Claims Associate Resume Samples
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Claims Associate Resume Samples
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EB
E Bartoletti
Eudora
Bartoletti
477 Flatley Springs
Boston
MA
+1 (555) 961 2349
477 Flatley Springs
Boston
MA
Phone
p
+1 (555) 961 2349
Experience
Experience
Detroit, MI
Claims Associate
Detroit, MI
Becker Inc
Detroit, MI
Claims Associate
- Processes assigned claims and determines benefits due pursuant to the client contract; makes timely claims payments and adjustments
- High work standards, results orientation, teamwork and self motivation
- Setting educational goals to improve personal performance
- Performs other duties as assigned
- Strong personal work ethics with commitment to build credibility and trust. This includes maintaining confidentiality and exercising discretion and tact
- Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision
- Makes coverage determinations based on investigation/evaluation
Boston, MA
Group Claims Associate
Boston, MA
Stokes Group
Boston, MA
Group Claims Associate
- Networks with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
- Supports and promotes all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
- Works directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
- Exhibits claim management performance according to quality and compliance standards
- Determines customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decisions based on facts presented
- Executes on all customer performance guarantees
- Manages both new claims and open claims equally and maintains decision times
present
Phoenix, AZ
Claims Associate Manager
Phoenix, AZ
Lindgren, Von and Jaskolski
present
Phoenix, AZ
Claims Associate Manager
present
- Determine and resolve workload and assignment issues to ensure effective claims processing, expense management and claims disposition
- Third party administrator oversight and management, including auditing of same
- Vendor oversight and management, including auditing of same
- Management and direction of outside counsel as well as reviewing and approving legal and/or expense budgets and bills
- Collaborative mind-set and willingness to work with people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency
- Attend client meetings and industry functions to support retention and development of client relationships and business
- Development and execution of claim strategies as well as resolution strategies
Education
Education
Bachelor’s Degree in Problem Solving Skills
Bachelor’s Degree in Problem Solving Skills
Arizona State University
Bachelor’s Degree in Problem Solving Skills
Skills
Skills
- Basic computer literacy and healthcare terminology
- Ability to meet or exceed Service Expectations
- Strong researching skills
- Detail-oriented
- Ability to multitask
- Basic Microsoft Excel skills
- Good negotiation skills
- Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions and decimals
- Ability to compute rate, ratio and percent
- Ability to determine the number of individual things in a unit or group
15 Claims Associate resume templates
Read our complete resume writing guides
1
Claims Associate Resume Examples & Samples
- Call centre experience
- Quality assurance/quality control experience
- General insurance knowledge, and/or specifically in Payment Protection Insurance
- Knowledge of insurance regulation/compliance requirements
- Relevant sales experience
2
Claims Associate Resume Examples & Samples
- Team player with exceptional customer service skills
- Excellent clinical reasoning skills
- An ability to liaise with the claimant's treating specialist and drive the best outcomes for the claimant
- A positive, energetic and empathetic approach to your day to day work
- High work standards, results orientation, teamwork and self motivation
- Sound relationship and rapport building skills (ability to persuade and influence colleagues, tactful and diplomatic approach)
- Strong complaints handling, dispute resolution and ability to manage difficult situations
- Ability to meet deadlines and ensure all tasks are completed within service standards to deliver outstanding customer service
- High degree of problem solving skills and an ability to make sound decisions with confidence
- Strong analytical skills – an eye for detail
3
Claims Associate Resume Examples & Samples
- Provide first-line assistance for member’s questions relating to post-service coverage of medical treatment or services which includes researching and resolving benefit claims issues, billing discrepancies, coding errors, insurance claims processing issues, and educating members on the components of their benefit plan coverage which ensuring adherence to corporate and department policies and procedures
- Handle assigned cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers, and members
- Research plan information and identify where there may be conflicting information which may include escalating to supervisor or other levels of management for clarification and assistance
- Research billing issues to determine the possible cause of the error and assist with claims resubmission when needed to correct the issue
- Assist members with setting up payment arrangements which may include reaching out to healthcare providers to determine payment options and discussing options with supervisor
- Utilize a variety of resources to research and resolve billing issues (e.g., plan documents, summary plan documents, benefits summaries, open enrollment material interpretation of benefits, understanding of medical, dental vision and behavioral health coverage, etc.)
- Remain current on knowledge of Flexible Spending Accounts (FSA), Health Reimbursement Accounts (HRA), Health Spending Accounts (HSA), and benefits Summary Plan Descriptions (SPD) to resolve billing issues
- Exercise exceptional customer service skills in an effort to optimize each contact with the member
- Ensure that claims are processed in strict adherence to established policies, procedures, quality standards as well as applicable federal laws and regulations
- Know and support approved departmental and corporate policies and procedures relating to claims issues
- Minimum of three years customer service, healthcare, or claims experience required
- Coordination of benefits and which plan is primary – simple and complex cases (commercial plans, Medicare plans)
- Government programs, resources and legislation and mandates including but not limited to Affordable Care Act, FMLA, Medicaid, CHIP
- Pharmacy benefits including injectable medications
- Individual Health Plans and Exchanges plans
4
Claims Associate Resume Examples & Samples
- Basic computer literacy and healthcare terminology
- Demonstrated critical thinking skills
- Basic Microsoft Excel skills
- Experience as an office manager
5
Claims Associate Resume Examples & Samples
- Ability to understand the meaning of written or printed matter and to record information by inscribing characters or symbols. The physical demands described here are representative of those that must be met by an Associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions
- Job Title:* Claims Associate
- Req ID:* 747192BR
- Canada Walmart Division:* Retail Store Associates
- Canadian Cities:* Surrey
- Employment Type:* Hourly PT
6
Group Claims Associate Resume Examples & Samples
- Determines customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decisions based on facts presented
- Networks with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
- 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
- Minimum of 1 year disability claim management experience
- Ability to thrive in a fast-paced environment and meet deadlines
- Excellent interpersonal, organizational, negotiation, investigative, analytical and research skills
- Critical attention to detail
7
Claims Associate Resume Examples & Samples
- Customer service experience
- Associates or Bachelors Degree
- 2 or more years of Insurance or claims work experience HIGHLY preferred
- Ability to multi-task and adapt to a changing environment
- Organization Skills and time management skills
- Experience in a work environment that required collaboration across work groups
- Willingness to embrace the Zurich Basics of Integrity, Sustainability, Customer centricity, Excellence and Teamwork
8
Claims Associate Resume Examples & Samples
- Learns to create and update files as well as utilize the Claims Management System (CMS). By using checklist and guidelines, learns how to properly document files and how to identify existing claims that are appropriate to close
- Learns to develop the ability to analyze, evaluate and participate in the decision making process to determine case resolution/adjustment
- Learns how to provide comprehensive reports as required. Learns how to pull information from various systems, compile and format data for reports. Learns how to identify and communicate basic claim trends and account and/or policy issues to management and underwriting
- Learns what constitutes adequate reserving for both indemnity and expense. Assists in reviewing reserves on a regular basis to ensure adequacy
- Learns how to investigate and evaluate initial policy coverage and how to communicate the interpretation of coverage
- Learns and participates in the claims audit process
- Learns and participate in the litigation management process
9
Claims Associate Resume Examples & Samples
- Zurich Certified Insurance Apprentice including an Associate Degree and no experience in the claims area
- Bachelors Degree and no experience in the Claims area
- AND
- Agricultural experience for handling Crop line of business
10
Rcis-hail Claims Associate Resume Examples & Samples
- High School Diploma or Equivalent and 2 or more years of experience in the Claims area
- Associate Degree or Bachelors Degree
- Agricultural experience preferred for handling Crop line of business
11
Rcis-claims Associate Resume Examples & Samples
- Zurich approved Apprenticeship program including an Associate Degree and no prior experience required in the customer service area
- Ability to obtain and maintain required adjuster license
- Experience collaborating across work groups
12
Claims Associate Resume Examples & Samples
- Resolution of customer claims, debit notes and disputes according to specified dispute registration and claims management procedures
- Timely investigation of claims (with all relevant departments), debit notes or disputes and the gathering of all the information needed to approve/reject claims, debit notes and disputes based on investigation
- Effective communication and collaboration between the functions of accounts receivable credit control, cash application, customer service, finance and the claims team
- Digital filing of all completed claims forms, documentation and proof of deliveries
- Timely issuing of credit notes according to the correct authorization schedule and accompanied by all required data
- Effective root cause analysis
- English and Portuguese (Native or Fluent) language
- Effective communicator, both written and verbal
- Quick thinker, able to negotiate and compromise
- Flexible and able to multi task
- Able to problem solve effectively
- Effective team player (able to backup colleagues and strive to achieve targets as a team
13
Group Claims Associate Resume Examples & Samples
- Ability to work with high sense of urgency
- Customer Service skills and experience
- Typing and Computer skills (Microsoft Office)
- Excellent Organizational and time management skills
14
Claims Associate Resume Examples & Samples
- Previous auto insurance claims experience or
- Previous vehicle appraisal experience or
- Previous finance/retail auto loan experience or
- Previous auto dealership work experience
15
Claims Associate First Report of Injury Resume Examples & Samples
- Answer incoming calls and emails for injured workers or employers of injured workers
- Establish a first report of injury with proper coding
- Obtain details about accidents or injuries that occurred at work
- Enter details into proprietary claims handling system to set up a new claim
- Deliver excellent customer service to customer and associates
- Maintain confidentiality at all times in accordance with company policy
- Previous insurance experience preferred
- Strong Customer service skills
- Professional written and oral communication skills
- Knowledge of MS Word, Excel, Outlook, and basic computer proficiency
- Strong ability to work in a paperless work environment
- Comfortable with high volume workloads and fast-paced service standards
16
Group Claims Associate Resume Examples & Samples
- BA/BS degree preferred
- Ability to solve problems and utilize analysis, experience, and judgment to make effective decisions
- Ability to communicate information in a clear, concise, and timely manner while using appropriate channels of communication
- Ability to meet expectations of internal and external customers
- Demonstrated excellent customer relations
- Strong customer service skills required
- Ability to continuously identify opportunities for improvement and take appropriate action
17
Group Life Claims Associate Resume Examples & Samples
- Manages assigned caseload of life insurance claims (life insurance, dependent life insurance, and accelerated death benefits). Analyzes a variety of criteria to determine decedent/beneficiary eligibility for coverage/benefits; determines payment. Corresponds with and/or interviews policyholders, beneficiaries and others to compile information. Ensures compliance with corporate as well as various statutory timing/payment requirements and regulations
- Manages assigned caseload of waiver of life insurance premium claims. Analyzes a variety of criteria to determine eligibility for coverage; evaluates claimants' degree of physical and/or mental limitations based on interviews, medical records and clinical review recommendations to determine eligibility for benefits; determines benefit level. Corresponds with and/or interviews policyholders, claimants and others to compile information. Coordinates with long term disability claims teams when benefits integrate
- Manages assigned caseload of accidental death and dismemberment claims. Analyzes a variety of criteria to determine decedent/beneficiary eligibility for coverage/benefits; conducts contestable and accidental death and dismemberment investigations; determines payment. Corresponds with and/or interviews policyholders, beneficiaries, medical examiners, police departments and others to compile information. Ensures compliance with corporate as well as various statutory timing/payment requirements and regulations
- Knowledge and Skills
18
Group Claims Associate Resume Examples & Samples
- Make claim / customer eligibility determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and leveraging expert resources
- Ability to handle potentially high levels of call volume from customers and clients. Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits
- 1 year minimum of professional experience is strongly preferred
- HS Diploma or GED required. Bachelor’s degree strongly preferred
- Proven track record through business/leadership experience
- Strong critical, analytical and investigative skills; ability to gather information, analyze facts, and draw conclusions
- Effective interpersonal, written and verbal communication skills
- Excellent planning, time management and organizational skills
19
Group Claims Associate Resume Examples & Samples
- 1 year minimum of professional experience strongly preferred
- Proven track record of successfully driving results in a complex matrix environment is a (+)
- Additional experience administering FMLA and/or State Leaves is a (+)
- Must have the ability to work with a sense of urgency and be a self-starter with a customer focus mindset
- Ability to manage multiple and changing priorities
- Knowledge of legal liability, insurance coverage and medical terminology is a (+)
- Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously
20
Group Claims Associate Resume Examples & Samples
- Determine customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented
- Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
- Manage both new claims and open claims equally and maintains decision times
- Adhere to standard time frames for processing mail, tasks and outliers
- Understand Cigna Group Operations and Corporate Compliance, Polices and Procedures and best practices
- High School Diploma or GED required. Bachelor's degree strongly preferred
- Strong written and communication skills demonstrated in previous work experience
- Specific experience with collaborative negotiations
21
Rcis Crop Claims Associate Resume Examples & Samples
- High School Diploma or Equivalent and no prior experience required in the customer service area
- Experience with Microsoft Office
- Claims experience
- Agricultural experience in handling crop line of business
- Analytical and organization skills
22
Senior Claims Associate Resume Examples & Samples
- Claims worked will primarily involve health, or disability type of insurance products. Determine claim processing protocols and apply the correct policies to the claim
- Interact with customers and internal departments to resolve issues and accurately process claims
- Properly adjudicate claims based on your knowledge of covered benefits, insurance and provider contracts
- Determine plan liability as well as diversion and recovery activity for claims
- Identify and resolve claims pending
- Integrate and use knowledge and experience as a skilled specialist
- Apply understanding of advanced principles, theories, and concepts as well as related knowledge to solve problems and deliver solutions
- Monday-Friday schedule 8am to 5pm or similar
23
Recovery Claims Associate Resume Examples & Samples
- Responsible for assigned inventory of files with recovery; maintains a monthly diary to receive the payment from at-fault parties; and follows up with the payees if payment is late
- Enters recoveries into various claim systems to ensure the recovery dollars are applied to appropriate claims file
- Works with collection agencies with appropriate to collect from at-fault parties; records details in claims file
- Using various search techniques, is responsible for skip tracing (finding someone who does not wish to be found)
- Responsible for obtaining a copy of the police report to support the recovery claim
- Processes invoices for various vendors involved in recovery, including attorneys, special investigators, medical experts, etc
- Processes checks received from adverse parties/payees for payment; maintains copies of all recoveries as required by internal and external auditors
- Responsible for responding to clients' questions timely and professionally
- Assists Salvage Associate with salvage disposition
- Responsible for filing, faxing, photocopy, scanning and other general office functions; opens and distributes mail within the department
- Analytical and interpretive skills
24
Claims Associate Resume Examples & Samples
- · Processes uncomplicated personal and commercial line property auto claims and ensures claim files are properly documented and coded correctly based on the policy
- · Maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution; escalates issues as needed
- · Identifies and pursues subrogation opportunities; secures and disposes of salvage
- · Communicates claim action/processing with insured, client and agent or broker when appropriate
- Knowledge of construction basics
25
Claims Associate Resume Examples & Samples
- Processes first party property claims based on basic coverage as defined by client-specific program
- Makes coverage determinations based on investigation/evaluation
- Adjudicates proper settlements or denials up to designated authority level under supervision
- Handles high volume of claims, phone calls and correspondence ensuring claim files are properly documented; meets quality and production goals; and meets customer guidelines and deadlines
- Knowledge of first party property claims adjudication as applicable to line of business
- Good oral and written communication, including presentation skills
- Good organization skills
26
Claims Associate Resume Examples & Samples
- Bachelor’s degree with emphasis in accounting, finance, or equivalent
- At least 1 year of related work experience
- Solid analytical and communication skills
- Proven negotiation skills
27
Claims Associate Resume Examples & Samples
- Perform loss analysis for the Claims Department to determine why advances were not recovered on home mortgage foreclosures, DILs, and Short Sales
- Perform analysis of all LSAMS transactions relating to advances and expenses on zero UPB loans and reconcile to all Claim funds and Third Party funds received
- Document and maintain all systems necessary for booking losses, assigning root cause and follow-up to prevent recurrence of loss types
- Manage a diversified portfolio and provide feedback to ensure advance actions taken within the default servicing processes comply with internal policies and investor guidelines
- Manage relations across business units, and collaborating with our investors and vendors, regarding procedural, technical and/or operational functions
- Drive For Results
- Learning On The Fly
- Knowledge of Microsoft Office – Excel and Word.Excel and Word-computer skills-should be at an intermediate level.Working knowledge in Access is a plus
- Working knowledge of LSAMS transaction histories
- Working knowledge of the loan servicing timelines, from originations to REO sale
- Working knowledge of FNMA 571 Claims guide and allowable advances during default process
- Working knowledge of FHLMC Claims guide and allowable advances during default process
- Minimum 12 months mortgage servicing experience
- 1-2 years prior experience within investor claims department
28
Claims Associate Resume Examples & Samples
- Provides a consistent, positive, and satisfying claims experience for our clients by delivering superior claims service
- Investigates claims by determining applicable policy coverage, evaluating damages, and settling assigned claims. Obtains and analyzes a wide variety of documentation related to the claim and draws the proper conclusions for the claim
- Coordinates activities with auto appraisers, body shops, rental companies, glass shops and others on auto claims to bring claims to a conclusion according to policy provisions while also working to control costs
- Initiates first contact with insureds and all relevant parties to gather basic information and explains the overall claims process in accordance to Best Practices
- Maintains continuous communication with all affected parties regarding each step of the claims process
- Communicates with clients via telephone to set up new claims and obtain necessary information. May also receive first notice of loss from agency offices and the internet. Explains the overall claims process in accordance to Best Practices
- Meets monthly phone, availability, customer satisfaction and other goals set by management
- Assists each caller to the fullest extent and takes ownership of each call
- Refers claims exceeding assigned scope to CCO for further investigation. Refers claims exceeding assigned scope to CCO for further investigation
- Evaluates and interprets state-specific policies and laws in each of the 18 states where the organization conducts business
- Performs other related work as required or requested
- Education equivalent to graduation from high school or the equivalent in related work experience
- Maintains the appropriate adjuster's licensing if required by the states in which we do business
- Demonstrates the ability to deal effectively and empathetically with a wide variety of internal and external contacts
- Demonstrates the ability to work in a fast-paced, team-oriented, production environment with the flexibility to meet service standards
- Deals effectively with conflict and potentially difficult situations
- Demonstrates strong personal computer skills with keyboarding proficiency and a sound working knowledge or Microsoft Office Outlook, Word, and the technologies used in support of claims, i.e. Siebel, etc
- Previous claims or customer service experience is preferred
- Previous user experience with Siebel (or similar systems) is preferred
- Must possess these effective skills and abilities
29
Claims Associate Resume Examples & Samples
- Maintaining positive stakeholder relationships with the insured, agents and service providers
- Interpreting basic policy coverage and determining if coverage applies to claims submitted
- Receiving, recording and processing incoming insurance claims
- Authorising payment within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements; and
- Identifying suspicious or potentially fraudulent claims and arranging investigations
- Highly developed customer service, communication and negotiating skills
- Previous experience within the insurance industry, preferably in motor or motorcycle claims
- Strong organisational and time management skills; and
- A high level of analytical and interpersonal skills
30
Claims Associate Resume Examples & Samples
- Communicate with internal and external customers and third parties clearly, professionally, and empathetically via telephone and Zendesk
- Investigate and submit new claims by reviewing first reports of loss and supporting materials
- Gather and verify loss information
- Reconcile incoming claims documents
- High school diploma or AA. College degree a plus
- 1+ years customer service experience as a high-performing customer service/support representative. Insurance experience a plus
- Intermediate Excel/Google Sheets knowledge preferred
- Ability to maintain quality in a fast-paced environment
- Uber love!
31
Claims Associate Manager Resume Examples & Samples
- Review and analyze coverage and prepare appropriate coverage position letters
- Investigation, analysis and evaluation of assigned claims
- Management and direction of outside counsel as well as reviewing and approving legal and/or expense budgets and bills
- Preparation of case summary reports related to matters of significant reserve activity
- Timely and appropriate setting of claim reserves
- Development and execution of claim strategies as well as resolution strategies
- Negotiation and resolution of claims
- Determine and resolve workload and assignment issues to ensure effective claims processing, expense management and claims disposition
- Attend trials and mediations
- Third party administrator oversight and management, including auditing of same
- Vendor oversight and management, including auditing of same
- Identify issues and trends in the portfolio; take appropriate and/or corrective action where necessary; communicate trends to underwriters, insureds and brokers
- Extensive communication with insureds, brokers, reinsurers, actuaries and business unit contacts
- Attend client meetings and industry functions to support retention and development of client relationships and business
- The ideal candidate will have 3-5 years of Property & Inland Marine claims experience and current, working knowledge of jurisdictional laws and regulations
- Insurance industry designation(s)/certification(s) preferred
- Strong negotiation and investigation skills
- Ability to evaluate coverage issues involving a wide variety of loss scenarios
- Currently holds or readily can obtain all required adjuster licenses
- Knowledge of the insurance industry, claims and the insurance legal and regulatory environment
- Knowledge of claims handling or insurance legal statutes and procedures
- Ability to identify and use relevant data and metrics to best manage claims
- Collaborative mind-set and willingness to work with people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency
- Ability to and willingness to present to senior management and other group settings
- Ability to influence others and resolve complex, disputed claims
- Travel is required
32
Temporary Credit Life & Claims Associate Resume Examples & Samples
- Process new business, cancellations, underwriting for new business
- Correspond with doctors’ offices, hospitals, agent and policyholders for information to complete the underwriting application
- Correspond with agents and policyholders regarding approval/denial from underwriting
- Calculate and verify premiums for new business and refunds
- Verify data entry of new business, cancellations, general ledger, claims, agent changes and outstanding balance reports
- Prepare, edit and process monthly statements
- Audit each claim submitted to determine if claim is payable or if additional information is required
- Correspond with physicians’ offices, hospitals, employers, agents or policyholders to audit claim
- Determine amount of claim benefit to be paid and process in a timely manner
- Request reinsurance on those claims having reinsurance
- Process claim reports monthly and at year end
- Answer all incoming telephone calls to FNL
33
Claims Associate Resume Examples & Samples
- Report new claims to the carrier within time period as set by company standard
- Direct contact with carrier claims department within 48 hours of reporting of all new claims to identify claim number and ensure adjuster assigned to loss
- Contact with adjusters to monitor status of claims in order to update relevant parties on status (on certain claims when requested)
- Assist Claims Team members with incoming and outgoing claims documentation and ad hoc projects
- Assisting Claims Team members in preparation of Claim Kits
- Accurate data entry in EPIC claims management system
- Setting educational goals to improve personal performance
- Under supervision of the Claim Team, direct communication with clients to advocate clients’ interest in all claims matters
- The essential duties contained in this job description reflect general details as necessary to describe the principal functions of this job, the level of knowledge and skill typically required and the scope of responsibility. It should not be considered an all-inclusive listing of work requirements. Individuals may perform other duties as assigned, including work in other functional areas to cover absences, equalize peak work periods or otherwise to balance the workload
- Experience in insurance industry an asset
- College or University Degree preferred
- Intermediate to Advanced Level of Microsoft Office Suite (e.g. Word and Excel)
- General familiarity with handling high volume of paperwork
- Good customer service, interpersonal, teamwork and organizational, skills
- Ability to multi-task, set priorities and meet deadlines
- Ability to use good judgment and strong ethical standards
34
Claims Associate Liability Resume Examples & Samples
- Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision
- Ensures claim files are properly documented and claims coding is correct
- May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims
- Knowledge of Social Security and Medicare application procedure as applicable to line of business
35
Claims Associate Resume Examples & Samples
- Providing support to HUB International clients on all claims related matters
- Providing guidance to internal teams on the claims process and building knowledge and capability
- Effectively analyze and interpret policy wording
- Working closely with the Vice President, Claims and Claims Team
- Providing status updates to Client and Account Teams and providing appropriate consulting and guidance where required
- Participating in team and client meetings when required
- Maintaining accurate and up-to-date electronic claims files through Epic
- · Bachelor’s Degree or College Diploma or equivalent experience
- · Minimum two (2) years’ experience in insurance
- · Strong customer service orientation (internal and external)
- · Self-starter and strong initiative
- · RIBO License preferred
- · Computer Proficient in Microsoft Office: Word, Excel, and Outlook
- · Strong sense of urgency, attention to detail and ability to manage requirements of the role effectively
- · Effective communication, negotiation and presentation skills
- · Ability to work independently and as part of team
36
Temporary Claims Associate Resume Examples & Samples
- Two years customer service OR claims handling experience preferred
- College degree and/or Basic insurance and claims principals a plus
- AMS 360 Experience in an Insurance Agency Environment is a plus
37
Claims Associate Resume Examples & Samples
- Processes uncomplicated personal and commercial line property claims and ensures claim files are properly documented and coded correctly based on the policy
- Maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution; escalates issues as needed
- Identifies and pursues subrogation opportunities; secures and disposes of salvage
- Communicates claim action/processing with insured, client, and agent or broker when appropriate
- Travels as required
- Good negotiation skills
- Ability to meet or exceed Service Expectations
38
Claims Associate Resume Examples & Samples
- 2 years’ experience in a production environment
- Claim processing experience
- Data entry experience
39
Claims Associate Senior Resume Examples & Samples
- Processes first party property, casualty and/or medical reimbursement claims based on multiple/additional coverage and/or programs as defined by client-specific program
- Makes coverage determinations based on investigation/evaluation and communicates claim actions with claimant and client
- Adjudicates proper settlement up to designated authority level
40
Claims Associate, PIP / Reinsurance Resume Examples & Samples
- Performs clerical duties, including data entry, filing paper documents, email, calendar management, and word processing
- Handles reinsurance related tasks for personal injury/medical payment claim files to include account balancing, requesting reimbursement from a third party and processing payments received
- Liaison between claim adjusters, leadership, and the MCCA
- Retrieves, prints, faxes, or mails supporting documentation to the MCCA or others as directed
- Adaptability to new technologies and programs
- Performs routine tasks of basic complexity under general supervision
- Prior financial or account experience preferred
- Prior Military are encouraged to apply
41
Claims Associate Resume Examples & Samples
- Sets up and enters new claims into claims management system
- Inputs and reviews notes/diaries in claims management system as instructed
- Processes payments
- Processes mail; handles filing, faxing and photocopying
- Reviews, prepares, creates, and/or sends letters, reports, and forms
- Answers and initiates telephone calls, sets up medical appointments, and may provide customer service as required
- Other activities/projects as assigned including the preparation and distribution of computer reports
42
Claims Associate Resume Examples & Samples
- Processes uncomplicated personal and commercial line property auto claims and ensures claim files are properly documented and coded correctly based on the policy
- Communicates claim action/processing with insured, client and agent or broker when appropriate
- Entry level; business administration, office administration; Claims associate, entry-level, trainee, receptionist, legal assistant, office assistant, trainee program, customer service, administrative assistant, CSR
43
Rcis Crop Claims Associate Resume Examples & Samples
- Build a working knowledge of crop hail insurance policy and claim procedures
- Work with more experienced team members on complex claims as appropriate; monitor and process suspended hail claims and ensure that the required information is received and timely processed in accordance with established SOPs and procedures
- Ensure all required documentation has been gathered to approve claim suspensions and edits, and coordinate with adjusters as needed for additional information
- Process incoming claims from adjusters on a first-in/first-out basis
- Monitor reports and research to ensure claims are processed accurately and timely
- Provide superior customer service by logging into the claims processing team queue and responding to policy and procedure questions that are basic to moderately complex from agents and field staff
- Create and maintain HEAT tickets to document software issues or enhancement requests
- Assist other departments during peak workloads as directed by manager
- Demonstrate superior customer focus while maintaining the highest level of professionalism to ensure the customer's needs are met
- High School Diploma or Equivalent and no prior experience required in the office environment or customer service area
- Experience in an office environment
- Agricultural or Crop Claims Experience
- Computer Proficient including basic Microsoft skills
- Ability to adapt to a changing environment
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Claims Associate Resume Examples & Samples
- The Claims Associate I role is responsible for helping our customers maintain a sense of security and their well-being by effectively managing an assigned caseload of claims, in a fair and ethical manner. This role is responsible for ensuring quality claim decisions and timely benefit payments due, that are in accordance with policy/contract provisions, regulations and claim procedures. The Claims Associate I will also be expected to analyze, evaluate, and interpret medical, financial, and other relevant information gathered to reach claim determinations
- Demonstrates ability to investigate, collect, examine, analyze and interpret claim information, including medical records to determine claim direction and to make accurate, impartial, and quality claim determinations in accordance with claim facts, policy/contract provisions, regulations, and department procedures for claims that are of a noncomplex nature
- Appropriately requests additional information as needed from providers, policyholders, beneficiaries, etc. to better understand claim facts. The Claims Associate I will also conduct relationship building interviews that contain probing questions with the claimant, policyholder, policyowner, insured, and/ or medical/care provider(s) as appropriate to obtain and reveal all claim facts, the root of a claim issue/problem, or to resolve a customer issue
- Clarifies insured’s functional/mental capacity through independent problem solving measures and discretion by utilizing investigative tools such as Medical Disability Advisor to determine expected durations, independent peer reviews, medical examinations, cognitive testing, vocational and transferable skills analysis, surveillance, etc
- Develops and documents claim facts, phone conversations, actions, strategy, and rationale for decisions according to department processes
- Correctly calculates and processes claim benefit payments due within authority level, in compliance with policy/contract provisions, regulations, and department procedures
- Prepares quality communication to agents, policyowners, insureds, beneficiaries, policyholders, medical providers, or other customer and business relationship parties. The Claims Associate I is able to effectively write claim decision letters that explains analysis of medical information and reasoning of decision
- Correctly utilizes multiple administrative systems and claim systems knowledge to obtain relevant claim information, to record claims, and to process claim benefits
- Effectively communicates and collaborates with internal and external customers. The Claims Associate I will establish, communicate, and manage customer expectations. This includes responding to all customer service inquires in accordance with departmental customer service protocols to ensure customer satisfaction and to show that we are flexible and responsive. The Claims Associate I speaks and responds respectfully to customers and other stakeholders
- Effectively organizes and prioritizes daily responsibilities to ensure adherence to standard time frames for processing mail, tasks, and clam decisions. This includes effectively utilizing tools/resources, according to department guidelines, and multitasking without losing sight of quality
- Identifies and appropriately refers matters to legal counsel or escalates claim issues or concerns to senior team members and/or management
- Actively delivers results by contributing to achieving and maintaining or exceeding departmental deadlines, requirements, service, accuracy, timeliness, and performance standards
- Completes accurate accounting transactions according to departmental procedures
- Demonstrates understanding of team and enterprise goals by effectively
- Effective interpersonal and listening skills to build solid relationships inside and outside the enterprise
- Strong personal work ethics with commitment to build credibility and trust. This includes maintaining confidentiality and exercising discretion and tact
- Ability to get high quality work done through personal & professional proficiency using company tools, processes, and procedures
- Ability to communicate information in a professional, empathetic, pleasant, accurate, clear, and concise manner with an appropriate level of detail
- Ability to be a team player, work professionally, collaborate, in addition to building and maintaining effective relationships for results
- Strong customer service orientation with high ability to empathize with customer
- Exhibits self-motivation and initiative
- Ability to excel in a fast paced environment
- Exhibits commitment to continuous self-development of technical and professional expertise
- Ability to embrace appropriate level of empowerment with accountability
- Microsoft Office proficient
- Strong analytical, problem solving, and conceptual abilities
- Ability and desire to conduct focused and extensive research on claims
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Claims Associate Resume Examples & Samples
- Refers claims exceeding assigned scope to Central Claims Office (CCO) for further investigation. Refers claims exceeding assigned scope to CCO for further investigation
- Demonstrates excellent oral and written communication, including telephone etiquette, possesses good decision-making skills and the ability to persuade and negotiate effectively, possesses the ability to handle potential conflict effectively and constructively, and demonstrates good organizational skills, analytical ability, and detail orientation
- Possesses the ability to multi-task while interacting effectively with financial representatives, claimants, insureds, internal staff members, and external contacts
- Basic computer and data entry skills
- Experience with insurance company operations and financial services products
- Experience with handling auto claims
- Working knowledge of business systems including Siebel and Microsoft office
- Bilingual in English and Spanish
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Claims Associate Resume Examples & Samples
- May negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits
- May participate in customer marketing efforts
- May contribute to profitable growth by providing risk insight, information and trends to Business Unit or customer as needed
