Claims Specialist Resume Sample
Korbin Herzog
640 Ebert Lodge,
Phoenix,
AZ
+1 (555) 112 3059
Work Experience
Claims Specialist
06/2016
-
PRESENT
Philadelphia, PA
- 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 general liability claims
- Prepare detailed settlement analysis and recommendations and present to senior management for approval
- Coordinate with internal and external partners to obtain all necessary material for timely claim resolution
- Coordinate with insurance brokers, third party administrators, in-house and outside legal counsel and other vendors as required to manage claim exposure and resolution
- Handle and/or coach team on handling escalated customer and risk management issues
- Contribute ideas, expertise and trend analysis to safety program
- Manage complex exposure claims using a high level of professional and customer service
Senior Claims Specialist
05/2010
-
12/2015
Boston, MA
- Conduct detailed bill reviews to implement sound litigation management and expense control
- Find opportunities to streamline and improve incident response and settlement process
- Support of corporate insurance program renewal activities as required
- General Liability legal/insurance adjustment experience required
- Undertaking small claims, fast track and multi-track claims with a particular focus on litigated proceedings
- Producing high quality legal documentation, proof reading and technical drafting
- Using current legislation and case law to provide options and solutions to technical arguments where required - keeping up to date with relevant legislation and case law
- Reviewing documentation; summarising and identifying key points, risks and issues; questioning and providing solutions
- Achieving targets for settlement based on value
Warranty Claims Specialist
11/2003
-
04/2010
Boston, MA
- Identifying internal and external contacts and liaising with them to gather information, whilst also responding to information requests in a timely and efficient manner
- Working with Team Manager and internal stakeholders to develop an effective litigation strategy to achieve overall financial targets
- Supporting, training and develop members of the wider team to increase the skill set and knowledge
- Supporting the operating model and ensuring consistent advice to the business
- Strong data entry, 10-key and P.C. skills
- Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer
- Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Education
DePaul University
1999 - 2003
Bachelor's Degree
Professional Skills
- Demonstrated strong verbal and written communications skills. Demonstrated strong negotiation skills
- Demonstrate strong written and verbal communication skills including cognitive skills such as listening, analyzing, and interpreting
- Excellent interpersonal skills including strong negotiation and influencing skills
- Excellent written and verbal communication skills; Customer service orientation; strong analytical and negotiation skills
- Strong problem solving skills, verbal and written communication skills
- Above average telephone and customer service skills, legal terminology, dependability and strong organizational skills
- Excellent organization and time management skills; capability of effective planning and prioritizing
How to write Claims Specialist Resume
Claims Specialist role is responsible for organizational, negotiation, claims, customer, analytical, interpersonal, computer, organization, communications, general.
To write great resume for claims specialist job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claims Specialist Resume
The section contact information is important in your claims specialist 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 Specialist Resume
The section work experience is an essential part of your claims specialist 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 specialist 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 specialist position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Claims Specialist resume experience can include:
- Excellent organizational skills and ability to effectively prioritize multiple projects and due dates
- Excellent grammatical and spelling, mathematical skills, multi-tasker and organizational skills
- Strong oral and written communication skills with the ability to work effectively with client representatives, team members and providers
- Good presentation skills and interpersonal skills
- Prior Aviation Industry experience –10 years + in a relevant sector where the skills learned would support the position
- Working knowledge of claims processing and banking regulations, specifically Regulation E. Strong oral/written communication and interpersonal skills
Education on a Claims Specialist Resume
Make sure to make education a priority on your claims specialist resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claims specialist 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 Specialist Resume
When listing skills on your claims specialist 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 specialist skills:
- Proven organizational skills to effectively prioritize increased and more complex workloads
- Excellent listening skills, customer service skills
- Excellent verbal and written communication skills, Ability to communicate effectively across all levels of the organization
- Excellent written and verbal communication skills necessary to effectively communicate and/or negotiate with various audiences
- Demonstrated excellent analytical and problem solving skills and decision making ability
- Work in a production environment, meet challenges in completing work, demonstrates good team skills and work overtime as needed
List of Typical Experience For a Claims Specialist Resume
1
Experience For Senior Claims Specialist Resume
- Analytical Skills: Possesses strong analytical skills and sound judgment
- Strong interpersonal skills with the ability to develop strong personal and professional relationships at all levels of the organization
- Strong organizational skills with the ability to prioritize work
- Demonstrates profound computer skills and experience with Microsoft Office Package (special focus on Excel, Power Point)
- Excellent judgement and decision making skills to ensure claims are resolved in the best interest of the Company
- Demonstrated 10 key data entry skills required
- Using strong technical skills, handle challenging claims within authority level and specialization
- Excellent written and oral communications skills; and
- Negotiation and strong interpersonal skills necessary to negotiate claim settlements acceptable to both parties
2
Experience For Claims Specialist Senior Resume
- Strong analytical and sound judgment skills with the ability to take initiative and to work independently
- Good communication skills and ability to build relationships with others
- Strong, relevant qualifications / good commercial experience
- Excellent organizational, time management, and customer service skills
- Excellent oral, written communication skills & customer service
- Effective analytical & interpretive skills
- One year of workers compensation lost time claims handling experience or 18-24 months of workers compensation medical only claims handling experience
- General accounting skills (reconciliations not GAP accounting)
3
Experience For Subrogation Claims Specialist Resume
- Prior Broking / Underwriting experience
- Profound IT-skills (MS-Office; knowledge of Claims Handling and administration systems is an asset)
- Data entry skills (10 key)
- Client service and support skills
- Previous experience is strongly desired in deduction management
- Experience with construction defect and a strong understanding of the litigation process
- In mediations and settlement conferences. Consistently employing strategic litigation management skills throughout the life of all claims
- Works with DP legal to effectively implement litigation management controls to any circumstance that warrants it whether reinsurance or direct insurance
4
Experience For Warranty Claims Specialist Resume
- Knowledge, Skills, & Abilities:
- Excellent organization and analytical skill
- Previous experience desired in deduction management TECHNICAL EXPERIENCE AND OTHER REQUIREMENTS
- Proficient presentation skills - ability to communicate across all layers of the organization
- Interpersonal skills and the ability to work within a team
- Strong claimant litigation experience, can draft, issue and progress proceedings to conclusion with minimal guidance
- Typically has up to 4+ years of P&C claims handling experience or P&C account management experience
5
Experience For Senior Look No Further Claims Specialist Resume
- Three (3) years experience as a Claims Specialist in hospital risk management setting and demonstrated successes in the field of Health Care
- Experience in the equivalent combination of education and experience
- FMLA & STD experience or Workers Compensation/Social Security Benefits experience
- Additional experience with clinical background/vocational experience/Workers Compensation/Social Security Benefits claim management or offset expertise
- Mentoring experience in LTD
6
Experience For Workers Comp Claims Specialist Resume
- Experience reading/comprehending medical records and reports, mediating/negotiating settlement
- Experience of operating an end-to-end claims handling process, dealing with parcel & freight cargo claims
- Demonstrate a proactive and systematic approach to information gathering, analysis and problem solving
- Experience mediating/negotiating settlements and exercise sound judgment
- 6 months – 2yrs loan servicing processing experience
- Experience of progressive responsibility in an insurance or corporate claims handling environment concentrating in general liability
- Managed care experience; claims review and processing background including coordination of benefits, subrogation, and eligibility criteria
- Understands “shared services” methodology and previously operated within a matrix organization, servicing multiple customers
7
Experience For Unemployment Claims Specialist Resume
- Needs reinsurance, insurance, or claim adjusting experience
- Previously gained experience of working within an international environment
- Understands “shared services” methodology and previously operated within a matrix organisation, servicing multiple customers
- Responsible for timely, ethical, and effective handling of all assigned general liability and auto claims
- Three years of experience applying the Kansas Workers Compensation Act
- Five years of experience applying the Kansas Workers Compensation Act, case law and board decisions
- Experience in working with people from different cultures
- Good working knowledge of the policy provisions and coverage’s associated with these claims
- Experience working in claims
8
Experience For LTD Claims Specialist Resume
- Experience calculating payments
- Handling experience
- Two years of experience with claims processing
- Recent claim processing experience in a managed care/IPA environment
- Experience with Epic AP Claims claim processing system
9
Experience For Liability Claims Specialist Resume
- Strong working knowledge of personal and commercial liability claims
- Experience handling bodily injury claims
- Combined 5-7 years of law and/or insurance experience required preferably in professional liability claims handling
- Effective communicator with ability to influence stakeholders during difficult conversations
- Work with multiple priorities, accomplishing deadlines
10
Experience For STD / Fmla Claims Specialist Resume
- Be really, really good at communicating with others – A “people” person
- Strong Science / Engineering Background
- Practical experience with a major insurance company or broker handling insured claims (or IHG peer group company) ACII or CPCU qualified
- Fast and very good understanding of legal and commercial matters and related risks
- Proven exemplary performance in the CARE Associate Sr. or equivalent position, including but not limited to
List of Typical Skills For a Claims Specialist Resume
1
Skills For Senior Claims Specialist Resume
- Excellent communication skills both written, and verbal as demonstrated by a complete application/resume, work history and interview process
- Good interpersonal skills that include professional & effective communication with internal & external customers
- Excellent organizational and time management skills with the ability to prioritize day-to-day work activities
- Demonstrates strong written and oral communications skills
- Knowledge, Skills, & Abilities: Attention to detail and organizational skills required
2
Skills For Claims Specialist Senior Resume
- Strong Excel skills - Pivots, V-lookups, formulas, formatting (All reports on team are Excel-based)
- Excellent research, analytical, and modeling skills
- Good organizational skills – Juggling occasionally required
- Strong communication skills- In person, on the phone and in writing
- Highly motivated candidates who possess excellent writing and analytical skills
3
Skills For Subrogation Claims Specialist Resume
- Experience adjusting claims or equivalent transferable skills
- Excellent communication skills (reading, written and verbal) in both Italian and English
- Excellent Correspondence and proofreading skills
- Demonstrated typing skills and accuracy rate
- Good verbal and written communication, organizational and interpersonal skills
- Demonstrates organizational skills while working on multiple projects
- Strong sense of urgency, attention to detail and ability to manage requirements of the role effectively
- Working knowledge of Excel, Word, and general computer skills
- Effectively evaluate, negotiate and resolve claims within delegated authority (ranging from $100,000 to $400,000) utilizing the appropriate denials or releases
4
Skills For Warranty Claims Specialist Resume
- 1-3 years' experience in health insurance business including customer service experience
- Problem resolution skills required to work with demanding claimants and dealers
- Experience ensuring effective claims managment for an Enterprise
- Experience in handling claims in Singapore with good relationships with local brokers, counsel and adjusters preferable
- Strong research and issue identification ability (mortgage insurance carrier guidelines, default reporting, prior servicer actions)
- In mediations and settlement conferences. Consistantly employing strategic litigation management skills throughout the life of all claims
- Problem solving and research skills PC proficiency to include Word, Excel, PowerPoint, Outlook
- Resolve conflicts and empathize with customers is critical. Negotiation skills are critical for resolving claims
- Time management skills (on call 24/7)
5
Skills For Senior Look No Further Claims Specialist Resume
- Great interpersonal skills with the ability to work independently and in a team environment
- Ability and willingness to cooperate and interact with a variety of other professionals, as demonstrated by work history and interview process
- Claim handling experience, with a strong preference for complex and/or latent bodily injury /GL exposures
- Prior Aerospace or related insurance defense experience – preferably in managing litigation
- Strong decision maker and team player with proven ability to negotiate and analyse/ solve complex problems in a timely and efficient and sometimes creative way
- Effectively present information to manager, claimants and
- Claims experience, with 2-3 years homeowner claims experience required
- Prior LTD experience is required
6
Skills For Workers Comp Claims Specialist Resume
- Handle complex claims situations effectively
- Demonstration of customer service attitude and customer service skills
- Investigate, evaluate and settle claims, applying technical knowledge and negotiation skills to reach fair and prompt claim resolution
- Experience in MPCI and Crop Hail claims experience
- Negotiation skills mandatory, and ability to interact with all levels of the organization
7
Skills For Unemployment Claims Specialist Resume
- Effectively interact and communicate at all levels of the organization
- Desired: Up to one year of related experience. Pharmacy Technician experience
- Effectively utilize the Internet
- General accounting skills (reconciliations)
- Effectively oversee claims in accordance with established claims handling strategies
- Claims/legal experience; or experience in a related field
8
Skills For LTD Claims Specialist Resume
- Organising and following up the workflow of the unit in order to achieve in an efficient and effective way
- Handling of Unclaimed Property claims which includes claims validation and researching beneficiaries
- Ensuring claims are in good order before being sent for claim adjudication
- Over 3 years and up to and including 5 years of experience in an indemnity and/or HMO setting processing, auditing or adjusting professional claims
- Strong working knowledge of Medicare Diagnosis-Related Group (DRG) pricing, OPPS APC pricing, Ambulatory Surgery pricing, and RBRVS payment
- Experience in managing, negotiating and resolving high exposure and complex claims arising under Bermuda-form policies and wordings
- Experience of operating an end-to-end claims handling process, dealing with freight & marine cargo claims
- Experience working with legal counsel for purposes of defending coverage decisions and pursuing recovery against liable parties
9
Skills For Liability Claims Specialist Resume
- Experience processing losses and reporting post-assessment invoices
- Demonstrable evidence of providing high standards of customer care is essential in a customer facing environment
- Direct claims experience researching and resolving complex claims issues
- Experience handling litigated Construction claims including coverage issues
- Claims processing experience Comprehensive knowledge of banking regulations, specifically Regulation E
- Work both independently or in a team while establishing priorities; ability to handle multiple tasks in a rapidly evolving environment
- Monitor any Property Preservation work being done prior to the claim being filed
- Around 5 years of experience in the insurance broking or insurance industry, with preference in claims, loss adjusting and/or legal
10
Skills For STD / Fmla Claims Specialist Resume
- File disputes by collecting and submitting evidence
- Experience in Workman’s Compensation and Motor Vehicle Claims processing
- Demonstrated knowledge of claims handling for Workers’ Compensation coverage
- Excellent employer contributed Profit Sharing & 401(K) Plans
- Solid understanding of the UK regulatory environment to include but not limited to: FSA and FOS
List of Typical Responsibilities For a Claims Specialist Resume
1
Responsibilities For Senior Claims Specialist Resume
- Strong communication skills both verbal and written with senior management
- Excellent communication, organizational & customer service skills
- Strong attention to details, superior organizational skills, ability to make consistently sound decisions and negotiate solutions is mandatory,
- Very good PC skills – MS office
- Good customer service skills, self-motivated and able to adapt in diversified environment and systems
- Good communication skills in both spoken and written English, Cantonese and Mandarin
- Good PC skills in MS Word, Excel and PowerPoint
2
Responsibilities For Claims Specialist Senior Resume
- Effectively manage litigation process and defense counsel to ensure timely and cost effective outcomes
- Identifying and implementing process enhancements to effectively provide timely and fair claims resolution
- Outstanding presentation and communication skills, both written and verbal
- Operate as an effective team member by supporting colleagues and contributing in the delivery and achievement of the overall team and business objectives
- Relevant Work Experience: 5 years’ of claims processing experience required
- Effectively communicate orally and in writing; calculate payments
- Proven experience working at an insurance company in a multi-state environment, a self-insured entity, or a third party administrator
- Detail oriented, exceptional organizational skills
3
Responsibilities For Subrogation Claims Specialist Resume
- The ability to work effectively with a team and possess the talent to provide contributions as a team member is a highly essential requirement
- Develop lost time claim disposition skills under the direction of supervisor
- Effectively and timely communicate appropriate responses to policy holder, brokers or underwriters on new losses
- Communicate effectively with internal and external customers on claims and account issues
- Willing to learn and be a good team player to achieve team goals
- Hiring appropriate and effective counsel
- Experience reading/comprehending medical records and reports, mediating/negotiating settlements
- Work in an energizing environment; flexibility to handle multiple priorities while maintaining a high level of professionalism
- Embrace SOX and Standard Operating Procedures and demonstrate commitment to expanding knowledge and application across Team
4
Responsibilities For Warranty Claims Specialist Resume
- Experience in end-to-end claims handling process improvement
- Serves as a mentor to less experienced claims associates and assists with training/presentations as assigned by claims management
- Experience handling customer support issues - ideally in an safety or claims environment
- Experience in multiple billing software
- Support cross functional stakeholders by reducing cash collection risk through effective claims management and resolution
5
Responsibilities For Senior Look No Further Claims Specialist Resume
- Recognizes variance and demonstrates divergent thinking in resolution
- Possesses strong working knowledge of Non-Disputed Claims Settlement process
- Experience in handling casualty claims to function properly in position
- Experience dealing with attorneys
- Thorough knowledge of and more than 15 years experience handling primary and/or reinsurance claims
6
Responsibilities For Workers Comp Claims Specialist Resume
- Experience in evaluating and audited DUA’s and Claim TPAs
- Has 1 to 6 years experience in claims processing
- Demonstrates leadership among peers by consistent application and modeling of the appropriate compliance, behavior and conduct
- Experience handling New York no-fault claims. Knowledge of Regulation 68, Personal Injury Protection law,
- Experience handling NY No Fault Litigation and Arbitration Claims
- Five years of experience applying the Kansas Workers Compensation Act
7
Responsibilities For Unemployment Claims Specialist Resume
- Experience in managed care, customer service, and claims processing required
- Experience handling Liability Claims
- Experience managing repair projects
- Experience with claims, customer service or accounting
- $32-36/hr, depending on experience
- Work experience handling workers compensation claims
- Juris Doctor and 2 or more years of experience in the Claims handling and Litigation area within the Insurance industry
- Experience handling litigated claim files
8
Responsibilities For LTD Claims Specialist Resume
- At least 6 months experience in with Global Strategic Equities (GSE) Servicing
- Claims handling experience within Italian Insurance Market
- Experience with claims avoidance and negotiating claims resolution
- Experience working with project managers
- Solid understanding of claims processes, knowledge of insurance products, policy line coverage, and industry operations
9
Responsibilities For Liability Claims Specialist Resume
- Experience and proficiency using Outlook, Word, Excel
- Demonstrated success in negotiation, persuasion, and solutions-based claim paying
- Driver’s License and good driving record are required to drive a company vehicle
- Accounts Receivables Pricing Claims Experience
- Strong knowledge of theories of liability and understanding of legal procedures and strategies
- Juris Doctor and 1 or more years of experience in the Claims Handling or Insurance area OR
- Demonstrated conceptual thinking
10
Responsibilities For STD / Fmla Claims Specialist Resume
- Proven track record in handling primary marine claims with limited direction
- Experience handling General Liability and bodily injury claims
- Experience supporting a Government agency as a Claims Specialist
- Good knowledge & understanding of insurance market and clients in country
- Proactive in sharing knowledge and experience with team members
- Good working knowledge of Microsoft Word, Excel, and Access
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