issues. Process credits for product defects or customer satisfaction
- Provide customer service, such as giving limited instructions on how to proceed with claims or providing referrals to other facilities or contractors
- Assist the customer in moving through the claims process, and assess the need for providing information or education to the customer
- Coordination of bill review; including scanning, approvals & payment of medical invoices
- Handles incoming calls and correspondence from insured’s, claimants and agents regarding questions or problems associated with claims
- Develop an understanding of the functions of other departments, such as Policy Ops and Marketing
- Utilizes claims and ancillary systems and adheres to processing procedure resulting in the finalization of basic and complex claims edits
- Maintains working knowledge of policies and procedures and attends additional training as need
9
Responsibilities For Senior Work Comp Claims Representative Resume
- Maintains the integrity of the Claims Management System (VAX) and Legal Files by providing monthly updates on claims and insuring the sufficiency of reserves
- Works with attorneys, account representatives, agents and insured's regarding the handling and/or disposition of claims
- Support implementation of updates to the current procedures and assist with new system training/mentoring
- Three years of administrating and investigating property damage claims
- Maintain other required credentialing and licensing necessary to perform the job assignment
- Able to work accurately, paying attention to detail and following oral and/or written instructions
- Advanced understanding of:- Vehicle repair procedures and issues or;- Building repair procedures and issues or;- Third party liability issues
- Work with Accounting and Collections staff to resolve carrier and customer Accounting issues related to claims
10
Responsibilities For PIP Claims Representative Trainee Resume
- Contribute to the growth of the business by referring quality candidates into the hiring process
- Claims (ICD-10, Coding, Processing, etc.)
- Provide various ad hoc reporting as requested
- Respond to inquiries from vendors, attorneys, investors, etc. regarding post liquidation claims
- Coordinates with the Claims Manager and/or Claims Supervisor on workflow issues and the handling of batches in date order
- Interfaces with customers or their representatives regarding the disposition of the claim
- Document all decisions, correspondence, reports and discussions that occur during the evaluation and investigation of the file
- Learn the necessary steps to determine if subrogation exists and takes steps necessary for recovering all potential dollars
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