Claims Rep Resume Samples

The Guide To Resume Tailoring

Guide the recruiter to the conclusion that you are the best candidate for the claims rep job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

Craft your perfect resume by picking job responsibilities written by professional recruiters

Pick from the thousands of curated job responsibilities used by the leading companies

Tailor your resume & cover letter with wording that best fits for each job you apply

Resume Builder

Create a Resume in Minutes with Professional Resume Templates

CHOOSE THE BEST TEMPLATE - Choose from 15 Leading Templates. No need to think about design details.

USE PRE-WRITTEN BULLET POINTS - Select from thousands of pre-written bullet points.

SAVE YOUR DOCUMENTS IN PDF FILES - Instantly download in PDF format or share a custom link.

Create a Resume in Minutes

M Zboncak

Marcelo

Zboncak

645 Thelma Parkway

Houston

+1 (555) 885 2129

645 Thelma Parkway

Houston

Phone

p +1 (555) 885 2129

Experience Experience

Boston, MA

Claims Rep

Boston, MA

Zboncak-Terry

Boston, MA

Claims Rep

Provide excellent customer service
Interpret Fee for Service (FFS) and capitated provider contracts
Analyze and identify trends and provides reports as necessary
Analyze and adjudicate claims to ensure accurate payment
Accurately process professional and institutional claims
Review claims on a periodic basis
Meet Department Quality and Accuracy Standards

Dallas, TX

Claims Rep-field

Dallas, TX

Jacobs LLC

Dallas, TX

Claims Rep-field

Participate in other projects or other duties as assigned
Negotiate with contractors or repair facilities regarding extent of damage and method of repair
Regular attendance
Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
Performs all other duties as assigned
Other duties assigned by management
Consistently meet established productivity, schedule adherence, and quality standards

present

Dallas, TX

Senior Claims Rep-field

Dallas, TX

Walsh, Harber and Hamill

present

Dallas, TX

Senior Claims Rep-field

present

Manage all administrative claim functions such as reserving, claim payments and file notes via electronic means and at times from remote locations
Participate in company sponsored educational programs to develop and maintain knowledge of products, producers and industry trends
Manage the salvage process
Prepare written investigative reports for the claim file to document all activity related to the loss
Maintain currency on case law and construction prices/methods/procedures
Conduct field investigation to include site inspection, diagram, photographs, interview and secure recorded statements of those possessing facts concerning the loss
Foster and maintain relationships with independent agency force

Education Education

Bachelor’s Degree

The University of Texas at Austin

Bachelor’s Degree

Skills Skills

Excellent time management ability
Strong focus delivering outstanding customer service
Strong desire to launch your career to the next level!
Demonstrated strong written and verbal communication skills
Accurately resolve coverage and compensability issues
Achieve fair, equitable and timely claim dispositions
Handle claim files in a manner consistent with Claim quality standards and goals
Develop advanced functional knowledge to appropriately interpret and apply insurance coverage
Apply general mathematical knowledge and / or financial analysis to achieve results
Maintain current knowledge of claim loss cost containment initiatives, and use them appropriately and consistently with company practices and procedures

Create a Resume in Minutes

11 Claims Rep resume templates

Read our complete resume writing guides

Claims Rep-iii Resume Examples & Samples

Learning the activities/tasks associated with his/her role
Works under direct supervision
Relies on others for instruction, guidance, and direction
Work is reviewed for technical accuracy and soundness
Primary duties may include, but are not limited to
Codes and processes claims forms for payment ensuring all information is supplied before eligible payments are made
Researches and analyzes claims issues. Requires HS diploma or equivalent; up to 1 year of related experience; or any combination of education and experience, which would provide an equivalent background. Good oral and written communication skills; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.)

Claims Rep-guest Claims Resume Examples & Samples

Proven experience and strong understanding of property and casualty insurance and claims handling
Demonstrated strong technical skills, including scene investigations, evaluation and negotiation of liability claims
Computer proficiency within a Windows environment, including Outlook, Word, Excel, and PowerPoint
Proven ability to deliver concise and informative written summaries in memo and presentation format, with appropriate business writing and usage of professional grammar

Claims Rep-iii Resume Examples & Samples

Up to 1 year of related experience
Good oral and written communication skills; previous experience using PC, database system, and related software (word processing, spreadsheets, etc.)
Microsoft Word, Excel, and Outlook experience preferred

Senior Inside Claims Rep-nac Resume Examples & Samples

Obtains information about vehicle damage losses from customers, claimants or other Insurance Companies through telephone and written reports
Arranges appraisals, reviews appraisal reports, communicates with customers, claimants, attorneys, and repair shops, etc. May secure title or other documentation required to sell vehicle for salvage
Secures the essential facts about the vehicle damage, assesses liability/compensability, negotiates settlements within prescribed authority and explains denials to policyholders and claimants
Uses internet and Liberty Mutual contracted vendors for pricing and/or validation of inventoried items
May assist in the training, coaching and counseling of less experienced Senior Inside Claims Representatives
Must be able to work in a fast paced, team-oriented environment
High School Diploma or equivalent training plus 1-2 years claims experience
Strong working knowledge of the various operations with the Claims Department and the ability to handle multiple claims work systems is required
Must demonstrate a proficient understanding and use of the basic policy/contract coverages and be able to recognize questionable coverage/contract situations which necessitate supervisory involvement
Ability to handle total loss

Claims Rep Resume Examples & Samples

Answer incoming calls from a queue; respond to/resolve claims in accordance
Two years of customer service and call center experience
Typing of 40 wpm
Proficiency in MS office and Windows-based applications
Proficiency with fax machine, copier, printer, telephone
Excellent dispute resolution/ customer service skills

Claims Rep., First Response Center Resume Examples & Samples

Effectively communicate problems or need for potential changes to allow the team leader to take further action
Records the accident or loss situation into the system with accurate and detailed information in order to determine the cause of loss, bodily injury, accident benefits and extensive property damage exposure (s). Where necessary identify appropriate services required by the client for example, emergency services, appraisal, rental vehicle, towing services etc
Apply working methods according to procedure. Where coverage exists, direct claimants through the claims settlement process by explaining coverage and procedures (in non-technical terms), recommended suppliers, and by informing the claimant of his/her obligations and responsibilities to move the claim toward settlement. Where coverage does not exist, inform the client by explaining the terms of the insurance contract
Participate openly and actively in coaching sessions by providing input and feedback to Telephone Unit, Team Leader and Quality Assurance Analyst

Claims Rep-field Resume Examples & Samples

Review assignments to determine severity, coverage and appropriate action
Manage all administrative claim functions such as reserving, claim payments and file notes via electronic means and at times from remote locations
Negotiate with contractors or repair facilities regarding extent of damage and method of repair
Industry designations such as AIC, CPCU, SCLA, CCLA or PCLA are preferred
Strong negotiation and problem solving skills
Individual must be analytical, precise and have the ability to work independently

Claims Rep-inside Resume Examples & Samples

Review assignments to determine severity, coverages and appropriate action
Conduct phone interviews and take recorded statements from all parties possessing facts regarding the claim
Write reports for the claim file to document all activity related to loss
Evaluate the loss/damages
Prepare files for arbitration
Negotiate with contractors or repair facilities regarding extent of damage and method of repair. Recover salvage and sell to appropriate salvage buyer
Keep current on court cases, changes in law, values and prices of property and materials
Promote positive working relationships with agents
Perform other job duties as assigned
Regular attendance
Four year college degree is preferred. A high school diploma is required
1 - 3 years of property and casualty insurance claims experience
AIC, SCLA, CCLA or PCLA designation preferred, or complete within orne ore more within two years of hire
Ability to meet appropriate state licensing requirements as needed
Ability to read, comprehend and interpret policy language and apply to loss
Must possess negotiation skills, human relations skills, analytical skills, organization skills as well as oral and written communication skills

Claims Rep IAP Wc-claims Trainee Resume Examples & Samples

Attendance and completion of designated classroom claims professional training program
Performs on-the-job training activities including
Ability to meet or exceed the organization's Core Competencies

Senior Multiline Claims Rep Resume Examples & Samples

Minimum 5 years prior Special Lines estimating experience
Able to quickly build rapport and successfully effect settlements
Excellent organization and problem-solving skills
Proficient in basic computer skills, including proficiency in using claims and estimating systems
Valid driver's license and good driving history
Individual will work in the field, office, body shops, or service center
Limited travel will be required to training classes or areas needing additional staffing
Company-provided cell phone for use during work hours

Claims Rep Resume Examples & Samples

Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
Authorize appropriate payment or refer claims to investigators for further review
Analyze and identify trends and provides reports as necessary
Consistently meet established productivity, schedule adherence, and quality standards
Accurately process professional and institutional claims
Responsible for editing and adjusting of claims per the EDI daily audit report
Analyze and adjudicate claims to ensure accurate payment
Interpret Fee for Service (FFS) and capitated provider contracts
Review claims on a periodic basis
Meet Department Quality and Accuracy Standards
Interfaces with other departments to obtain necessary information required for resolution of claims
Advise management of any claim issues or inappropriate and/or incorrect billing
Other duties assigned by management
An education level of at least a high school diploma or GED
2 - 3 years’ experience as a Medical Claims Examiner
Experience in contract interpretation
Intermediate experience with Word and Excel
Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
1 - 2 years’ experience of Institutional Claims processing
Prior Medicare, HMO experience
Working knowledge of Medical Terminology, ICD9, CPT4, UB92/1500 forms
Excellent Data Entry skills needed
Revenue and HCPCS coding skills helpful

Claims Rep IAP Liability Resume Examples & Samples

Ability to meet or exceed position specific competencies
Concern for order, quality and accuracy
Knowledge of personal computer applications including Microsoft Office products
Ability to demonstrate excellent oral and written communication, including presentation skills
Ability to demonstrate effect teamwork skills

Senior Claims Rep-field Resume Examples & Samples

Review and interpret policy coverage to determine whether the claim is payable under the policy, deductible, actual cash value or replacement cost
Conduct field investigation to include site inspection, diagram, photographs, interview and secure recorded statements of those possessing facts concerning the loss
Prepare written investigative reports for the claim file to document all activity related to the loss
Manage the salvage process
Maintain currency on case law and construction prices/methods/procedures
Foster and maintain relationships with independent agency force
Participate in company sponsored educational programs to develop and maintain knowledge of products, producers and industry trends
Participate in other projects or other duties as assigned
Minimum of five years of multi-line claims experience
Minimum of five years of commercial property and casualty claims experience

Homeowner Field Claims Rep Resume Examples & Samples

Investigate, analyze, evaluate and settle insurance claims involving property damage losses
Deliver exceptional customer service through professional and timely communication including telephone, email and written correspondence
Determine value of a claim and negotiate settlements within prescribed limits of authority, in accordance with established procedures, contractual obligations and all state regulatory requirements

Claims Rep First Response Center Resume Examples & Samples

Listen to client needs and treat each encounter as unique and clarify clients request to ensure they are well served
Provide clients with value-added service in explaining claims procedures and coverage and offering clear and complete information based on client needs
Meet productivity objectives set by the department in terms of average handle time, after call work, service levels, abandoned percentages, overall adherence compliance and number of incoming telephone calls handled
Collaborate with other departments to ensure missing policies are offered to clients
Adapt quickly to systems changes and/or modifications
Take appropriate action to complete various insurance claims transactions
Identify needs and proactively seek coaching to generate improvement opportunities

Multiline Claims Rep-southern California Resume Examples & Samples

Investigate, analyze and determine Progressive's liability concerning loss or damages
Negotiate settlements with claimants
Bachelor's degree or a combined total of five years of work experience and/or college education
Annual gainshare bonus of up to 16% of your salary! Progressive rewards each of us with an annual bonus based on company performance
Wellness program with discounts & rewards

Senior Work Comp Claims Rep Resume Examples & Samples

Plan recommend, reserve and execute the investigation, valuation, disposition and settlement of claims for the California jurisdiction
Achieve fair, equitable and timely claim dispositions
Properly assess the indemnity, medical and expense exposure of assigned claims
Set reserves accurately and in a timely manner
Accurately resolve coverage and compensability issues
Plan, organize and establish priorities, determine realistic completion dates
Use services of others appropriately
Develop advanced functional knowledge to appropriately interpret and apply insurance coverage
Develop technical and jurisdictional expertise
Maintain current knowledge of claim loss cost containment initiatives, and use them appropriately and consistently with company practices and procedures
Identify and initiate mitigation, subrogation and other recovery opportunities on assigned claims
Identify fraud indicators and initiate investigation on assigned claims
Apply general mathematical knowledge and / or financial analysis to achieve results
Handle claim files in a manner consistent with Claim quality standards and goals
Dedicate your focus to ensuring our customers have a positive and pleasant experience
Workers’ compensation claim handling with experience handling California claims
Certification exams and adjusting licenses as required by state
Outstanding interpersonal skills working within a dedicated, supportive team
Strong focus delivering outstanding customer service
Demonstrated consistent high level of performance and achievement over career span E
Excellent time management ability
Strong desire to launch your career to the next level!
NO AGENCIES PLEASE **

Claims Rep Resume Examples & Samples

Responsible for accurate and timely adjudication of claims according to guidelines
Analyze, process, research, adjust, and adjudicate claims with the use of accurate procedure/revenue and ICD-9/ICD-10 codes, under the correct provider and member benefits, i.e. co-payments, deductible, etc
Claims processing based upon contractual and/or St. Joseph Heritage Healthcare agreements, involving the use of established payment methodologies. Division of Financial Responsibility, applicable regulatory legislation, claims processing guidelines and company policies and procedures
Alerts manager or supervisor of issues that impact production and quality, i.e. incorrect database configurations, non-compliant claims, etc
Resolves issues as presented or as referred by the Customer Service Coordinator
Process claims based on compliance regulations and time frames
Maintain quality and productivity standards as set by department
Resolve provider or physician group (network) claims inquiries and apply resolution in a timely fashion
Responds to questions from Customer Service Coordinators
Explains processing guidelines and internal processes when needed
Review services for appropriateness of charges and apply authorization guidelines during claims processing
Prepare written requests to providers; follow-up and handle completion of claim for returned correspondence
Good Customer Service and organizational skills required
Meet and maintain established quality and production standards
Develop and maintain effective working relationships with all levels of staff and providers
Handle multiple tasks and meet deadlines
Effectively utilize computer and appropriate software and interact as needed with St. Joseph Heritage Healthcare Claims Processing Systems
Revenue Codes, CPT-4/HCPCS, ICD-9/ICD-10 codes
Industry pricing methodologies, such as RBRVS, Medi-Cal and Medicare Fee Schedules, etc
Benefit interpretation and administration
One Care Connect/Medi-Cal guidelines and regulations

Subrogation Claims Rep Resume Examples & Samples

Pursue subrogation recovery in one or more jurisdictions from other carriers, uninsured motorists, and other parties on auto, medical, and/or property claims
Handle claims in accordance with regulatory and statutory requirements
Review claim files to evaluate recovery potential and take appropriate action in support of recovery strategy
Prepare and submit demands to appropriate parties
Refer cases to outside recovery agencies and attorneys when necessary
Correspond and negotiate within settlement authority with third parties and other carriers
Communicate with internal and external partners, including but not limited to member insureds, claimants, attorneys, service providers, recovery agencies, governmental entities and other carriers
May initiate arbitration or oversee files in arbitration and litigation

Claims Rep Resume Examples & Samples

Florida 6-20 All-Lines Adjuster License in Good Standing
Ability to work under deadline pressures and handle multiple priorities
Demonstrated strong organizational skills and attention to detail
Demonstrated excellent time management skills
Demonstrated ability to effectively solve problems and make decisions
Demonstrated ability to handle confidential information
Ability to work in multiple computer programs and in a paperless claims environment
Minimum 5 years of experience handling liability claims (Including Bodily Injury, Property Damage, Auto BI, PIP, Auto Property Damage, Discrimination, ADA Compliance and subrogation, etc.)
Previous experience handling Florida claims
Proven bilingual ability