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Auto Claims Adjuster Resume Example

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JC
Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000, resumesample@example.com
Summary

Insurance Claims Professional with 5 years of experience investigating and processing insurance claims. Excel in analyzing causes, interpreting policies, and negotiating payment solutions.

Skills
  • Billing
  • Policy interpretation
  • Claims investigations
  • Customer service
  • Internet-savvy
  • Fraud detection knowledge
  • Administrative support
  • Communications
  • Process improvement
  • Relationship development
  • Inventory management
  • Organization
  • Problem resolution
  • MS Office
  • Insurance billing
  • Business operations
Experience
04/2019 to Current Auto Claims Adjuster Metromile | Los Angeles, CA,
  • Reviews and adjusts Auto claims by claim processing auto guidelines.
  • Maintain quality standards by reviewing claims while working off project list.
  • Determine the cause and extent of damages by investigating claims with underwriters and insurance agents in the field.
  • Provide customer support to members, providers, billing departments, and other insurance agency's regarding claims, appeals, and eligibility.
  • Presented claims to insurance companies.
  • Evaluated extent of damage and documented findings.
  • Researched and verified insurance policy coverage.
  • Communicate with numerous team members, policyholders, claimants, and witnesses by telephone, email, and written correspondence to gather facts of loss to aid in claim resolution.
  • Utilize resources and prior experience in the auto insurance industry to determine if claims should be approved for payment or denied.
  • Verified liability extent with reviews of police reports, medical treatment histories and other records.
  • Determined insurance coverage levels and restrictions by thoroughly examining claims forms and associated records.
  • Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
  • Gathered and documented evidence to support court proceedings.
11/2017 to 01/2019 Auto Claims Adjuster Metromile | New York, NY,
  • Reviews and adjusts auto claims by claim processing auto guidelines.
  • Maintain quality standards by reviewing claims while working off project list.
  • Negotiated settlements with customers and lien holders paid out total loss settlements and obtained necessary documents to process titles for branding.
  • Determine the cause and extent of damages by investigating claims with underwriters and insurance agents in the field.
  • Provide customer support to members, providers, billing departments, and other insurance agency's regarding claims, appeals, and eligibility.
  • Presented claims to insurance companies.
  • Evaluated extent of damage and documented findings.
  • Researched and verified insurance policy coverage.
  • Coordinate benefits while applying applicable deductibles, co-insurance, and out of pocket costs.
  • Communicate with numerous team members, policyholders, claimants, and witnesses by telephone, email, and written correspondence to gather facts of loss to aid in claim resolution.
  • Utilize resources and prior experience in the industry to determine if claims should be approved for payment or denied.
  • Verified liability extent with reviews of police reports, medical treatment histories and other records.
  • Determined insurance coverage levels and restrictions by thoroughly examining claims forms and associated records.
  • Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
06/2015 to 10/2017 Subrogation Claims Representative Pinnacol | Denver, CO,
  • Investigated and compared insurance policies, including fire, homeowners, personal line, liability and commercial coverage.
  • Fostered relationships with customers to expand customer base and enhance loyalty and retention.
  • Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
  • Provided excellent service and attention to customers when face-to-face or through phone conversations.
  • Reviews and adjusts claims by claim processing guidelines.
  • Negotiated settlements with customers and lien holders paid out total loss settlements and obtained necessary documents to process titles for branding.
  • Determine the cause and extent of damages by investigating claims with underwriters and insurance agents in the field.
  • Maintain quality standards by reviewing claims while working off project list.
  • Provide customer support to members, providers, billing departments, and other insurance agency's regarding claims, appeals, and eligibility.
  • Presented claims to insurance companies.
  • Evaluated extent of damage and documented findings.
  • Utilize resources and prior experience in the industry to determine if claims should be approved for payment.
  • Verified liability extent with reviews of police reports, medical treatment histories and other records.
  • Process demands to at fault parties/ carriers
02/2015 to 06/2015 Medical Biller Vibra Healthcare Inc. | Fresno, CA,
  • Reviewed medical records to meet insurance company requirements.
  • Compiled and maintained logs, and statistical or research records to locate requested health data.
  • Maintained knowledge of new or revised codes and industry regulations to complete accurate coding services, including local coverage determinations.
  • Recorded, stored and reported medical coding information to create statistics of healthcare encounters.
  • Submitted claims to insurance companies.
  • Reviewed all claims for accurateness and appropriateness.
Education and Training
Expected in 12/2014 Bachelor of Arts | English Bridgewater State University, Bridgewater, MA GPA:

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88Good

Resume Strength

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  • Length
  • Measurable Results
  • Personalization
  • Strong Summary
  • Target Job
  • Typos

Resume Overview

School Attended
  • Bridgewater State University
Job Titles Held:
  • Auto Claims Adjuster
  • Auto Claims Adjuster
  • Subrogation Claims Representative
  • Medical Biller
Degrees
  • Bachelor of Arts