Claims Analyst Resume Samples

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O Yundt

Otha

Yundt

57718 Brant Locks

Phoenix

+1 (555) 330 8779

57718 Brant Locks

Phoenix

Phone

p +1 (555) 330 8779

Experience Experience

Los Angeles, CA

Claims Analyst

Los Angeles, CA

Denesik, Kshlerin and Willms

Los Angeles, CA

Claims Analyst

Provide assistance and ensure transparency in the communication to key internal and external clients e.g., IT, business development, actuarial
Develop conclusions based on data analysis and make recommendations to management
Assist management in the development of claim resolution strategies
Works with Cat Insurance Business Systems to develop claims data interface and management processes
Researches claims data, performs analysis and makes recommendations on go-forward actions to management
Assist with administrative work for application preparation
Provide technical leadership and guidance to the analytics, reporting, and process improvement teams

Dallas, TX

Resolute Claims Analyst

Dallas, TX

Steuber-McGlynn

Dallas, TX

Resolute Claims Analyst

Demonstrates/models the Network’s Service Excellence Standards of Performance in interactions with all customers (internal and external)
Familiar with process improvement and project management methodologies
Provides on-call support after go-live
Performs additional duties as assigned
Maintains confidentiality of all materials handled within the Network/Entity as well as the proper release of information
Complies with Network and departmental policies regarding attendance and dress code
Proactively completes assigned application deployment, management and testing tasks

present

San Francisco, CA

Senior Claims Analyst

San Francisco, CA

Rosenbaum Inc

present

San Francisco, CA

Senior Claims Analyst

present

Provide coaching to peers and proactively provide input to improve process and procedures. Performs other duties as assigned
Develop and execute Construction Claims Service strategies and programs in the NYC Metro
Directs internal partners and third party service providers in various Risk Management activities
Assists with policy management and the collection/compilation of renewal data
Assists management with HUD audits, as necessary
Market and promote construction claims services, management of projects, financial planning, and control
Interface effectively with clients, coworkers, and others

Education Education

Bachelor’s Degree in Accuracy

Colorado State University

Bachelor’s Degree in Accuracy

Skills Skills

Advanced Knowledge of healthcare delivery Strong functional knowledge and broad multifunctional knowledge of healthcare delivery
Excellent ability to build and maintain business relationship with clients by providing professional and accurate service
In addition to other lines, knowledgeable of liability and worker's compensation claims processes and best practices
Demonstrated ability using all Microsoft applications, including strong keyboard and navigation skills, and capability to learn new programs
Excellent customer service skills with the ability to diffuse difficult customer challenges and possess excellent problem solving skills
General knowledge of the Cat Inc. warranty related systems for registration, claims and quality & reliability (is assigned to ESC)
Ability to work under pressure; ability to work proficiently and efficiently in a timely manner
3-5 years professional experience in (re)insurance, with solid knowledge/subject matter expertise in claims administration
Excellent communication skills & attention to detail
Advanced knowledge of and the ability to recommend and implement claims policies and procedures

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15 Claims Analyst resume templates

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Claims Analyst, Bodily Injury Resume Examples & Samples

Investigates claims regarding liability, injuries and other accident related damages promptly
Establishes and maintains adequate case reserves by adhering to the BI reserving protocol and practices; complies with all established protocols regarding identification, notification and reporting to Major Claims; complies with all established protocols respecting claims settlement authority
Collects and documents claims related information in a clear and concise manner while adhering to established protocols to ensure accuracy and quality of information
Establishes and maintains proactive and sound litigated claims file handling by adhering to established guidelines
Manage both potential indemnity and expense to ensure sound cost management principles and practices
Exercise sound judgment in the evaluation and resolution of all meritorious claims considering all available information adhering to established guidelines
Makes prompt contact (in person where practical) with all unrepresented claimants to establish and maintain a relationship of trust and cooperation in order to resolve claims of minor to moderate complexity in a timely manner through a fair and proactive process
Manages expectations of claimants throughout the claims process by maintaining regular follow up contact, and delivering on commitments made to resolve claims in a timely manner and fair process
Communicates with clients, third party claimants, witnesses, health care professionals, law enforcement personnel and forensic experts with respect to their role, rights and responsibilities in the claim process in order to establish and maintain their cooperation and / or collaboration
Build trust and business relationships with Plaintiff Counsel to resolve claims files in a timely manner through a fair, reasonable and professional manner through good communication
Proactive management and collaboration with Defence Counsel in partnership around all established claims handling and best practices
Complete all required reports and all notepad entries in a timely manner
Generally works inside the office environment; are expected to attend out of office settlement meetings, mediations and trials. In person visits are also expected
Occasional or frequent overnight travel, daily travel to other locations. Some travel required outside of business hours
May be required to work irregular hours to schedule activities around availability of key contacts or events
Driving and travel as required

Claims Analyst Resume Examples & Samples

Highly adaptable to an ever changing environment
Knowledge of PC functions in a Windows based environment
Excellent communication skills & attention to detail
Ability to work in a very goal oriented environment
Claims background
Fraud background

Claims Analyst, Bodily Injury Resume Examples & Samples

Investigates complex claims regarding liability, injuries and other accident related damages promptly and thoroughly by pursuing investigation to logical conclusion
Exercise sound judgment in the evaluation and resolution of complex meritorious claims considering all available information adhering to established guidelines
Makes prompt contact (in person where practical) with all unrepresented claimants to established and maintain a relationship of trust and cooperation in order to resolve claims of high complexity in a timely manner through a fair and proactive process
Manages expectations of claimants throughout the claims process by maintaining regular follow up contact and delivering on commitments made to resolve claims in a timely manner and fair process
Generally works inside the office environment; are expected to attend out of the office settlement meetings, mediations and trials. In persons visits are also expected
Driving and travel as required. May include occasional or frequent overnight travel and daily travel to other locations
Demonstrate strong leadership and provide coaching, mentoring and training more junior analysts

Claims Analyst Resume Examples & Samples

Prior experience in the healthcare industry
Claims processing experience
Proficient in Microsoft Suite
Managed care and/or delegated group experience
Prior analytical work
Ability to read contracts

Claims Analyst Resume Examples & Samples

Experience using DOFR
Medical record coding experience
Certified Professional Coder (CPC) and/or Certified Coding Specialist (CCS) preferred

Senior Claims Analyst Resume Examples & Samples

Manage client relationships by providing and updating the client on status of information needed. Request and evaluate medical information. Manage the information as it is received. Communicate with clients, advisors and other parties regarding the handling of the claim. Handle claim referrals from team members and assists other analysts with complex claims as necessary
Within designated authority level, adjudicate timely claim payments by determining the type and amount of the claim, verifying in-force status of the insurance policy, confirming policy provisions and determining the appropriate payee of the benefits
Coordinate investigative efforts ensuring appropriateness of referral of claims to internal resources and outside vendors. Provide thorough review of contested claims
Actively manage claim reserves throughout the claim process
Understand regulatory requirements both legal and compliance related to contracts and insurance claims in general
Utilize referral resources and vendors appropriately to manage claim costs throughout the life of the claim. Performs other duties as assigned
Demonstrated problem solving and negotiation skills
College or equivalent with 3+ years of experience

Claims Analyst Resume Examples & Samples

Education/ Training
HS Diploma, some college preferred
3 plus year claims resolution and collection experience, preferably in the apparel industry
Clear understanding of basic Accounting terms, practices and concepts is required
Strong verbal and written communication skills are necessary
Intermediate knowledge of MS Office Excel, Word and Outlook is required
Basic knowledge of the Internet and web browser is required
Data entry experience on personal computers and mainframe
Sense of urgency and ability to work under pressure
Able to communicate professionally and effectively in both written and verbal forms
Completes administrative tasks accurately and in a timely manner
Develop effective strategies to achieve organizational goals
Ability to multi-task and prioritize workload independently

Senior Claims Analyst Resume Examples & Samples

Manage client and advisor relationships over the course of the life insurance settlement
Determine settlement requirements
Request and evaluate medical information as required on contestable life claims. Manage the information as it is received
Handle claim referrals from team members and assist other analysts with complex claims as necessary
Provide thorough review of contestable, foreign and complex claims
Understand regulatory requirements related to contracts and insurance claims in general
Utilize referral resources and vendors appropriately to manage claim costs throughout the life of the claim. Within approval limits, provide peer review and approvals
Provide coaching to peers and proactively provide input to improve process and procedures. Performs other duties as assigned
Understanding of life insurance terminology and life claim settlement practices

Claims Analyst Resume Examples & Samples

Obtain deduction detail and back-up from specific customers
Investigate unknown deductions by calling customer AP depts./Vendor Relations
Negotiate deductions and settlements as needed
Work closely with sales, customer service, shipping, VAS to resolve deductions
Reconcile deduction information obtained to determine if credit needs to be issued or if the deduction should be denied and collected back from the customer
Must keep DDO and DDNAO within specific targets
Communicate effectively and asservitely with customers, both internal and external
Follow up, Organizational; Negotiation, Communication, and strong Analytical/problem solving skills are all crucial factors for success in this position. In addition excellent written and verbal skills are required. Strong sense of urgency
Associates degree in Business Management or Business Administration or related degree. Applicable experience will be considered over degree

Claims Analyst Resume Examples & Samples

Validation of marketing and pricing claims and deductions
Business partnering with cross functions including external customers, Regional Sales and
Marketing, Finance and Supply Chain

Claims Analyst Resume Examples & Samples

All Claims started within five business days of receipt from loss mitigation or foreclosure
Filing of all investor/insurer claims within required guidelines to reduce exposure to curtailments and/or fines. In 2005, claims paid to Fifth Third totaled approximately $30.0 million
Track all claims monthly for status update and/or proceeds
All claims proceeds posted per investor/insurer requirements within 48 hours of receipt includes posting principal, interest, escrow, other advances, buydown funds, unapplied funds, up to $1 million per week
Close out accounts to ensure all balances equal to zero through chargeoff and correct the appropriate MortgageServ system settings
Work with attorney network to ensure evictions, redemption, title issues, mobile home issues, conveyances and reconveyances are handled with due diligence to reduce exposure to curtailments and/or fines
Work with property preservation vendor, hazard claim vendor, claims outsourcing vendor, city officials, etc. to ensure that the properties are being maintained to investor/insurer requirements
Math skills
0-2 years mortgage default or mortgage servicing related experience
Prior PC experience to include advanced Excel, Word and Access

Claims Analyst Resume Examples & Samples

Adjudicate claims promptly and effectively in a professional and empathetic manner
Approve legitimate claims within prescribed authority limits and Service Level Agreements
Deny claims or rescind policies when required based on contractual definitions, limitations and exclusions
Approve disability payments based on diagnosis, treatment, restrictions and limitations and occupation
Material misrepresentation, innocent and fraudulent
Rescinding insurance coverage
Disability case management
Accidental death
Contractual medical diagnosis vs clinical diagnosis
Executors of estates and letters of administration

Senior Liability Claims Analyst Resume Examples & Samples

Interacts with TWC employees and business partners, the public, local defense counsel, external insurance representatives, and TWC’s Third Party Administrator (TPA) in the investigation and resolution of liability claims within a predetermined amount of monetary authority
Researches, resolves and responds to verbal or written requests from insurance carriers, defense counsel, employees and TWC business partners
Directs the TPA adjusters on the use of cost-containment measures such as the retention of experts, subrogation, etc
Participates in periodic and ongoing claim reviews and audits to ensure that the claim file is reserved appropriately and that the TPA has implemented an aggressive action plan to resolve each claim in a timely and cost effective manner
Assists with training of TWC personnel throughout the organization
Candidate must have 11 - 15 years of experience in managing Auto and/or General Liability claims for a Third Party Administrator (TPA), insurance carrier or within a corporate environment
Broad knowledge terminology across multiple jurisdictions as it relates to liability claims; grasp of basic liability principles
Must be able to handle sensitive and confidential information appropriately
Proven track record managing multiple projects/initiatives independently
Ability to follow through on assigned tasks with limited supervision
Attention to detail and ability to edit and proofread effectively
Ability to build internal and external collaborative relationships and work as part of a team
AIC, ARM or other equivalent designation
Bachelor’s degree (B. A.) from a four-year college or university or equivalent training, education and experience

Claims Analyst Resume Examples & Samples

3 or more years MTV claims processing experience
Ability to analyze and use data to make decisions
Project and testing experience
Ability to review and create reports

Claims Analyst Resume Examples & Samples

Research and resolve wholesale customer disputes and claim charges for all divisions to final disposition
3+ years’ accounts receivable, claims resolution and collection experience, preferably in the apparel industry
Attention to detail with accuracy; Sense of urgency and ability to work under pressure

Claims Analyst Resume Examples & Samples

Analyzing, adjudicating and managing Life and Disability claims taking into account contractual provisions, medical history and all other pertinent information, to determine eligibility for benefits
Approving disability payment periods based on medical evidence
Communicating effectively with customers,physicians, lawyers and branches verbally and in writing
Handling phone inquires/complaints promptly
Meeting or exceeding all service and quality objective
Deny claims or rescind policies when required based on contractual definitions, limitations and exclusion

Claims Analyst Resume Examples & Samples

Prior experience working within the Health Service Industry
Intermediate knowledge of Microsoft Word, Excel and PowerPoint
Intermediate knowledge of Access database reporting
Knowledge of SQL
Strong analysis background
Experience in a medical claims environment
Prior testing experience
Bachelor’s Degree in Business Administration or a related field

Professional Claims Analyst Resume Examples & Samples

Analyzes insurance and matured endowment claims to ensure compliance with organizational and government guidelines
Maintains an ongoing effort to determine and maintain equity with current claims trends
Conducts analysis of current claims trends and investigates means to improve claim processes. Recommends improvements and implements same as approved
Researches and investigates claims systems to evaluate potential impact to organization. Recommends adjustments or changes to systems as appropriate
Analyzes claims financial reporting practices and reconciliation for client companies. Identifies issues and recommends alternative courses of action
Informs management of potential liabilities or process improvements related to current claims practices
Bachelor's degree in insurance, business administration or related field preferred
Two or more years of claims experience
Experience working with Lotus Notes, Vantage, DRPS, Life 70, Keymaster and CK4
Experience with investigating internal claims practices
Experience working with appropriate claims processing procedures and documentation, and administrative procedures, legislative requirements, and medical principles as they related to examination and approval of life and disability insurance claims
Strong interpersonal skills to interact with team members
Strong communication skills to communicate with clients
Good human relations skills to provide leadership and work guidance to less experienced personnel

Senior Claims Analyst Resume Examples & Samples

Lead a team in the analysis or preparation of a complex construction claims, being responsible for the deliverable to the client, whether it be a report, presentation, or expert testimony
Management experience, along with extensive experience in Project Controls, CPM scheduling, delay analysis, productivity analysis, claims, and dispute resolution
Experience with Heavy Highway, transit or building construction, and a strong construction background on large, complex projects is highly preferred
Establish and maintain professional business relations with clients
8+ years of construction claims experience

Claims Analyst Resume Examples & Samples

This position is in a fast-paced, high volume environment with set production goals
Personal computer operation with skills in various software applications such as word processing, spreadsheet, electronic mail and presentation
Strong organizational skills, attention to detail with high degree of accuracy, and the ability to work somewhat independently
Life Insurance experience

STD Claims Analyst Resume Examples & Samples

Makes sound decisions at the time of initial adjudication
Develops file that demonstrates appropriate decision was made based on documentation
Develops appropriate business relationship with claimant and the employer. Initiates constant communication with the claimant and employer throughout the life-cycle of the claim
Reviews and determines continuing claim liability, which includes evaluating and obtaining claim documentation, resolving questions, and determining any changes in status or benefits
Determine financial liability based on salary, other income sources and contract language. Approve initial payment and determine qualification of continuing payments. Benefit periods can be from 13 - 104 weeks
Communicates any change in liability or claim status to claimants, policyholders, and appropriate Home Office departments
Provides various reports to policyholders per contract requirements
Determine eligibility based on contract language, payroll records, and other supporting documentation
Demonstrates flexibility and ability to support unique customer requirements
Knowledge of disability claims procedures
Knowledge of disability and group insurance
Strong knowledge of medical terminology
Analytical and decision-making skills
Proficient with personal computer and Microsoft applications
Ability to maintain regular and predictable attendance in adherence to department and company attendance expectations
Short-term disability claim processing experience (2 or more years required)
Ability to recognize when to escalate an issue
Excellent organizational skills, attention to detail with a high degree of accuracy, and the ability to work somewhat independently and apply a sense of urgency
Proven leadership and/or mentoring experience

Claims Analyst Resume Examples & Samples

Investigate, analyze and respond to complaints from the following sources: Consumer Protection Agencies, Regulatory Agencies, letters of intent/demand letters from Attorneys, claims addressed to Upper Management, claims forwarded to the Corporate Offices
Investigate liability complaints against First American and/or independent contractors dispatched by First American
Represent the Company in Small Claims Cases
Basic mechanical, technical and contract knowledge and understanding (expected to increase with time)
Possess analytical and investigative skills

Claims Analyst Resume Examples & Samples

Associate degree or equivalent education in any business or communication related field required. Bachelor degree preferred
Ability to recognize, prioritize, and perform required activities with minimal supervision required
Must be detail-conscious, organized, responsible, and dependable
Ability to handle a variety of tasks with an appropriate sense of urgency required
Excellent interpersonal and communication skills required, with the ability to function independently as well as in a team environment with both internal and external customers
Keyboarding, Windows, Word, and Excel proficiency required
Must be able to consider all inputs in making sound decisions in choosing a course of action
Must be willing and able to assume additional duties, responsibilities, and assignments as needed

Claims Analyst Resume Examples & Samples

Approving disability payment periods based on medical evidence, treatment, restrictions and limitations
Communicating effectively with customers, physicians, lawyers, and branches verbally and in writing
Meeting or exceeding all service and quality objectives

EDI Claims Analyst Resume Examples & Samples

Knowledge of HIPAA/EDI X12 v5010 healthcare-related file formats including the 820, 834, 835, 837, 270, 271, 276, 277, 278, 999, TA1 and 824 are required
Proficiency with regulatory requirements associated with HIPAA, CAQH CORE, ICD-10, and the Affordable Care Act,
Fluent with commonly used EDI concepts, best practices, and procedures within the health care industry
Strong verbal and writing communication skills - both technical and non-technical
Ability to look at the larger picture and understand the interactions of different business and IT teams
Leadership, communication, interpersonal skills coupled with strong customer driven orientation
Specific knowledge of claims, enrollment, and premium business processes in a commercial, Medicare, or Medicaid health plan/TPA organization
Familiarity with Quality Assurance concepts and test plan development

Senior Business Claims Analyst Resume Examples & Samples

3+ years of experience in business / finance and data analysis
3+ years of experience gathering requirements from the client / business and documenting
3+ years of experience in claims operations and claims experience (fully understand how claims are paid and various aspects of claims)
2+ years Claims processing platform experience, (i.e., CSP Facets, Unet, Cosmos)
Network Management background
Clinical background or experience working with clinical is desirable
Coding experience

Claims Analyst Resume Examples & Samples

2+ years of Health Insurance and Claims Administration experience
High School Diploma and/or Associate's Degree in a related field
Experience in Customer Service and Medical Billing
Knowledge of ICD-9, ICD-10, CPT, HCPCs, Revenue Codes, and Medical Terminology
Medical Practice Front-end Billing and/or Claims follow-up experience
Solid analytical, problem solving and troubleshooting skills
Knowledge of HIPPA Rules and Regulations and Experience with Medicaid and Medicare claims

Claims Analyst Resume Examples & Samples

Serves as the primary claim contact for designated clients as assigned
Proactively progresses our clients’ claims from first advice to final settlement
Ensures prompt payment of claims within compliance requirements
Acts as an advocate for the client and maintains positive relations with Account Handlers, Client Managers, Account Executives and carriers
Reports claims to carriers
Provides initial and ongoing advocacy when required, including detailed coverage analysis, interpretation and negotiation of coverage and reserves
Resolves technical queries and problems
Notifies and works with sales teams on highly significant cases requiring Claims Manager involvement
Coordinates the servicing of all accounts in accordance with client requirements and internal professional standards
Gathers and reviews loss information and prepares claim status reports
Responds to and advocates on claims, coverage and exposure questions from clients and production teams
3+ years claims experience
High School diploma required; degree preferred
Knowledge of claim handling processes and procedures
Understand medical case management and cost containment programs
Understand company products, services, global network, and industry practices
Understand the basic process and value basic data analytics and benchmarking
Ability to communicate technical information orally and in writing
Ability to analyze and provide concise conclusions
Handle multiple tasks simultaneously and effectively prioritize to meet deadlines
Be self-motivated, able to work both independently and within a matrix team structure

Claims Analyst Resume Examples & Samples

Demurrage analysis
Process demurrage claim
Update p/l (inform deals desk) - Ensure all income/costs are being captured in the p/l
Chasers

Business Claims Analyst Resume Examples & Samples

Handle customer injury claims including premise and loss prevention security claims of varying severity; Responsible for all aspects of claim handling including gathering and reviewing key documents/evidence, interviewing witnesses, drafting correspondence, negotiating resolution, and managing the documentation of all work in our claim system
Investigate and respond to cease and desist letters, primarily intellectual property business matters
Provide litigation support for attorneys on litigated files, including consumer class actions, trademark/copyright lawsuits, and bank related actions; Responsibilities include identifying and interviewing witnesses and gathering documents, reviewing and responding to discovery requests, and maintaining an updated central litigation file of notes, documents, and key dates
Advise on vendor payment disputes and collection efforts
Assist with product recalls, including gathering sales information, communicating with customer, vendors, the CPSC and Health Canada
Investigate and respond to customer-related agency charges, including Better Business Bureau and Attorney General complaints
Respond to third party subpoenas
Some legal research and work on long-term projects as requested

Seasonal Claims Analyst Resume Examples & Samples

Evaluates/processes Travel Bonus rebates, Buyers claims, wholesale claims and cash back rebates for Affinion products. Enters member and rebate information into Travel bonus system/GRS system
Performs back up responsibilities for evaluating/processing GRS claims
Handles bonus/claim/rebate customer service calls and escalated calls. Provides program specific information to members and agents. Handles member inquiries regarding fulfillment, processing and status of claims/rebates
Performs daily audits of all bonus, claims and rebates to ensure accuracy. Document audit results and corrects errors
Performs follow up inquiries and makes necessary call backs
Assist supervisor with the completion and documentation of processes and procedures
Performs filing and documentation functions
Handles backline service support as needed

Claims Analyst Resume Examples & Samples

2-3 years physician/medical billing experience, specifically with charge entry, claims processing and third party payor reimbursement
Working knowledge of CPT, HCPCs and ICD-10 coding; Medical billing or coding certificate preferred
EMR/EHR experience required
Detail oriented and demonstrates high quality work product
Analyze and verify claim details submitted, check for conflicts, errors or billing inconsistencies and submit all claims for payment. Maintain all related claims submission reports
Monitor claim status and resolve claim edits, rejected and denied claims
Processes account adjustments when applicable, including reviewing and resolving edits created by internal billing system and electronic transfer
Prepare and generate invoice, paper claims and billing statements
Ensures pertinent information relating to patient accounts and/or payer interaction is documented in billing system
Communicates effectively, both verbally and in writing, to third party payors, government agencies, MSO staff and other internal departments
Monitor and process unapplied credits and overpayments within the system in a timely manner

Claims Analyst Resume Examples & Samples

Creates or reviews complex claims disputes large projects
Researches claims data, performs analysis and makes recommendations on go-forward actions to management
Reads Project Diaries and Assign CPM Codes to Contractors Activities
Correlates and Organize Project Documentation Data
Read and Understand Construction Plans and Documents
Perform complex claims analysis with minimal supervision
Draft Reports of Claims Analysis for management review
LI-NF

Senior Claims Analyst Resume Examples & Samples

Oversees property claim documentation and supports Risk Management staff in handling other claim types
Assists in the evaluation of claim reserves and settlement requests, providing support information and recommendations to the VP Risk Management for authorization decisions
Directs internal partners and third party service providers in various Risk Management activities
Prepares monthly and quarterly Risk Management status reports as well as ad hoc loss runs and other claim data analyses from the TPA’s system, company information and other sources
Supports Risk Management in department-related research and projects as requested
Minimum 5 years’ experience in a large, multi-location corporation, with at least 2 years’ experience in a Risk Management department
Claims experience with emphasis on workers compensation management required
Ability to effectively prioritize, organize, and perform multiple tasks with varying deadlines
Workers Compensation Claims Administration Certified (or designation in-process) preferred

LTD Claims Analyst Resume Examples & Samples

Communication with other areas of underwriting, sales and special investigations may also be necessary. The claims must be managed while ensuring customer satisfaction
Determine eligibility based on contract language, payroll records, and other supporitng documentation
Determine financial liability based on salary, other income sources and contract language. Approve initial payment and determine qualification of continuing payments
Adhere to ERISA and other federal/state law concerning group disability insurance
Creates written letters to the claimant for the purpose of providing concise explanations for claims determinations
Experience with the application of policies, practices, and procedures in a business environment
Some knowledge/skill in presentation, electronic mail, data entry, plus PC knowledge to include various software packages, e.g. Word, Excel
Strong organizational skills, attention to detail with a high degree of accuracy, and the ability to work somewhat independently and apply a sense of urgency
Good analytical and decision-making skills

Claims Analyst Intern Resume Examples & Samples

Research and support revenue related deduction disputes and post audits from customers
Assist in account analysis, reconciliation and reporting at month-end
Assist with internal and external financial audits and reviews
Prepare ad hoc analyses and participation in special projects as needed
Review of customer contracts and procedures for revenue deduction programs to ensure compliance

Claims Analyst Resume Examples & Samples

Investigate, analyze and respond to complaints from the following sources: Consumer Protection Agencies, Regulatory Agencies, letters of intent/demand letters from Attorneys, claims addressed to Upper Management, claims forwarded to the Corporate Offices
Investigate liability complaints against First American and/or independent contractors dispatched by First American
Represent the Company in Small Claims Cases
Excellent communication skills (Oral and written)
Basic mechanical, technical and contract knowledge and understanding (expected to increase with time)
Exceptional customer service skills
Possess analytical and investigative skills
Proficient in Microsoft Word, Outlook and ability to navigate through Access
Fundamental understanding of the home warranty industry
Ability to keep composure in hostile conversations
Bachelors Degree or commensurate work experience
1-2 years of previous customer service experience
Previous leadership experience desired but not required (experience could be work related, school or extracurricular activities related)

Claims Analyst Resume Examples & Samples

Analyzes referrals and claims information for accuracy according to established guidelines and provides education/feedback and reports as applicable
Assists Claims Auditor with tracing sources of inaccuracies; reports and proposes remedial action to appropriate manager
Prepares detailed analysis of claims activity and submits reports/findings as requested
Carries out and maintains records of special processing payment adjustments/check requested
Works with Finance Department and others as resource regarding all aspects of Outside Medical Claims; researches and provides reports as requested
Reviews processing of outside medical payments on a continuous basis
Ensures safeguarding of assets through the verification of documentation, approvals and accurate coding of provider service and accounting data
Monitors and coordinates special transactions such as check adjustments and credits
Formats and prepares statistical reports and works close with CAD and local Finance Department to assist with budget monitoring and to assist with financial analysis activities
Reviews and recommends accurate recording of outside medical utilization data by testing for appropriate and consistent invoice coding
Performs special comprehensive reports as indicated or requested by management
Minimum two (2) years of claims analysis and medical billing experience
Bachelor's degree in accounting, audit, finance or management

LTD Claims Analyst Resume Examples & Samples

This position requires extensive or prolonged typing/keyboarding and phone communication
Ability to travel and assist in sales presentations when necessary
Experience in insurance, investigation, research, LTD claim processing or financial reconciliation

Claims Analyst Resume Examples & Samples

Must have experience in Project Controls, CPM scheduling, delay analysis, productivity analysis, claims, and dispute resolution
An intuitive knowledge and ability to quickly understand principals of construction and contractor means and methods is necessary
Exceptional written and verbal communications and organizational skills are a must
The successful candidate must interface effectively with clients, coworkers, and others
A Bachelor of Science in Construction Management, Civil/Mechanical/Electrical Engineering, Architecture or related degree is required

Claims Analyst Resume Examples & Samples

Initial intake, review and submission of all General Liability and Property Damage claims
Maintain General Liability and Property Damage claim database
Maintain Litigated claim database
Assist in coordination of funding for repairs with Property Management and Construction department for damage claims where outside monies are expected to be reimbursed
Review, document and analyze financial reserving on all claims
Review and analyze lease terms on all claims
Provide direction & interpretation on coverage and lease terms & make recommendations on all newly submitted claims
Maintain active diary system for frequent and routine follow up on existing files
Directly pursue financial recovery on property damage claims below deductible
Document all information and status updates on claims in Risk Management Information System
Discuss maintenance and property condition issues with Property Management and Construction when premise condition appears to be root cause of incident
Ensure carrier and/or TPA’s active review of claims with routine follow up and status requests
Recommend & select specific carrier adjusters authorized to handle the account
Oversee claim conference calls with insurance carrier and insurance broker
Main contact, both internal and external, for claim related issues
Co-Lead claim and litigation routine meetings with the General Counsel of Real Estate
Pursue appropriate deferment on cases where company is not contractually obligated to indemnify
Ensure that insurance carrier keeps focus on disposition of cases, reserve accountability, appropriate contract interpretation and legal exposures to company
Strong communication skills: written, verbal and listening
Financial analysis skills [insurance cost allocation]
Prior experience with RMIS systems
Above Average computer skills including Microsoft Word, Excel and Outlook
Professional work ethic and demeanor
Detail-oriented in order to complete work accurately and timely
Must have commercial property/liability insurance experience

Project Claims Analyst Resume Examples & Samples

Must have experience in analysis or preparation of a complex construction claims, being responsible for the deliverable to the client, whether it be a report, presentation, or expert testimony
Earned Value analysis and trending, construction contracting, planning, staffing, budget management, and resource allocation required
Market and promote construction claims services, management of projects, financial planning, and control
5+ years of construction claims experience
Previous success developing new business
Knowledge and ability to quickly understand principals of construction and contractor means and methods is required

Claims Analyst Resume Examples & Samples

Bachelor's degree with 1+ years of experience preferred, or a high school diploma or equivalent with 3+ years of related work experience
Ability to actively listen while you gather information on the telephone and provide excellent customer service skills
Excellent analytical, organizational, problem solving, decision-making, and multi-tasking skills
May be required to become an associated person of Princor Financial Services Corporation, which requires fingerprinting, and a full background check

Workers Comp Claims Analyst Resume Examples & Samples

1+ year of Claims experience
Workers' Compensation background
Microsoft Office/Suite proficient (Word, Excel, Outlook, etc.)
Prior Processing experience in a Claims support role
Familiarity with Insurance policies, coverage forms and basic coverage analysis

STD Claims Analyst Resume Examples & Samples

Manages assigned caseload of disability claims for Short Term Disability
Develops plan to address disability obstacles and coordinates with claimants attending physicians, and employers to return people to work
Coordinates with Life Waiver team when benefits integrate
Steps in to manage other team members’ work assignments as necessary
Strong organizational, interpersonal, and written and verbal communication skills
Strong analytical and conceptual thinking abilities

Advanced Claims Analyst Resume Examples & Samples

Adjudicate life insurance claim payments by determining the type and amount of the claim, verifying in-force status of the insurance policy, confirming policy provisions and claim requirements, determining the appropriate beneficiary and processing payments. Work with legal, medical and underwriting to determine benefits available on contestable and other complex claims. Coordinate referrals for additional investigation and/or litigation management
Manage client and advisor relationships by providing and updating on status of information needed. Request and evaluate medical information. Manage the information as it is received. Communicate with clients, advisors and other parties regarding the handling of the claim. Handle claim referrals from team members and when appropriate provide direction to team members. Review and approve claims that are complex or technically difficult
Understand and clarify legal, compliance and regulatory requirements related to insurance contracts and claims in general. Stay apprised of changing regulations and updates to insurance law. Provide expertise to business partners and team members regarding required process changes
Provide coaching and training to team members. Provide feedback to improve processes and procedures. Identify issues and provide direction to proactively address issues. Manage and oversee projects in the insurance claims area
3 to 5 years Life Insurance death claim experience
Excellent communication skills; written, verbal
Ability to work on and influence a team
Understanding of life insurance contract law, regulations
College degree or insurance claims industry experience
Industry course work such as ICA, LOMA, ALU, CLU, etc. is preferred

GAP Claims Analyst Resume Examples & Samples

Handle initial report of loss and control costs. Investigate and maintain a complete and thoroughly documented claim file
Conduct timely investigations including recorded statements
Identify subrogation and/or salvage situations in a timely manner to protect the interests of the Corporation
Develop subordinates
Maintain necessary licensing and continuing education
HS diploma or equivalent required. Associate / Bachelor's degree in business related discipline preferred
3 + years in financial services or similar industry is needed. Prior leadership experience is preferred. Education may be used as a proxy for experience
Perform technical tasks required to support ongoing business operations
Typically requires advanced knowledge of Microsoft Office Programs

Warranty Claims Analyst Resume Examples & Samples

Demonstrate high integrity and compliance with all laws and regulations
Be focused on long-term value creation
Possess an entrepreneurial spirit, and prioritize her/his work to focus on the highest-value activities first
Be comfortable delivering on short time frames and meeting deadlines
Understand and anticipate customer requirements
Be open to learning and challenge
Embrace change and be motivated to identify new opportunities for the company
Be modest in nature, recognizing the accomplishments of the team before the individual
Be respectful of others
At least one year of relevant work experience in customer service
At least one year of relevant work experience in insurance or warranty claims

Claims Analyst Resume Examples & Samples

Acts as Claims Department subject matter expert on departmental and corporate projects. Supports business definition and testing efforts, attends project meetings, and provides internal and external status reports
Works with management and associates to document current business and workflow processes and collaborates in identifying, defining and documenting process improvement options and alternatives
Prepares detail and summary level reports including written interpretation of analytic results for senior management
Analyzes and trends claims issues, performs true root cause analysis and determines next steps for resolution and process improvement
Researches issues, compiles feedback and drafts corresponding business requirements documents and business decision documents as needed
Participates on conference calls with supervisor/manager/director other departments to provide project status, communicate changes in processes, and issue resolution
Communicates test findings in a structured report format
Build strong cross functional relationships that can be leveraged to understand issues that would not be in the sample size
Escalate issues when on issue results in multiple discrepancies
Assist supervisor, manager, and/or director with projects and problem resolution as required
Runs and analyzes ad-hoc reports
Formulates and applies analytical reports using the company’s database to develop and interpret information that assists in developing test cases
Tests validity of data using related software, service, manual calculations, or products. Frequently concentrates on collecting and analyzing data and developing test case scenarios both positive and negative
Recommends processes or updates to current workflow as a result of research or analysis
Provides assistance and support as needed to develop training material on new updates and enhancements
Responsible for special projects that require analytical skills, forward-thinking whereby data is analyzed from different angles to think of the unknown, test the process
Track and follow-up on all assigned high-level discrepancies, utilizing systems and procedures
Maintain a high standard of data integrity, including systems and reports
Preferred A Bachelor's Degree in a related field or equivalent directly related experience
Preferred 5+ years of experience in practical work within a healthcare organization
Required 3+ years of experience in claims processing with a solid understanding of internal company claims functions
Advanced Knowledge of healthcare delivery Strong functional knowledge and broad multifunctional knowledge of healthcare delivery
Advanced Demonstrated organizational skills Demonstrated organizational skills with the ability to prioritize, coordinate multiple tasks, and work independently
Advanced Demonstrated problem solving skills
Advanced Demonstrated written communication skills
Advanced Demonstrated interpersonal/verbal communication skills
Advanced Ability to effectively present information and respond to questions from peers and management Strong analytical and problem solving skills
Preferred Intermediate Microsoft Access
Required Intermediate Other Knowledge of Perot / Peradigm system
Required Intermediate Other Thorough knowledge of WellCare claims processing environment and procedures
Preferred Intermediate Other Knowledge of Legacy and Intelliclaim systems / processes

Claims Analyst Resume Examples & Samples

Provides guidance, direction and specialized assistance for the resolution of difficult and complex claims issues
Works on claims issues of significant risk or impact to the organization requiring advanced knowledge of claims principles
Presents claims findings in a formal environment
May oversee claims review
Performs “what if” analysis
Research claims data
Documents and drafts reports of claims analysis findings
Read Project Diaries and Assign CPM Codes to Contractors Activities
Correlate, Organize, and Synthesize Project Documentation Data
Assist management in the development of claim resolution strategies
Assist in training less experienced staff
Bachelor's degree in Engineering, Architecture, Construction Mgmt or Business plus 7 years related experience. Without preferred degree, 11 years’ experience in project controls required
Able to use and Primavera, P6, Microsoft Project or similar planning and schedule analysis tools
Suitable experience involving construction litigation or alternative dispute resolution matters in lieu of Project Controls experience will be considered

Claims Analyst Resume Examples & Samples

Corresponds through verbal/written communication with policyholders, claimants, travel coordinators, etc. to gather important information to support claim decision
Serve as a customer advocate in all interactions to provide an outstanding customer experience
Productivity (Review, assess, and process claims with adhering to established SLAs)
Solid knowledge of principles and processes for claim examination, evaluation, and disposition
Strong problem solving and decision making , and active listening skills
Ability to adjust readily to multiple demands and constituencies, shifting priorities, and rapid change
Ability to communicate in a clear, concise manner appropriate to the audience via phone, email, and in writing
Strong computer literacy with demonstrated keyboard skills, solid knowledge of technology used for claims administration, and familiarity with Microsoft office software
Prior customer service experience, within a claim environment a plus
Bachelor’s degree or equivalent work experience preferred

Claims Analyst / Senior Claims Analyst Resume Examples & Samples

Reviews, analyzes, evaluates, investigates and determines benefits for larger dollar or more complex claims in accordance with policy provisions and government regulations; exercising limited discretion in the application of rules, and procedures for claim handling
Initiates payment or denial of claims via the claims system when all claim-related questions are resolved, according to policy provisions
Communicates with external and internal customers to obtain specific claim information in order to finalize pending claims and to explain claim handling
Remains abreast of Company and industry changes, federal and state legislation and regulations, as well as changes in internal processes and procedures
May provide various reports to internal and external customers
Actively participates in the identification and implementation of process improvements
Maintains frequent written and verbal communication with the claimant and employer during the duration of the claim
Communicates via telephone with claimant, employer and other appropriate parties
Ability to meet deadlines under pressure
Good analytical and decision making skills
Experience as a Claim Analyst or other claims environment
Accident claims experience

Claims Analyst Resume Examples & Samples

Use technical skills to develop reporting tools and applications to support business objectives
Provide consultative services to the claims department to thoroughly understand their needs and translate those needs into technical solutions
Provide analytical support for various ad hoc reporting and claim support activities
Look for ways to improve efficiencies and minimize processing and workflow issues
Provide technical leadership and guidance to the analytics, reporting, and process improvement teams
Maintain understanding of departmental service standards and guidelines, systems, workflows, reports, products, and other information needed to complete work assignments
Intermediate expertise in VBA, SQL, Access and Excel. The top candidates will complete online testing for skill proficiency
Strong written and oral communication skills, including the ability to ask the right questions to fully understand business needs and to communicate technical information in a business friendly manner
Flexibility in adapting to rapidly changing technical environment
Exceptional analytical and problem solving skills and creativity in developing business solutions
Self-motivated and able to work with a high degree of independence

GAP Claims Analyst Resume Examples & Samples

Handle initial report of loss, explains claim process, coverage, and follows up for necessary documents to conclusion of the claim
Investigate and maintain a complete and thoroughly documented claim file
Handle inquiries from retail customers, financial institutions, and dealers
Review finance documents and ancillary products/refund amounts to determine outstanding balance owed on the date of loss
Review insurance company valuation (CCC, Mitchell, Audatex, NADA, Market Research, etc.), settlement breakdown, and declaration page to confirm or ensure that the primary insurance carrier paid/pays their liability
May handle special projects
Computer literate with experience with Microsoft products (Outlook, Word and Excel)
Strong data entry/typing skills
Must be able to handle up to 20-30 calls per day
Insurance license preferred
Call Center, Auto Finance, or Insurance experience preferred
Bilingual (Spanish/English) a plus
Must be able to successfully pass a pre-employment drug screen and a comprehensive background check
Must be authorized to work in the U.S

Field Claims Analyst Resume Examples & Samples

Delivers continuously improving year on year expense results by improving processes and increasing productivity
Supports rigorous quality, control and compliance programs to include an ongoing control/compliance self-assessment process
Basic knowledge of general/standard office and administrative procedures and methods

Salvage Claims Analyst Resume Examples & Samples

The Analyst will determine when and who to bill, provide actual cash value for vehicle and what documents need to be sent with the letter on initial billings for US subrogation files. The Analyst will be responsible for maintaining an accurate pending eSalvage current and backlog count; and other duties as assigned by the Supervisor
Review Legal Holds on a timely basis to ensure releases are processed timely and accurately; and in accordance with Risk Management guidelines
Handle salvage calls from customers, insurers, or Hertz locations to determine if information needs to be appended to an existing file, referred to HCM, or a new file opened. If new, all information is to be documented in a pre-established form
Initiate billing process providing actual cash value or estimated value of unit less sale proceeds to bill at fault party
On all unmatched salvage claims but no VDA, follow-up with the return location for submission of the VDA
Meet all quality standards and expectations per Best Practices
Comply with State specific regulations
3-5 years Claims Management or Accounts Receivable experience
Accounts Receivable
Auto damage appraisal a plus, but not required
Knowledge of insurance industry relating to auto damage claim recovery preferred
Superior independent decision making and critical thinking
Strong task management skills
Proficient in Microsoft Word and Excel
Strong Computer/Software skills

GI Claims Analyst Resume Examples & Samples

High quantitative affinity and highly developed curiosity
Very high desire to constantly learn and improve the front end tools to achieve best in class results for the application of the tools
Conduct sophisticated claims data mining and analytic investigations to spot underlying root causes on behalf of the Claims Analyst
Work closely with internal and external IT application and platform provider to achieve the most efficient IT set up to ensure high performing and compelling front ends
Collect data from sources and prepare reports including commentary and an analysis of trends to facilitate decision-making
Input relevant data into established systems accurately so that analysis can be undertaken
Knowledge of Claims
Effective Communications
Knowledge of Insurance Industry

Claims Analyst Resume Examples & Samples

Accurately adjudicate claims in accordance with health plan guidelines, company standards, and company procedures
Maintain minimum production standards as set by Care1st Maintain a 98% or above financial accuracy rate and a 95% or above procedural accuracy rate
Review claims for appropriate information and accurate reimbursement
Prioritize and manage individual workflow as needed
Maintain completed and updated set of resource materials necessary for processing claims
Attend all company-mandated training and remain current with knowledge in the claims field
Assist with data entry of claims as needed
3-4 years of claims processing (Commercial experience preferred)
Knowledge of CPT, HCPC, ICD-9, and Revenue codes, medical terminology, general billing guidelines, pricing, and provider contracts
Experience in processing claims according to multiple plan guidelines
Experience with application of deductible, coinsurance, and copayments
Ability to research and adjudicate CMS-1500 and UB-04 claims of all levels of complexity
Analytical skills to resolve complex claims
Strong multi-tasking skills and the ability to identify and trend processing/billing issues
Must be organized with a positive attitude
Working knowledge of Microsoft Word, Excel, and Outlook
Ability to work as a team player in a professional, fast-paced environment
Able to communicate effectively and tactfully in both oral and written form

Claims Analyst Resume Examples & Samples

Manage Workers Compensation claim activity from initial claim notice to claim conclusion; ensure a timely return to work and coordinate all activity with Benefits, Payroll and Human Resources
Assist the Director of Risk and business teams in the handling of all General Liability, Property, Builders Risk and Auto claims throughout the country
Manage the activity of the Third Party Administrators and/or adjusters on a daily basis with respects to all claims
Possess the ability to analyze claims, interpret insurance policies, and direct strategize on the resolution of all claims in coordination with the Legal Department
Evaluate and authorize claim settlements when provided with a given limit of authority
Communicate effectively the Legal Department and all business teams on updates, claim information requests, and recommendations
Review, and track all Incident Reports; follow up for additional information where necessary; make recommendations to the Director of Risk on insurance programs that may be triggered
Investigate, evaluate and strategize on resolution of non-litigated matters
Prepare monthly claims reports and identify loss trends
Assist with loss run review and analysis
Maintain Workers’ Comp-related OSHA Logs (OSHA 300) for all required business teams on a daily basis and distribute on an annual basis pursuant to OSHA guidelines
Assist the Director of Risk Management in the day-to-day operations of the Department as necessary
Bachelor’s degree with emphasis in Risk Management, Business or Finance
Minimum five or more years of experience in claims management
Knowledge of a Captive Insurance Company preferred
Must possess strong organizational and communication skills
Experience in Outlook, Excel, Microsoft Word, Power Point, Autonomy /i-Manage HP experience is a plus
Ability to work independently and manage multiple projects simultaneously

Claims Analyst Resume Examples & Samples

Bachelor’s Degree in a business related field preferred or the equivalent amount of related experience required
2-4 years’ experience in project management, and intermediate experience with analysis of information and data
Advanced MS Excel skills required. Proficiency with desktop and MS Office applications
Excellent analytical, organization, and multitasking skills
Able to work well under pressure and within short deadlines

Claims Analyst Co-op-consumer Markets Resume Examples & Samples

Monitor & report on the results of one or a few initiatives in market, conducting analysis on performance relative to expectations, and making recommendations for enhancements
Utilize current and emerging data science techniques to manipulate large structured and unstructured data sets, help identify patterns in raw data, and develop models to predict the likelihood of a future outcomes
Prototype new algorithms in software systems

Claims Analyst Resume Examples & Samples

Must be educated in shipping studies to degree level
FLUENT in English
Organised, careful, pays attention to detail, able to work in a high-pressured environment, dealing with a range of high priority issues

Claims Analyst Resume Examples & Samples

To handle, book and administer Reinsurance Claims (Treaty Non Proportional & Facultative) out of the India Reinsurance portfolio across all Non-Life Lines of Business
To perform technical claims administration duties following governing claims guidelines and processes. This includes analyzing, checking and booking of claims received from various brokers and cedants, verifying Treaty/Facultative coverage, handling reserves and settlement of claims, booking of Reinstatement Premiums
Close cooperation and coordination with Shared Services regarding Proportional Claim Events and Cash Losses, coordination of combined payments, etc
Co-ordinate and collaborate on complex claims matters with the Reinsurance Claims Manager and support risk and claims data analysis and reporting, including data quality control activities
Proactive review, reconciliation, processing and adjustment of claims (following internal claims guidelines and processes) - from first loss advice through to loss reserving updates up to claim settlements; for non-proportional treaty and/or facultative reinsurance claims/programs
Check claim coverage, treaty/risk limits and process/book relevant claims data (incl. reinstatement premiums) reported by clients (brokers or cedants) electronically, assuring accuracy and integrity of the technical claim bookings in proprietary Claims Reinsurance Ledger system
Verify, prepare and process outgoing claim settlement requests and general claim related administrative requests from clients (brokers or cedants)
Conduct ad hoc data cleansing/refinement tasks, based on specified data quality control/’housekeeping’ reports
Investigate inconsistencies, claim/account discrepancies and related issues and raise/resolve these independently or in cooperation with the Reinsurance Claims Manager
Closely cooperate with the Technical Accounting and/or Shared Services teams in respect of Proportional claims and its payments
Provide value and insight to the Reinsurance Claims Manager, Underwriters and Actuaries in respect of claims issues, loss reporting and/or large loss information, etc
Conduct month-end, quarter-end and year-end claim reserves reconciliations, supporting financial closing and reporting processes
Assist the Reinsurance Claims Manager in the collation of data, respond to queries raised by internal and/or external parties in a confident, timely and accurate manner
Bachelor degree (or equivalent), preferably in a quantitative discipline (e.g. economics, law, finance or accounting)
3-5 years professional experience in (re)insurance, with solid knowledge/subject matter expertise in claims administration
Analytical approach, diligent and accurate working style, flair for numbers, attention to detail and a meticulous eye for identifying inconsistencies or inaccuracies in claim data entry or claim data outputs
Comfortable taking ownership for own work, identifying the need for action whilst working effectively within a team. Team player with good communication and interpersonal skills
Proactive mind-set: able to work independently, demonstrating strong prioritization and time management skills and delivering against tight deadlines. Demonstrates a ‘can do’ attitude
Knowing what it takes to provide a consistently first class customer service
Proficient with MS Excel (MS Access optional/would be a plus)
Solid English language skills (spoken and written)

Senior Claims Analyst Resume Examples & Samples

Previous knowledge and experience with medical insurance processing; preferably FSA, QME, PRA claims
BA/BS Degree preferred and minimum of 3+ years related work experience in a benefits administration or outsourcing environment
Possess basic understanding of wide variety of benefit issues including health and welfare and retirement
Able to prioritize and manage multiple competing responsibilities
Show initiative including anticipating needs, suggesting improvements, and follow-up on work items
Proficient in Windows and Microsoft programs with excellent navigational skills
Projects positive, professional attitude
Detail-oriented and superior organizational skills
Works independently and with minimal supervision
Will be trusted to secure and maintain confidential information

Senior Claims Analyst Resume Examples & Samples

Basic understanding of costs and revenue streams associated with tankers trade
Overview of cargo (oil) operations on ship's side
Basic understanding of different bunker grades with their usage in different operations with regulatory 4. Good understanding of costs associated with war zone related trading
Awareness on currency regulations while dealing with invoices associated with embargo nations
Very good understanding required to grasp key contractual terms (charter party terms) with business intent
Good at written communication and negotiation skills
Culturally aligned to the company
Ability to carry out first level stakeholder management
A number cruncher
Ability to continue on a repetitive set of activities

Priority Claims Analyst Resume Examples & Samples

Perform internal and external review of data, files or medical charts to ensure that all required documentation is in compliance with guidelines; such as, CMS and other medical policies
Prepare assessments based upon facts, document the company’s position, and obtain all documents to support the analysis
Consult with management, clinicians, physicians and physician staff (if acceptable within the Region), as needed, on documentation issues, clinical deficiencies, new trends, and other regulatory issues potentially require internal policy changes
Develop and manage relationships with colleagues in a professional manner
Update tracking and billing systems accordingly
Attend department meetings and discuss unique audit findings
Responsible for conducting special projects, which may include reconciling and reviewing medical necessity
Attention to detail with the ability to quickly identify trends
Able to communicate well and exhibit good interpersonal skills
General knowledge of Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs), policy articles, and medical terminology
Self-starter and take the initiative to proactively solve/investigate problem areas
Personal accountability and able to meet deadlines
Demonstrates general knowledge of MS Office suite programs
General knowledge of Electronic Health Record systems; such as, OPS and NextGen
Demonstrates the ability to pull data, scan, and migrate into OnBase
Demonstrates high ethical standards regarding confidential patient and billing information; ensuring compliance with relevant laws, including HIPAA requirements, regulations and established Hanger policies and procedures
Bachelor’s degree is required; 4 years of practical experience in lieu of education is acceptable
Typically requires less than 1 year of related experience regarding CMS policies and medical policy
Para-Legal background (preferred)

HFP Claims Analyst Resume Examples & Samples

Conducting investigations and analyzing and evaluating the information learned
Accurately analyzing and determining coverage, liability and damages based upon the facts of each claim
Proactively managing caseload including evaluation of overall exposure and identification of potential financial impact to the policy, leading to the development of effective file strategy and sound reserve rationale
Communicating written position(s) to insured’s and other required parties on coverage, liability, damages and other issues
Appropriately working with stakeholders including defense counsel, insured’s and co-defendants
Proactively managing litigation and counsel, inclusive of litigation planning and execution, budgeting and bill review
Developing and implementing resolution strategies to achieve high quality outcomes
Ensuring files are appropriately documented
Presenting cases to management for expense or indemnity reserve authority on appropriate files
Preparing comprehensive reports to claim leadership on case developments and policy issues, etc
Participating with others in the preparation for or attendance at mediations
Providing support to, and working collaboratively with unit members on case specific issues as needed, departmental reporting and/or projects, etc
Responding appropriately and timely to inquiries/requests for information from all business partners, including agents and policyholders, providing superior customer service
Bachelor’s degree required; professional designation and/or legal degree a plus
1 to 3 years’ experience at a law firm or insurance company highly desired
Basic knowledge/understanding of financial product lines coverage and liability exposure desired
Candidate should possess strong analytical skills and be disciplined and results-oriented
Strong strategic thinking abilities and execution skills
An ability to communicate thoughts clearly and concisely, and to influence and persuade others
Superior interpersonal skills, with an ability to work well as part of a team and/or in supporting roles

Warranty Claims Analyst Resume Examples & Samples

Analyze and process engine warranty claims
Review claim information provided by dealers and, working independently or with Vendor Recovery, Engineering or Quality, process claims per established guidelines
Provide best in class support to our Fleet Customers and Dealers on a regular basis
Perform additional technical and administrative duties as assigned
Serve as a subject matter expert for assigned responsibilities
Work closely with external/internal stakeholders to understand business challenges and opportunities for improvement
BS/BA preferred; A.A. required or a minimum of 3 years of truck production, order processing, purchasing, sales administration experience, or diesel mechanic certification required
2+ industry related experience preferred
Ability to create and manage ad-hoc SQL queries within MS Access or Tableau to help support management decision making a plus
Must have strong communication and negotiation skills; proficiency in MS Word, Excel, PowerPoint and Access; and have good recall of detail and a mechanical aptitude
Must be self-motivated and able to work in a fast paced just-in-time environment with rapidly changing objectives
Must be able to accept responsibility for assigned projects and work effectively under general or minimal supervision
The ideal candidate will have a mechanical or technical aptitude, be comfortable with processing large volumes of data, and be able to provide data driven answers to questions about the material processed

Claims Analyst Resume Examples & Samples

Research customers claims and make decisions to determine if UMG should deny the claim or make a billing adjustment for pricing errors and shipment discrepancies deferring more complex issues to the credit management
Prepare paperwork for billing adjustments and, if necessary, follow up with correspondence to the customer
File claims with trucking company for lost or damaged product
Travel to accounts when necessary to assist Credit staff with reconciliation meetings
Act as a liaison between junior claims staff and Credit Manager. Give direction to junior staff when necessary
Assist Credit staff with claims reporting, special projects, return reconciliation and trouble shooting
Exceptional Problem solving skills
Computer skills including knowledge of spreadsheet and word processing
3 Years claims processing experience within media/entertainment, retail, manufacturing or similar industries with an emphasis on chargebacks and deductions

Risk Claims Analyst Resume Examples & Samples

Work closely with the General Counsel and Risk Manager on litigated matters (status and responses)
Manage Liability and Workers Compensation claims, including working with TPA’s, Attorney’s and Insurance Companies. Facilitate reports to support reserve increases and settlement approvals for such claims
Identify loss trends and work closely with the Risk Manager and Director of Safety to assist in mitigate of such trends as necessary
Collect, analyze and maintain assets schedules as needed for insurance exposure reporting
Bring to the attention of the Risk Manager any activities related to claims, insurance or contracts that generate concern
Work closely with Legal, Operations and Insurance Agent to review insurance, certificates and related contract language for the approval or denial of Newpark’s vendors
Work closely with the Risk Manager in the maintenance and renewal of Newpark’s Global Insurance Program
Assists with identification and analysis of risk exposures in areas of safety, security, safety, customer/vendor contracts, insurance policies, insurance coverage levels
Coordinates insurance policy renewals, claims and administration, issuance of insurance certificates and other risk minimization programs
Assists with reviews of insurance language and indemnification provisions in contracts, leases and agreements to protect company and ensure compliance with contractual requirements
Provides insurance summaries to business units as needed
Responds to inquiries regarding insurance programs and premium allocations
5 years of experience or equivalent

Claims Analyst Resume Examples & Samples

Ongoing review of insurance coverage and contract language
Verification and formalizing internal fee allocations and schedules
Assist with administrative work for application preparation

Claims Analyst Resume Examples & Samples

Ensure correct termination of policy according to the legal documents submitted
Disbursement of claim values based on the policy complexity and provisions; completeness and validity of documents
Accurate adjustment and calculation of claim proceeds from life insurance accumulated values
Assess survivorship death notices for policy riders, update systems and disbursement of proceeds
Notification of outstanding claim requirements through outbound correspondence
Deliver precise and comprehensive communication
Constantly meet and maintain productivity, accuracy and service level standards
Update pertinent documents, work inventories and trackers
4-year College graduate with either of the following courses
Medical
Note: Nice to have claims processing experience
MS Word, MS PowerPoint, MS Excel
Good communication skills written and oral
Ability to compose email correspondence
Alpha numeric: 28 wpm
Numeric: 33 wpm
Completion of the compliance training
Completion of the 4 - 8 weeks training period
Passed New Hire Skills Verification Exams
AWD10
Outlook360
ELAPS
Knowledge of company plans/line of business, riders and benefits
Knowledge of insurance contract law and state legislative requirements

Business Risk Management / Claims Analyst Resume Examples & Samples

Directs claims administrator or insurer for general liability, property, automobile and other types of claims as needed
Coordinates with the appropriate business unit associates to obtain additional claim information
Builds, maintains, and manages relationships with claims adjusters, insurers, outside legal counsel, and other claims related parties
Provides recommendations on settlements and reserves
Provides monthly reports of activity status and financials
Identifies claims trends and collaborates on solutions
Completes required external reporting requirements
Other duties include bookkeeping entries and claim system reconciliations
General understanding of property casualty insurance coverage
2+ years’ experience directing claims - preferred
Experience with Risk Management Information Systems and/or web page design a plus

Claims Analyst Resume Examples & Samples

Strong interpersonal and communication skills required
Strong Microsoft Office skills required – thorough knowledge of Excel spreadsheets, PowerPoint presentations and WORD documents required
Proven track record in providing a positive customer service experience while handling customer and third party claims required
Experience in dealing with claims adjusters and legal professionals required
Experience in handling claims within a corporation preferred

Claims Analyst Resume Examples & Samples

Complete claims reviews to validate accuracy and validity of client reported claims
Perform claims administration as required: validating and logging claims files and data, tracking, reviewing and aging of claims
Produce, analyze and update control reports and escalate any issues with potential or known financial impact
Analyze and validate reinsurance files and corresponding premium payments. Processing and providing accurate and timely information to internal and external stakeholders in relation to the client data
Document and follow operations procedures and adhere to SOX process controls
1-3 years experience in reviewing/approving insurance claims
1-3 years life reinsurance/insurance experience preferred
Post -secondary education or equivalent with a background in business, mathematics, economics or accounting
Intermediate to advanced MS Excel skills
Shows judgment in critically evaluating client data
Takes responsibility for quality, completeness and accuracy of work

Quality Claims Analyst Resume Examples & Samples

Review and evaluate the accuracy of the examiners’ claim decisions. Identify any inconsistent and/or inaccurate benefit and policy usage
Maintain statistical data tracking quality and production totals. Analyze trends in claims management
Conduct training needs analysis and work with managers to develop group and/or individualized training to correct developmental and performance issues
Review and assess claims reporting mechanisms to determine system inaccuracies
Identify claims-related training needs of other departments and facilitate or assist with training, if needed
Work on resolving more complex claim issues

Tslc Claims Analyst Resume Examples & Samples

Analyzes medical claims and reviews billing information for correctness and completeness
Submits data to CMS to ensure compliance with all PACE and Medicare Part D reporting requirements in the Health Plan Management System (HPMS)
One year experience in claims, claims adjusting or billing experience preferred
Previous experience in billing preferred
Familiarity with ICD-9-CM and CPT coding

Resolute Claims Analyst Resume Examples & Samples

Reviews and understands system options and specifications of Applications and utilizes the specifications as applicable to make recommendations on use
Analyzes design alternatives and makes appropriate design decisions. Designs, validates and confirms new or changed functionality with the application environment that meets customer specifications. Understands and translates the business/department functionality into Application configurations and workflow validations
Builds, tests, and debugs application to ensure the system meets end-user requirements. Builds complete testing plans to validate system parameters and functionality performs as specified with minimal guidance
Provides guidance and mentorship to other analysts
Maintains project documentation including resources used, decisions, outcomes, agreements etc
Works with vendors as appropriate to ensure smooth operation of products, reporting and resolution of issues
Supports new project development including system analysis, planning and preparation
Provides Epic product function, design, and build expertise and experience needed for successful product implementation
Participates on new implementation / installation project teams
Supports all project team members with application and information systems knowledge
Logs, tracks, analyzes, and coordinates system changes including any software code implementations
Maintains current knowledge of technology by attending appropriate continuing education training/seminars and reading related periodicals
Maintains confidentiality of all materials handled within the Network/Entity as well as the proper release of information
Comply with Network and Departmental policies regarding issues of employee, patient and environmental safety and follows appropriate reporting requirements

STD Claims Analyst Resume Examples & Samples

*This job posting is reflective of the entry level Analyst essential functions, qualifications, and physical requirements. The Sr and Specialist levels have variable essential functions, qualifications and physical requirements. Competency and skill set will determine level of placement within the posted job family
Develops appropriate business relationship with the claimant and the employer
Maintains frequent communication with the claimant and employer throughout the life-cycle of the claim
Communicates via telephone with employers, physicians (or other providers), and claimants
Communicates any change in liability or claim status to both internal and external customers
Provides various information to policyholders per contract requirements
Embraces process improvement and pursues ways to simplify and streamline our operations
The ability to perform extensive or prolonged typing/keyboarding and telephone usage
The ability to operate in a fast-paced, high volume environment with set production goals
Executes daily activities that support our core purpose, what we do and our strategic anchors. Uses the strategic anchors to guide decision-making and prioritization of work

Claims Analyst Resume Examples & Samples

Recording new claims directly onto the AIG system tahat are receives via telephone, ost, fax or emails
Entering accurate and detailed information into cliam handling platform to generate a claim number
Creating and sending customers an acknowledgement letter which includes claim number and adjuster contact information
Taking pro-active stesp to effectively manage customer expectations in order to achieve overall customer service proposition
Contributing to ensuring the Unit's Key Performance targets are met and that own objectives are achieved
Ensuring that all allocated wrk is handled within the Key Performance Targets. Department following agreed internal and external processes, policies and procedures to ensure quality and service standards are met

Casualty Claims Analyst Resume Examples & Samples

Approximately 5 years handling commercial casualty claims
College/University or equivalent industry experience
Ability to make decisions and give directions to adjusters and/or counsel
Must be a quick learner with strong communication and negotiating skills
Proficient computer skills to navigate paperless claim file system

Claims Analyst Resume Examples & Samples

Claims or litigation background
Employment practices or financial experience is a plus
Strong written and verbal communication skills
Strong interpersonal and organizational skills
Strong computer skills (Microsoft Word and Excel)

Claims Analyst Resume Examples & Samples

If assigned to other than Extended Warranty Claim, acts as the first point of contact when a property damage claim, suit or underlying material is reported. Determines the nature of the loss, coverage provided, and scope of injury and/or damage. After reviewing documents and information related to the loss, directs an investigation, if needed, secures and files all supporting documentation and verifies it for accuracy and completeness. Provides interim claim processing information and final settlement notices
If assigned to Extended Warranty Claims, establishes regular dialogue and reporting with Caterpillar Inc. product groups and CPI to inform them of claims trends or possible design problems and suggestions indicated by the trends
If assigned to other than Extended Warranty Claims, supports the cargo expediting process for Caterpillar Inc. This process involves the receipt and disposition as a result of any notice of transit damage for Caterpillar goods via ocean, rail or truck from anywhere in the world where coverage applies to goods in transit.
Updates and documents claim procedures and monitoring system with reporting capability by product line. Analyzes claims data to reduce or minimize claims. Audits and monitors claim handling performance of any Cat Insurance vendors or Third Party Administrators (TPAs) and stays abreast of claim details on significant claims. Directs the activity of claim analyst or adjusters as needed and adheres to all NAIC guidelines, Common goals agreements, and the Unfair Claim Practices Acts
Works with actuarial staff to keep them informed of trends and is involved in setting pricing and reserves based upon claims trends
Works with resources and industry contacts to stay abreast of current claims trends, technology and resources. Helps dealers achieve above average claims service and educates dealers, CISC staff, and vendors on claims goals, loss control initiatives and supporting metrics
Ensures the development of timely and meaningful claims reports
Works with Accounting to process and pay the third party legal expenses and allocated loss expense for Caterpillar Inc
Works with Cat Insurance Business Systems to develop claims data interface and management processes
Provides support to Caterpillar Dealers who elect to place their business insurance with CISC. This process involves, but is not limited to, reporting claims, resolving any problems, monitoring the performance of the selected insurance carriers, monitoring the performance of the programs, providing loss runs, and filing reviews and audits
Responds to inquiries and complaints from insurance carriers, customers, dealers, brokers, and CISC management
Participates in accomplishment of continuous improvement objectives for the department. Progress toward accomplishment of these is measured through maintenance of necessary measurements and analysis of associated data. Participates in the identification of problem areas and development of resolutions to address them
Advanced in depth knowledge of property and casualty insurance terminology
Demonstrated knowledge of and ability to apply documentation and flowcharting techniques to be used for claims procedures
Working knowledge of the functional area procedures and operations related to Caterpillar’s engine and machine businesses including PSP and PIP (is assigned to ESC)
Working knowledge of ESC products, policies, and procedures including understanding and ability to read Customized Coverage Codes (if assigned to ESC)
General knowledge of the Cat Inc. warranty related systems for registration, claims and quality & reliability (is assigned to ESC)
Proven ability to provide timely and accurate claims processing, reporting and loss prevention
Demonstrated ability to identify claims trends
Demonstrated knowledge and the ability to establish documentation, processes, and controls that support compliance with Sarbanes Oxley
Advanced knowledge of and the ability to apply statutory regulations and the Unfair Claim Practices Acts
Demonstrated knowledge of and ability to understand property and casualty policy forms and coverage descriptions
Demonstrated ability to audit and monitor claims performance of vendors, dealers, adjusters, and warranty analysts
Demonstrated knowledge of the Caterpillar dealer organization
Advanced knowledge of and the ability to recommend and implement claims policies and procedures
Knowledge of Caterpillar Inc. and CFSC operations
Advanced ability to apply effective oral, written and listening communication skills with dealers, customers, company personnel, and the financial and legal communities
Demonstrated ability to apply human relations skills
Advanced ability to apply teamwork and cooperation skills with CFSC/CISC and outsourced companies’ employees in order to accomplish given tasks
Advanced ability to work independently
Must be able to utilize a keyboard for 75% of the workday and use Microsoft software
Proven organization skills and the demonstrated ability to recognize and manage priorities
Advanced ability to provide high level of customer service support

Junior Claims Analyst Resume Examples & Samples

Terminate policy before setting up the claims process
Process death benefits based on the policy provisions, complete requirements, validity of claims and disbursement of claims benefits
End-to-end process- validation of claims, computation of death benefit value, check preparation
Assess survivor ship death notices, update required systems and make payments for policy riders
Update applicable systems with payment details made on the claim request
Generate hard copy communications regarding status of client requests and create diary reports
Follow-up outstanding death claims requirements after the report of a death in a timely manner
Meet and maintain productivity, accuracy and service level standards and deadlines on the above-mentioned transactions
Maintain and update work inventories, time trackers and other reporting documents pertinent to the process
College/University graduate preferably with previous related work experience in the financial services
Booting and shutting down computer, using mouse and keyboard (keyboarding)
Knowledge of search engine, browsers, and relevant computer applications
Minimum keyboarding skills of 30 words per minute
Keyboarding skills
Paragraph: 40 wpm
Successful completion of the compliance training
Successful completion of the eight week training program
Manages and uses the work and production tracker accordingly
Ability to use email
Proficient in using all In-Force administration systems
Knowledge of Claims and Titles functions
Able to identify the complex and non-complex transactions
Knowledge of insurance beneficiaries
Knowledge of company plans, riders and benefits including sound knowledge of insurance contract language
Mainframes
Bridger
BOSS
E Treasury

Claims Analyst Resume Examples & Samples

Good oral and written communication skills with a demonstrated ability to interact effectively with individuals at many levels in the organization and external business contacts. Good voice quality that is both conversational and professional
Ability to project a positive image on behalf of the organization
Ability to interpret and follow oral and written instructions, policies, guidelines, and processing standards
Must be detail-oriented with good organizational skills. Ability to manage time effectively
Ability to calculate figures and amounts such as discounts, interest, commissions, and percentages

Risk & Claims Analyst Resume Examples & Samples

Provide claim oversight to the company's contract claims adjusters in order to minimize claim cost
Work closely with outside counsel and TPA to negotiate claim settlements and set appropriate reserves on files
Attend mediations/trials on the company's behalf
Ensure accurate and timely claim reporting
Organize and lead semi-annual claim reviews with claims administrator
Design and implement supporting claim services to minimize claim cost
Design and distribute management reports, identifying trends and assisting field operations to take necessary steps to reduce losses
Assist managers and internal department heads with ad-hoc insurance/claim requests
Track all financial loss data and develop benchmarking statistics to be used in assessing policy limits and deductibles
Participate in market visits, ensuring all company and OSHA requirements are being met
Assist with the annual and semi-annual motor vehicle records (MVR) review process
Ensure safety training compliance with our driver training, power equipment and MSDS training
Collect underwriting data necessary for the annual insurance renewal process
Special projects requested by management

Claims Analyst Resume Examples & Samples

Administers worker's compensation, general liability, property, automobile and various other lines of insurance claims including
Bachelors Degree in Business Administration or related field, required
Fully developed communication, organizational, analytical and computer application skills

Senior Stop Loss Claims Analyst Resume Examples & Samples

This position displays effective communication skills while performing the following functions
Providing counseling to clients and assisting with client service programs
Interaction with internal departments (Underwriting, Managed Care, Accounting etc)
Claims Analysis
Process daily incoming Stop Loss claims
Monitor, review and analyze various potential claims with emphasis on controlling losses through effective managed care
Frequent overnight travel nationally to assist Manager with performing client performance evaluations to assess the accuracy of client reports submitted to HM Insurance Group, efficiency of claim operations, and adequacy of systems and procedures
Evaluate various claims submitted by TPAs on behalf of self-funded clients for compliance with the following
Ability to communicate concise accurate information effectively
Problem Solving and analytical skills

Claims Analyst Resume Examples & Samples

Track all inquiries in CP (online correspondence tracking system) by appropriate category
Adhere to all established policies and procedures
Review and resolve benefit-related discrepancies
Request Trust-required information from participant and/or provider as appropriate
Reconcile claim totals accurately and thoroughly, and apply appropriate benefits
Meet minimum weekly production standards as established by Claims Manager
Resolve personal daily aging and error reports
Resolve and handle daily mail
Answer department phone calls in a timely manner; research each call and seek assistance from Claims Manager as needed
Demonstrate excellent internal and external customer service skills
Demonstrate strong working knowledge of coordination of benefits (including Medicare)

Claims Analyst Resume Examples & Samples

Reviews medical billings for the reasonableness of tests, procedures and hospital stays
Refers medical claims for further investigation when more information is necessary or when claims are not medically reasonable
Identifies inaccuracies of paid claims and works with third-party billers to resolve claims paid in error
Stays up-to-date on PACE Health Plan Operations and Medicare Part D changes through HPMS notifications and the national PACE Association Part D Conference calls
Acts as liaison between the insurance carriers and insurance broker to maintain loss expenses reserves that are reflective of the company’s exposure
Minimum three years' experience in claims, claims adjusting or billing experience preferred
Computer skills including knowledge of Microsoft Word, PowerPoint, Excel required. Microsoft Access preferred
Familiarity with ICD-9/10-CM and CPT coding
Experience with Medicare reimbursement rules and systems
Ability to read, analyze, and interpret general business periodicals, technical procedures, or governmental regulations
Candidates should also possess the ability to work as part of a team

Claims Analyst Resume Examples & Samples

Submit and monitor reimbursement requests to GSE Investors (FNMA, FHLMC and HUD/VA) for advances incurred on defaulted mortgage loans
Submit and monitor reimbursement request to Mortgage Insurance companies for losses incurred on defaulted loans
Perform Loss analysis reconciliations on defaulted loans post claims to identify and report accountability and root cause for unreimbursed advances on foreclosures, DIL's and Short Sales
Reviews payment histories and reconciles loans
Verify claim proceeds, short sale proceeds, and 3rd party foreclosure sale proceeds are accurately credited, write-off/charge-off approval obtained and processed, if applicable, all system balances are zero, and loan removal is process in MSP
Document and maintain all systems necessary for booking losses, assigning root cause and follow-up to prevent recurrence of loss types
Comply with all state and federal laws, regulations and investor and insurer guidelines
Responsible for keeping abreast of relevant changes to investor/insurer guidelines, industry standards and client expectations. In particular, must keep up-to-date on all FHA, VA, and USDA, PMI and FNMA/FHLMC servicing requirements and revisions
Maximize the recovery of potential losses through the timely and accurate filing of mortgage insurance and investor claims. Ensure that supplemental claims are filed as needed
Prepare monthly reports on monetary losses due to curtailments of servicing deficiencies and present to management
Negotiate full or partial settlements with MI, Investor, or other 3rd party as required
Provides proper application instructions once claim funds are received
Has knowledge of all Default Servicing processes up to and including Loss Mitigation, Foreclosure, Foreclosure, Conveyance and Claims in addition to mortgage servicing state, federal and agency guidelines and timelines
In depth knowledge of MSP, with at least (2) years recent experience working with MSP
Strong analytical skills and decisive decision-making skills
Ability to interact at a professional level with customers and attorneys
Must be detail oriented and have excellent time management and organizational skills
Ability to meet time deadlines while working under pressure
Handles simultaneous tasks and projects in a fast paced environment. Able to work independently and in a team environment
Good business writing and business math skills
Strong PC skills. Must be proficient in MS Windows, MS Outlook, MS Office Suite, MS Visio and MS SharePoint
Bachelor's Degree in Finance, Accounting or Business Administration preferred. Will consider a combination of equivalent experience and education
Combined, 2+ years of experience working in Default Claims with direct experience in filing forward mortgage FHA/VA Claims and knowledge of FHA Repurchase and Conveyance processes
Overall, 3+ years Mortgage Servicing or other relevant financial services industry experience

Claims Analyst Internship Resume Examples & Samples

Validation of marketing and pricing claims and deductions support in accordance with established program policies and procedures
Business partnering with cross functions including external customers, Regional Sales and Marketing, Finance and Supply Chain
Identify improvement opportunities in claims processing and support process changes
Assist in UAT (Oracle R12 implementation) and Cutover activities

Claims Analyst Resume Examples & Samples

Handle moderately complex commercial auto claims including first and third party property damage exposures and bodily injury claims. Knowledge of accident benefit claims is an asset
Perform detailed liability and damages investigations and conduct independent assessments of potential exposure
Prepare timely coverage assessments, Reservation of Right letters and required denial letters
Develop and implement the most cost effective disposition and litigation plan to ensure timely claim resolution through settlement or trial
Maintain good rapport and close working relationship with business partners including underwriters, brokers, insureds and claims vendors
Participate directly in negotiations including attending settlement conferences, mediations and trials
Stay abreast of legal developments which impact the insurance industry in general as well as those which are specific to commercial auto claims
Conform to company best practice guidelines and required reporting

Lead Stop Loss Claims Analyst Resume Examples & Samples

<25% travel will be required nationally for audits and/or customer meetings.*
Evaluates daily claims submitted by HMOs and Provider Excess clients against underlying policy provisions, industry standards, and systems requirements
Monitor, review and analyze various potential claims with emphasis on controlling losses through effective managed care and use of our Navigator vendors Identifies claims for potential saving initiatives and/or audit prior to client reimbursement
Evaluates claims for eligibility and coverage specific to reinsurance agreement on file for client
Manages daily workload and back log independently and escalates issues to Director, Clinical Consultant and/or other business leaders
Provides client service function for managed care claims including clients, broker and/or internal departments and customers (Underwriting, Medical Risk, Accounting and Management)
Process internally vendor adjusted claims for our Provider Excess Loss line of business
Provide support for the payment and mailing of checks and E-mails with payment documentation to all of our clients
Some overnight travel nationally to assist Director with performing client performance evaluations to assess the accuracy of client reports submitted to RBS Re, efficiency of claim operations, and adequacy of systems and procedures

GAP Claims Analyst Resume Examples & Samples

Gathers and assembles pertinent claim information by contacting lenders, auto dealers, borrowers and/or agents and ensuring the completeness and accuracy of documentation for processing
Calculates claim proceeds in accordance with the Gap Contract coverage by analyzing and reviewing borrower’s loan history, MSRP/NADA valuations and primary carrier’s coverage documentation
Responsible for fielding calls from customers, lienholders, and insurance companies while providing excellent customer service
Submits claims calculations and supporting documentation to management for payment approval
Requests additional documents to assist in the determination of a claim
Must have a High School Diploma or equivalent
Must have at least one (1) year of claims adjusting or related experience in the automotive field (Dealer/Lender)
Must have excellent organizational and communication skills (verbal and written)
Must be able to communicate professionally with customers, co-workers and management
Must have a working knowledge of Microsoft Word and Excel
Must be able to type 40 WPM accurately
Must be able to use basic office equipment including a copy machine and fax
Administers claims of numerous ancillary products that are financed when a customer purchases a vehicle; primarily Guaranteed Automobile Protection (GAP)
Starts the claims process and is responsible for recognizing the required documentation that is sent in by a request
Claims processing and GAP contract support

Professional Liability Claims Analyst Resume Examples & Samples

Prepare and execute investigative action plans
Negotiate fair and timely settlements
Attend mediation and other court ordered settlement functions. Monitor trials
Reports to a Claim Director and senior claims management

Post Claims Analyst Resume Examples & Samples

Research insurance claims to identify set characteristics related to fraudulent behavior
Logically link existing claims together based on fraud patterns and decision appropriately
Become a SME on all client billing systems and internal claims systems
Ensure projects are researched, documented, and completed in accordance with departmental standards
Understand and stay up to date on all adjuster processes and procedures
Interact with key stakeholders within Program Management
Effectively communicate research findings to appropriate parties
Knowledge of Asurion business processes
Specific knowledge of Asurion verification process a plus
Knowledge of Asurion administration and billing systems

Temporary Senior Casualty Claims Analyst Resume Examples & Samples

Draft coverage position letters
Investigate & evaluate cases
Comply with all statutory and regulatory requirements in all applicable jurisdictions
Obtain and reviews medical records
Obtain and maintain all required licenses and certifications and meet all continuous training and certification requirements
Determine extent of the client’s financial exposure with respect to claims; set case reserves for use by clients and regulatory authorities
Revise case reserves based on developments in the course of adjusting the claim
Handle complex litigated claims with limited input from the Unit Manager and/or AVP
Select and manage experts including defense and coverage counsel
Capable of proactively managing litigation
Excellent written and verbal communication skills, a strong customer service focus
Ability to work in a paperless claims environment
Engage and manage coverage counsel and defense counsel
Able to multitask
5 to 7 years’ experience with a strong background in Environmental Claims, the interpretation of coverage and the ability to author ROR and Declination letters

Senior Casualty Claims Analyst Resume Examples & Samples

Evaluate insurance coverage based on claim report, the insurance policy and applicable statutes and case law to determine if a claim can be accepted as being within coverage
Interviews, telephones, and/or corresponds with claimant and witnesses; obtains and reviews police hospital records, appraisals and repair estimates to evaluate injuries property damage; Reports to client as required by contractual account instructions; utilize appropriate methods of investigation according to type of coverage
Obtain, review and evaluate medical records
Identify key coverage, damage and liability issues and plan investigation as required in accordance with contractual obligations and prevailing professional standards
Comply with all statutory and regulatory requirements of all applicable jurisdictions
Obtain and keep in effect all required licenses and certifications and meet all continuing training and certification requirements
Determine extent of the client’s financial exposure with respect to claims; set case reserves for use by clients and applicable regulatory authorities
Revise case reserves based on developments in the course of adjusting the claims
Be alert to insurance fraud and implement special procedures if possible fraud is detected
Settle claims within assigned levels of authority as set forth in client account instructions
Select and manage experts with limited input from supervisor
Work with and provide claim-specific guidance to Field Adjuster
Involve client in decision-making as appropriate and/or follow client-specific requirements for escalation when client decision-making and/or notification is required
Strong customer service and client interaction skills
Litigation management skills
Coverage knowledge is required
Strong Public Entity experience is needed
Extensive knowledge of investigation management including, but not limited to, taking and using recorded statements, determining coverage and application of coverage to claims, delivering case value and negotiation and resolution of claims
5+ years experience in handling general liability claims
Strong Public Entity experience is required

100

Claims Analyst Resume Examples & Samples

Effective interpersonal and listening skills to build solid relationships inside and outside the Enterprise
Strong personal work ethics
Ability to get high quality work done through personal & professional proficiency using company tools, processes, and procedures
Ability to communicate information in an accurate, clear, concise manner with an appropriate level of detail
Ability to be a team player, collaborate, in addition to building and maintaining effective relationships for results
Strong customer service orientation with high ability to empathize with customer
Self-motivation and initiative
Excellent math and calculation skills
Committed to continuous self-development of technical and professional expertise
Ability to embraces appropriate level of empowerment with accountability
Microsoft Office proficient
Strong analytical, problem solving, and conceptual abilities
Ability to be self-directed and function with limited supervision

101

Claims Analyst Resume Examples & Samples

Insurance follow-up on outstanding accounts
Identifies patient liability
Perform correspondence, including denials, appeals and updates interprets explanation of benefits
Insurance re-bill requests or update accounts
Advise manager of negative payment trends as related to specific clients
Evaluate accounts for payment opportunities based on timely filing and other criteria
Contact payer and management on how to proceed on accounts that need to be addressed
Maintain accurate documentation and reports following established process and procedures and client specific guidelines
Perform other insurance department duties or special projects as assigned by Management
Basic computer skills; knowledge of Microsoft Word and Excel
Ability to work under pressure; ability to work proficiently and efficiently in a timely manner
Preferred experience in health care billing environment
Familiar with major medical insurance carriers; medical terminology, some knowledge of HCPC, CPT & ICD9 codes

102

Risk Management Claims Analyst Resume Examples & Samples

As a member of the Risk Management Department, assist the Director, Claims Management, in the documentation and administration of claims related to the company’s property, casualty, and financial/executive risk programs
Provide guidance to business units on appropriate and timely reporting of incidents/claims
Maintain claim files as appropriate
Collect, compile and analyze claim data, generating administrative reports that coherently and succinctly identify loss data and trends
Assist in the resolution of claims, working with insurance company adjusters, third party adjusters/administrators, legal counsel, brokers and corporate personnel as necessary
Minimum of 5 years in the risk management and/or insurance claim industry with experience in the processing or administration of claims
A knowledge of real estate operations is helpful but not required
Ability to analyze complex problems involving varying viewpoints and to develop viable solutions
Ability to multitask, adapt to changing developments, and communicate clearly
Ease in working with people up and down the organization hierarchy
A demonstrated ability to interact with senior executives
Naturally adaptive to different audiences
Diplomatically assertive
Strong sense of integrity and ethics. Values entrepreneurialism. Demonstrates strong intellectual curiosity; always seeking new approaches and challenging the organization to new levels of success

103

Senior Casualty Claims Analyst Resume Examples & Samples

Manage litigation
Evaluate insurance coverage based on claim report, the insurance policy, applicable statutes and case law to determine if a claim can be accepted as within coverage
Interview, telephone, and/or correspond with claimant and witnesses; obtain and review police hospital records, appraisals and repair estimates to evaluate injuries property damage; Report to client as required by contractual account instructions; varying method of investigation according to type of coverage
Identify key issues and investigation required
Effectuate prompt payment (with client’s funds) to claimants and service providers
Be alert to insurance fraud and implement special procedures if fraud is suspected
Review and analyze medical records
Review and analyze expert’s reports
Litigation management
5+ years’ experience in Commercial Lines including Commercial GL and Construction Defect claims
Strong background in the investigation of liability and damages and will also possess a strong background in the interpretation of coverage, including the authoring of ROR's and declination letters

104

Senior Claims Analyst Resume Examples & Samples

Processing Medicare Part D Claims
Monitoring production workflow
Reviewing quality of processed claims
Manage varying priorities and lead projects
Maintain high level of accuracy and quality ratings

105

Claims Analyst Remote Resume Examples & Samples

4-5 years of medical billing experience in a physician practice or hospital setting
2-3 years of experience analyzing medical data and a thorough understanding of medical claims coding (such as ICD, CPT, NDC, HCPCS)
Proficiency with various analytic querying and reporting tools, in particular SQL
Knowledge and experience with relational database systems (MySQL, MSSQL, Oracle, etc.) is preferred
Ability to work with little supervision and collaborate with remote staff to meet deadlines
Exceptional interpersonal, communication, and organization skills in order to pace your work with that of other team members
Willingness and ability to train and educate peer team members
College degree and / or coding certification preferred (RHIT, RHIA, CCS, CCS-P, CPC-H, etc.)

106

Construction Claims Analyst Resume Examples & Samples

Develop and execute Construction Claims Service strategies and programs in the SF Bay Area
10-15 years of construction claims experience
Extensive experience in Project Controls, CPM scheduling, delay analysis, productivity analysis, claims and dispute resolution
Experience on large, complex construction projects
Strong experience with P3 or P6

107

Claims Analyst Resume Examples & Samples

You have a strong working knowledge of digital platforms
You have an understanding of the analysis process for large metadata files
You have a passion for metadata research, analysis, interpretation and drawing accurate conclusions
You are highly organized with strong attention to detail and follow-up
You work well in a fast-paced evolving work environment requiring strong multitasking skills, excellent time management, with ability to prioritize within the workload and meet deadlines
You have excellent interpersonal skills, strategic thinker and brainstormed, results-oriented
You have strong communications skills (written and verbal)
You are a team player who thrives in an inclusive environment
You have a Bachelor's degree plus preferably 1-2 years of claims analysis or metadata research experience

108

Group Claims Analyst Resume Examples & Samples

BA/BS degree or equivalent work experience preferred
Minimum of 3 years disability claim management experience preferred
Canadian/International claims management experience required
Exceptional customer service standards and delivery
Ability to thrive in a fast-paced environment and meet deadlines
Strong math and calculation skills
Excellent interpersonal, organizational, negotiation, investigative, analytical and research skills
Critical attention to detail

109

Claims Analyst Resume Examples & Samples

Perform claim analysis and summarize results with detail at the individual claim level
Perform root cause analysis and/or statistical analysis to determine underlying causes of errors
Gain and maintain proficiency in TRICARE policy, claims systems, and adjudication rules. Stay abreast of changes
High school graduate
Knowledge of health care or insurance industry for those non-degreed applicants
Strong communication and research skills
Personal computer literacy with spreadsheet, word processing database capabilities (Microsoft Office Suite; specific concentration with Access, Excel, and PowerPoint)
Familiarity with SharePoint capability as a resource and as a dataset
Ability to gather accurate information from a data warehouse or other relational database environment
Familiarity with TRICARE Policy and claim adjudication systems

110

Claims Analyst Resume Examples & Samples

Works cross-functionally with other key departments to identify and implement process improvement opportunities
Understand and interpret customer business requirements, benefit structures, and payment policies, including Medical Coverage Guidelines, to drive configuration within CCX platforms
Aide with the integration of business rules into CCX platforms using clear communication, adherence to policies, procedures and regulations while maintaining regulatory compliance and industry standard practices
Strong analytical and problem solving skills, including experience with medical claims processing
Participate in testing efforts as necessary between cross-functional areas to accurately promote CCX system enhancements
Aide in the research, documentation, and testing of CCX systems for the implementation of new business or software
Aide in data analysis of various platforms, documentation and testing, and assist in CCX projects from initial scoping through final delivery and sign-off
Aide in maintenance of business rules repository by actively monitoring and participating in IT meetings, understanding and documenting changes to CCX platforms
Associates degree in Health Information, Healthcare Administration, or the equivalent; or a minimum of 5 years of equivalent Healthcare experience
Previous experience in configuration at a Health Plan company
Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills
Must be able to manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking
Must be able to work independently as well as part of a team in a fast-paced environment

111

Public Entity Claims Analyst Resume Examples & Samples

Analyze Coverage
Evaluate exposure and set appropriate reserves
Direct and manage defense and coverage counsel and insure they work within scope and litigation budget
10 years in P&C claims and at least 5 years’ experience with complex litigation claims handling
Superior writing skills for communications of claim exposure to the company’s senior management
Experience using paperless automated claim systems along with Micro Soft products
B.S or B.A. from an accredited college or university. Advanced degrees, industries designations (CPCU, AIC, etc.) or J.D. is a preferred
The ability to travel domestically

112

Claims Analyst Resume Examples & Samples

Collect and analyze numeric data from various sources and format the data into KPI/KPO’s for use in monthly metric reviews
Generate recurring charts and analyze the data
Develop and maintain trend charts that display trends over time
Utilize IT skills to setup automated data fields in common sharepoint databases
Generate complex statistical analysis for use in common sharepoint databases
Analyze data for accuracy and integrity on a daily basis
Develop conclusions based on data analysis and make recommendations to management
Monitor and report KPI/KPO’s to management on developed frequencies
Maintain/champion the Novi Auto Sharepoint. (shared database)
Bachelor’s degree in Business Data Analytics, Industrial Engineering, Business, or other analytical field
Prefer 1-2 years of experience in claims, prefer one to five years’ experience or internship/Co-op
Understanding of data analysis packages such as MiniTab.or other statistical analysis system, data mining and text analytics software
Excellent communication (oral and written) skills; ability to communicate, lead, and drive performance and change with all levels in the organization
Desire to take initiative and develop a pro-active relationship with internal and external customers and suppliers
Proven record of success and expanded responsibility within a growing and complex organization
Matrix organization experience
SAP Experience, Share Point Experience
Strong analytical skills with advanced proficiency in Excel
Strong understanding of relational database design and query tools
Ability to perform work accurately and independently

113

Claims Analyst Resume Examples & Samples

Input Notice of Loss setup (NOLS)
Handle incoming calls and route to the appropriate party
Take new losses by phone
Open mail, scan and attach to Claims Assure
Photocopy as requested
Process invoices to ensure timely payment
Assign appraisals upon request

114

Claims Analyst Resume Examples & Samples

Monitor and review submitted incidents for accuracy and integrity, ensuring all incident fields have been properly entered and are distributed to communities and stakeholders
Work with associates at each community to ensure a prompt response and resolution of each incident. Complete a thorough investigation for all incidents. Provide advice and guidance to communities to resolve all risk management related issues
Investigate claims by collecting pictures, statements, contracts, leases, etc. to provide a complete record to claims adjuster for review and resolution
Gather information for discovery requests including: reviewing insurance policies, property ownership information and historical incident reports
Serve as system owner and relationship manager for the risk management information system. Ensure system data integrity, import data as needed, verify accuracy of data, and run ad hoc reports from the risk management system. Troubleshoot all system issues, make changes to forms and code tables, perform data updates and work with the vendor to implement new features
Investigate and settle in-house claims with designated authority by negotiating with attorneys, insurance companies and other third parties
Provide oversight and direction to third party claim administrators and outside counsel for assigned claims. Manage and settle assigned claims within designated authority
Investigate, gather Invoices and other documentation to send subrogation demands to insurers and other responsible parties for assigned property claims

115

Claims Analyst Resume Examples & Samples

Must have a full understanding of claim adjudication for First & Third Party, Med Pay, No-Fault, Group Health, Workers Compensation, hospital claims and PPO
Must have full understanding of the various types of medical billings and ability to identify which system database should be used
Must be able to cross reference different types of billings to ensure consistency in the review process
Must possess knowledge of standard fee schedule review, UC&R review, drug and supply charges, rarity, utilization review, CPT guidelines, ICD-9 coding, bundling/unbundling and duplicate billing
Must possess complete knowledge of general computer, fax, copier, scanner, and telephone
Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet
Must have a full understanding of HIPPA regulations and compliance
Must be a qualified typist with a minimum of 35 W.P.M
Ability to follow instructions and respond to managements’ directions accurately
Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met
Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed
Must be able to work independently, prioritize work activities and use time efficiently
Must be able to demonstrate and promote a positive team -oriented environment
Must be able to stay focused and concentrate under normal or heavy distractions
Must be able to work well under pressure and or stressful conditions
Must possess the ability to manage change, delays, or unexpected events appropriately
Demonstrates reliability and abides by the company attendance policy
Must maintain a professional and clean appearance at all times consistent with company standards

116

Salvage Claims Analyst Resume Examples & Samples

Handle initial set up of Salvage claim file and determine plan of action to perfect recovery. Control costs. Investigate and maintain a complete and thoroughly documented claim file
Treat customers in a courteous, friendly and professional manner. Provide timely, thorough, accurate information and assistance
Conduct timely follow up and evaluate if changes in plan of action is necessary
Maintain regulatory compliance with state salvage requirements
Handle high profile files that may involve interacting with management, legal counsel, or other legal entities
3 + years in insurance industry is needed with a background in salvage preferred
Skilled technician in a hands-on environment, often highly specialized

117

Claims Analyst Resume Examples & Samples

Three to four years of related experience (Claims, Financial analysis/Accounting)
Thorough knowledge of financial analysis techniques and general accounting procedures
Well-developed mathematical and analytical skills
Advanced knowledge of financial analysis, forecasting, and planning
Expert ability to identify and resolve exceptions and to interpret data

118

Claims Analyst Resume Examples & Samples

Handle commercial auto claims including first and third party property damage claims, including total losses
Prepare timely coverage assessments and appropriate correspondence including reservation of rights and denial letters
Perform detailed investigation and conduct an independent assessment as to potential exposure
Develop and implement the most cost effective disposition plan to ensure timely claim resolution through settlement
Maintain good rapport and close working relationship with business partners including customers, underwriters, brokers and vendors
Participate directly in negotiations when required
Stay updated on legal developments which impact the insurance industry in general as well as those which are specific to commercial auto claims
Follow company best practice guidelines and required reporting requirements

119

Claims Analyst Resume Examples & Samples

Provide superior customer service to clients
Analyze quarterly survey responses, determining billing codes and compliance
Communicate with software developers to improve existing functionality and resolve issue
Internal product management
Participate in and support project development and planning
Support special projects
Strong analytical skills, including the ability to recognize trends, determine first and second order effects, identify incongruences, and present data in a format that drives decision making
Excellent ability to build and maintain business relationship with clients by providing professional and accurate service
Excellent organizational, oral presentation, and written communication skills
Proficiency in MS Office products, including Outlook, PowerPoint, Excel and Word
Ability to learn and retain new technology quickly

120

Claims Analyst Resume Examples & Samples

Develop a solid understanding of assigned client’s process in order to strategically review and analyze their A/R functions
Conduct regular audits of Medical Billing Specialist claim work for accuracy and quality; manages clean claim ratios for assigned clients
Provide direction to Client Leads on claim audit corrections and resolution
Prepare and analyze reports of audit reviews and performance issues with a focus on identifying trends, instituting continuous quality improvement initiatives, and identifying and providing on-going training opportunities for specialists
Provide second-tier review on advanced and escalated claim issues to a satisfactory resolution
Resolves outsource vendor’s escalates claims and claim rework
Log all client issues encountered in internal tracking system, including enhancement requests, bugs, errors, and inquiries. Make management aware of any client issues or problems
Modifies process and procedures to prevent claim rework through automation ideas
Participate in continuing education of applicable software and hardware

121

Internal Mortgage Claims Analyst Resume Examples & Samples

Familiarity with VA, FHA and USDA servicing guidelines
Solid understanding of
College degree preferred in Business, Math, English, Legal or other related subject (and/or equivalent work experience)
Knowledge of mortgage banking, familiarity with RESPA, FDCPA, GLBA, and federal and state laws related to foreclosure and bankruptcy processes
2-4 years of experience preferably is a mortgage banking environment learning all the rules and regulations
Ability to audit and analyze work outputs by interpreting government agency and department guidelines/standards
Advanced analytical skills, ability to analyze problems and provide the appropriate solution
Advanced problem solving, multi-tasking and organizational skills with strong attention to detail
Ability to analyze data and make recommendations on how to improve trends
Must be highly confidential to protect the client's privacy rights
PC skills including (but not limited to) advanced Word, Excel, Access, Internet, MSP (LPS/Fidelity) application skills

122

Internal Mortgage Claims Analyst Resume Examples & Samples

FHA Part A and B Claim Filing
FHA Supplemental Claim Filing
FHA Loss Mitigation Claim Filing
VA Claim Filing
USDA Claim Filing
Track claim findings and respond to LoanCare leadership team
Review all past claims filed to determine possible recoverability, report on identifiable recoverable losses & document steps to assist with loss recovery
Integrate specific servicing requirements regarding loss analysis processes
Expedite claims processing and share feedback with processors/staff
Provide flexible, scalable claims management solutions
Comply with all state and federal laws, regulations, investor and insurer guidelines
Responsible for keeping abreast of relevant changes to investor/insurer guidelines, industry standards and client expectations
Reconciliation goal is to maximize the recovery of losses through the timely and accurate filing of mortgage insurance and investor claims
Identifying gaps in the department policies and procedures which allowed breakdown and provide recommendations to correct breakdown in process
Field questions about the file from management as well as present complete file case review to management with recommendations for improvement
Excellent professional verbal and written communications skills
Ability to meet strict deadlines and take direction from more senior personnel
Previous Default servicing experience preferred

123

Claims Analyst Resume Examples & Samples

Provides high quality customer service by determining the best approach for handling issues
Conduct claim audits of adjusters' work product and monitor accuracy of loss data
Responsible for analyzing any claims assigned in accordance with the department's claim handling guidelines
Responsible for the appropriate documentation of all analytical and evaluative processes and communication interfaces with respect to the determination of coverage, the investigation and assessment of liability and damages exposures, settlement within established authority and reinsurance reporting
Provide appropriate input and direction to loss adjustment resources (independent adjusters, claims adjusters, etc.) and legal resources (defense attorneys, etc.)
Maintain and document accurate loss data and the basis for reserve changes and recommended reserve changes
Focus on quality work and job performance
In addition to other lines, knowledgeable of liability and worker's compensation claims processes and best practices
Must be able to multi-task, be well organized and detail oriented
Must be proficient working with database and processing software, Excel, Word and Outlook
Must be able to successfully complete licensing and claims certification schools/classes, where required
Phone
Pen and paper

124

Claims Analyst Resume Examples & Samples

Clear data and claim exceptions and ensure deficiencies are flagged correctly
Analyze claims as a whole along with supporting documentation to ensure eligibility determination is reasonable and correct
Send deficiency and rejection letters and process claimant responses
Identify and correct beneficial owner errors
Identify and clear basic duplicate claims
Identify and process shorts and transfer transactions
Other duties or tasks as assigned by management
Intermediate knowledge of standard Microsoft software; WORD, OUTLOOK & EXCEL
Typing 40 WPM
Working knowledge of financial products (e.g. stocks, bonds & options)

125

Warranty Claims Analyst Resume Examples & Samples

Analyze and process warranty claims
Review claim information provided by dealers and, working independently or with Supplier Recovery, Engineering, Field Service, or Customer Service process claims per established guidelines
Manage accurate invoicing and reconciliation of all Supplier Recovery related warranty costs
Travel to Fleet/Dealer/Production locations as needed (<5% travel required)
A.A. required or a minimum of 3 years of PACCAR, or related, experience required; BS/BA preferred
2+ years related experience required. Experience can be substituted with degree

126

Group Claims Analyst Resume Examples & Samples

Determines customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decisions based on facts presented
Works directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
Networks with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
Pays all covered claims accurately and timely
Executes on all customer performance guarantees
Responds to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
Ability to handle potentially high levels of call volume from customers and clients
Exhibits claim management performance according to quality and compliance standards
Manages both new claims and open claims equally and maintains decision times
Adheres to standard timeframes for processing mail, tasks and outliers
Supports and promotes all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
Demonstrates focus on team and office goals by developing an understanding of relationships with our business partners and positively interacting with business partners as needed
Understands Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices
Stays abreast of ongoing trainings associated with role and business unit objectives
Mentors and coaches new hires as needed
Ability to serve as a point person for projects and/or reporting functions
Contributes actively to team service and quality objectives to help create a high performance and supportive work environment
Provides assistance to Senior Claim Manager with responsibilities as needed
Identifies issues, proposes solutions and follows through on commitments
BA/BS degree preferred
Minimum of 3 years disability claim management experience
Multilingual skills are highly desired

127

Claims Analyst Resume Examples & Samples

A minimum of 1 year of experience in a Customer Service Claims environment
Excellent customer service skills with the ability to diffuse difficult customer challenges and possess excellent problem solving skills
Customer-centric approach to problem resolution
Must work well in a team environment, as well as independently
Must be flexible and adapt quickly to change
Should also have great typing skills and be familiar with 10-key
Must be a meets in performance results
Proficient in Excel and Word

128

Claims Analyst Resume Examples & Samples

Follows written procedures and scripts
Uses proprietary software tools to access and review claim documents, enter claim decisions, and create escalations when needed
Communicates immediately to leadership all obstacles to completing work
Meets and exceeds departmental expectations for accuracy and productivity
Utilizes documented team processes to ensure compliance with departmental standards
Data entry and verification
Supports Claims Analysts 1 (CA1) with processing questions and escalations
Analyzes escalation content to resolve and routes as appropriate
Reviews and distributes reports on work assignments, escalations, and/or QA results
Drafts claimant facing communications based on guidance provided
Verifies data and processing requirements and makes corrections as necessary
GED or High School Diploma
Strong written English language skills
Ability to sit at a computer workstation for long periods of time
Demonstrated skill in analyzing data
Demonstrated success in a CA1 role

129

Senior Claims Analyst Resume Examples & Samples

Develop and execute Construction Claims Service strategies and programs in the NYC Metro
Lead a team in the analysis or preparation of a complex construction claims, being responsible for the deliverable to the client, whether it be a report, presentation or expert testimony
Interface effectively with clients, coworkers, and others
7-10 years of construction claims experience
Heavy Highway or Building construction experience

130

Senior Claims Analyst Resume Examples & Samples

Qualification in Construction Law, Engineering or Quantity Surveying is a prerequisite and any further qualifications in Arbitration are desirable
The individual must have extensive international field based experience (preferably in the Middle East) on large Infrastructure and Aviation Projects and be able to confidently determine the requirements in order to prepare and present large value Extensions of Time claim
The individual must be fully conversant in planning all aspects of a large value claim including the timescales and resources required and the cost implications, and be proficient in drawing up a detailed plan
The individual must be an effective communicator in both written and oral forms and be able to produce technical papers/material and confidently report and present these to external consultants and senior managers. He/she must be able to prepare Statement of Claims, reply to Respondents and provide consultancy for preparing experts’ reports and witness statements
The individual must have very significant relevant experience in hands-on planning of large international Construction Projects as well as particular experience in forensic delay analysis, preparing Extension of Time Claims for the relief of Liquidated Damages
The individual must be fully conversant with P6 with substantial Primavera related experience preferably up to expert level. He/she must have expertise on disruption/and productivity analysis using methods such as As-Planned/As Built and Impacted as Planned
The individual must have experience of working with Arbitration teams and external consultants on Extension of Time and Quantum Claims with FIDIC contracts together with detailed knowledge of Pickavance/SCL/AACE Protocols and be able to demonstrate competent use of concepts such as concurrent and parallel delays, excusable/non-excusable compensable/non-compensable case law and reference text

131

Claims Analyst Resume Examples & Samples

Minimum of 3 to 5 years of experience in the handling of professional liability claims
Knowledge of construction industry
Proficient computer skills
Excellent communication skills (both written and oral) to effectively and professionally interact with brokers, insureds, counsel and other industry professionals
Multi-state adjuster licenses and/or JD preferred
Claims and/or litigation background
Bachelor's Degree (or equivalent) required; Juris Doctor (JD) preferred

132

Claims Analyst Resume Examples & Samples

Knowledge of CPT, HCPCS, AND ICD-10 codes and understanding of medical terminology
4 years of experience in a healthcare environment
Demonstrated ability using all Microsoft applications, including strong keyboard and navigation skills, and capability to learn new programs
Ability to multitask which includes understanding multiple insurance products and multiple levels of benefit within each product
Ability to work independently and demonstrate good judgment
Demonstrated ability to collaborate with internal and external teams external partners, and other stakeholders
Creative problem solver with demonstrated ability to provide pragmatic legal solutions to complex business problem
Knowledge of the fertility industry

133

Medicaid Claims Analyst Resume Examples & Samples

The Medicaid Claims Analyst II will assist Specialists with quarterly state invoices. Able to identify invoices discrepancies and communicate proposed unit and rebate amounts to states. Support and/or give recommendation to Specialists to apply correction to invoices. Able to work independently and give recommendations to issues related to disputed claims. Work closely with Sr. Medicaid Manager and/or Finance to communicate accrual accounts where significant rebates impact quarterly accruals. Work with Brand Teams to resolve issues related to accrual forecast. Able to identify and provide feedback to brand team when needed
Prepare & analyze claim level detail utilizing Validata for brand/generic products for assigned states and ensure all analysis is completed within 30 days from receipt of invoices. Review Revitas variances test results and make determination of findings; work with state to address discrepancies and provide recommendation and/or propose resolution
Resolve disputes and propose recommended amounts to be paid for historical outstanding utilization that is routinely submitted with Medicaid claims. Ability to work independently and make recommendation on state disputes and apply proper amounts to be paid & ensure CMS codes are applied correctly; notify states of results/findings
Review, Approve and Settle all claims to $100K. Ability to work with minimal supervision and make recommendation to outstanding Medicaid claims amounts
Ensure all Validata analysis Export is completed weekly for Teva brand claims. Make quality work-related decisions based on results of data
Review of Teva Medicaid usage to determine which state formularies could be excluding a Teva NDC from its program and work to add such products to state formularies. Note: such actions will add to Teva’s sales totals via spillover measures
Work with Sr. Manager & Govertnment Pricing team to resolve Rebate Per Unit issues & update Quarter Package Price(s) in Revitas
Work with Sr. Manager on various projects including price reporting issues and provide ad hoc analytical and administration support with a variety of projects
Quarterly review products based on each states formulary and compare to transactional details available utilizing preferred drug list by states; and/or other data reports to identify why states are not reporting Teva products
HS Diploma or GED required, Bachelor’s Degree highly preferred
6+ years experience handling Medicaid claims or similar finance detail within a pharmaceutical company or comparable. Equivalent combination of education and experience will be considered
Must have Intermediate to advanced knowledge of the Model N or Revitas Medicaid and/or Validata system (or other comparable system). Must have Intermediate to advanced Microsoft Excel skills
Expereince with Validata, Oracle, SAP, Business Intelligence, Oracle Discoverer preferred
Pharmaceutical industry experience/knowledge strongly preferred

134

Senior Claims Analyst Resume Examples & Samples

Maintains knowledge of HUD regulations and guidelines regarding the claim procedure
Reconciles corporate expenses to the loan transaction history
Reviews servicing timelines to determine if the servicing was in compliance with HUD guidelines
Self-Curtails claims if they are not in line with compliance measurements
Verifies default monthly interest to ensure accuracy of its calculation
Verifies taxes and hazard insurance are pro-rated accordingly
Ensures all support documentation required for a HUD claim are included in the claim package and are sequentially placed in order according to HUD requirements
Audits parts B-E on the 27011 form to ensure the correct dates, descriptions, paid amounts, and invoice amounts are documented / makes adjustments, if necessary
Documents the claims database and Navigator with the status of the claim
Ensures the transaction history is up to and including the due and payable date
Reviews disbursement transaction histories to ensure all claimable expenses have been claimed and disallowed expenses have not been included
Conducts a balance analysis to ensure the claimable expenses included on the Hermit worksheet are reconciled with the claimable expenses included in the Hermit upload
Responds to HUD’s requests for additional information within established timelines
Works with other departments to correct support documentation, when required
Assists management with HUD audits, as necessary
2 years mortgage servicing experience preferred
4 years of mortgage loan servicing in default, foreclosure, and/or bankruptcy or 4 years of claim experience and/or accounts payable
Ability to be a team player
Ability to calculate basic financial figures
Ability to research and collect data
Working knowledge of Microsoft Outlook, Word, Excel, and Adobe Professional

135

Claims Analyst Resume Examples & Samples

Serve as point of contact for the claims Team to delegate, prepare, and prioritize escalated indemnity issues for the Account Management, Client Benefit Administration, and Client Service Center. Responsible for claims team professional and timely responses to all inquiries. To attend strategic meetings regarding corrections to projects to correct benefit and eligibility issues
Make independent judgments in order to respond to complex or critical customer claim related issues requiring a higher degree of expertise or discretion to resolve customer or client issues and ensure timely resolution. Involve Account Manager or Leadership team in heightened client/member issues. Analyze research and resolve requests for expedited or escalated claim issues including member submitted, pharmacy submitted, or indemnity issues. Manipulate any of the five separate applications in order to research and resolve claim issues
Maintain accurate and complete documentation. Update all logs and Call Center tools with claim status. Maintain service levels and performance guarantees
Identify, document and report all repetitive questions and/or problems as well as adjudication errors to identify trends and recommend potential solutions
High school diploma or equivalent required, some college or technical training preferred
3-5 years experience in PBM industry or ESI claims department or equivalent work experience
Strong data entry, 10-key skills, general PC skills and MS Office experience
Strong

136

Senior Casualty Claims Analyst Resume Examples & Samples

Responsible for claims management (Liability and TX Non-subscriber) including oversight of the third party administrator, real-time response to claims, maintaining integrity of claim data, reviewing DriveCam, development and monitoring of the claim strategy, approval of settlements, oversight of the litigation process, monitoring vehicle legal holds
Support the execution and oversight of the Temporary Transitional Duty Program through assistance to the field with education, job functional analysis, compliance and challenging issue resolution and guidance
Ensure that the company’s claim reserves are adequately and timely established for financial reporting purposes and compliance with required Reserve & Settlement policy guidelines
Responsible for maintaining DriveCam videos in support of auto claims as needed to include categorizing DriveCam utilization
Utilize on-going review of claims and analytics to identify higher cost claim trends, partner and communicate with Safety resources to identify areas of potential improvement
Provide education and training support to operations in the development and execution of consistent liability claim management programs
Build, maintain and manage relationships with internal customers, third-party administrators, insurers, legal counsel and other claims related parties
Complete claim audits, claim leakage audits and other developed processes to identify TPA improvement opportunities
Provides assistance to field operations, EHS, Logistics, and other business units on challenging claim issues, coordinates and works with Director of Risk Management on complex issues
Attend and/or participate in claim reviews as requested,
Other projects or responsibilities as requested
Bachelor’s degree with 5+ years of experience in a claims department
Associate in Claims designation or licensed adjuster designations are preferred
Experience in liability claims; Texas Non-subscriber a plus
Familiarity with claims systems such as ClearSight preferred
Flexible nature, the ability to prioritize effectively and the desire to work in a team-oriented environment
Claims management and claim process skills
Strong PC skills including, but not limited to, knowledge of spreadsheets

137

Claims Analyst Resume Examples & Samples

Quality control auditing and analysis experience preferred
Medical billing knowledge and Healthcare experience preferred
Strong analytical skills; ability to conduct research, creatively solve problems, and deal with ambiguity
Able to read, analyze, and interpret complex documents
Independent, logical, strategic thinker with high focus and attention to detail
Effective written and verbal communication and presentation style
Proficient compute skills including Microsoft Office, Word, and Excel
Excellent interpersonal skills and able to work with a variety of personality types
Excellent organizational skills; ability to multitask, set priorities, and meet deadlines
Strong customer services skills and a high level of professionalism

138

Claims Analyst Resume Examples & Samples

Calculate clients’ recognized losses
Initial analysis of trades
Researching new claims
Prepare new case summaries to be uploaded to claim tracking system

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