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claims adjuster resume example with 10+ years of experience

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Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Summary

Dedicated and forward thinking professional with a complete range of Account Management, Administrative and Project Coordinator experience. I have excellent relationship skills and seeking a position in which I can contribute to greater office efficiency and productivity. Experience in Finance and optimizing workflows and communications for overall positive client experiences. Highly trained with strong analytical and decision-making skills. Confident individual with a strong history of taking on diverse project tasks to meet tight deadlines, accurate reporting analysis and increasing productivity.

Skills
  • Project Scheduling
  • Cost-Reduction Strategies
  • Budgeting and Cost Control Strategies
  • Administrative
  • Project Management
  • Customer/Client Relationship Management
  • Preparing contracts
  • Issue Resolution
  • Business Development
  • CRM
  • Data Analytics
  • Report Generation
  • Report Creation
  • Customer Service
  • Process Optimization
  • Data Evaluation
  • Quality assurance controls
  • Billing
  • Sales and Marketing
  • Account Investigations
  • Merchandising proficiency
  • Account Updating
  • Document Management
  • Processing Payments
  • Recruiting
  • Problem-Solving
  • Resource Management
  • Cost Management
  • Task Delegation
  • Regulatory Compliance
  • Critical Thinking
  • Customer Management
  • Flexible and Adaptable
  • Microsoft Office
  • Task Prioritization
  • Project Management
  • Project Coordination
  • Multiple Priorities Management
  • Verbal and Written Communication
  • Business Recovery and Sustainability
  • Forecasting and Planning
  • Integrated Reporting Information System (IRIS)
  • Reusable Knowledge Assets
  • Templates Management
  • Business Analysis
  • Data Summaries
  • Business Requirements
  • Process Improvement
  • Data Synthesizing
  • Report Generation
  • Risk Assessment
  • Cost-Benefit Analysis
  • User Acceptance Testing
  • Revenue Development
Experience
05/2023 to Current Claims Adjuster Sedgwick Claims Management Services, Inc. | Sun Prairie, WI,
  • Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
  • Negotiated and settled claims according to information presented through reports, research and data verification.
  • Identified and obtained evidence to ascertain claim value.
  • Completed required investigations on referred files within established timeframes.
  • Reviewed data to verify validity of claims and determine case management actions.
  • Obtained necessary information to complete proper evaluation of injury claims.
  • Investigated potentially fraudulent claims with focus on thoroughness, quality and cost control.
  • Coordinated benefits while applying applicable deductibles, co-insurance and out-of-pocket costs.
  • Analyzed and audited open claims to calculate additional payments owed.
  • Explained premiums owed to policyholders, agents and underwriters.
12/2021 to 04/2023 Project Coordinator Bastian Material Handling | San Dimas, CA,
  • Prioritized needs and delegated assignments to simultaneously handle multiple projects.
  • Assessed, monitored and reported on work progression.
  • Collaborated with internal teams to develop project solutions resulting in on-time execution.
  • Liaised between departments, vendors and clients to monitor project expenses.
  • Used control tools to update and monitor project schedules.
  • Served as point-of-contact to support order management, testing and reporting
  • Created and maintained project. documentation to drive transparency with stakeholders.
  • Assisted project manager in drafting schedules and related documentation
  • Increased product knowledge by staying up to date on product offerings, features and functionality.
  • Established and maintained quality performance metrics to meet objectives
  • Drove communication within high-performance, cross-functional organization to meet aggressive goals.
  • Handled portfolio of initiatives to support organization's goals.
  • Managed portfolio of projects to drive on-time deliverables within scope and budget.
  • Troubleshot and resolved non-technical issues using support documentation and training.
  • Developed and implemented project tracker or calendar to meet and maintain standards.
  • Produced status reports for customers and senior management.
  • Liaised with project managers to evaluate project scope and define milestones and deadlines.
  • Coordinated with department leads to identify and outline solutions to client-specified challenges.
  • Allocated resources and materials to respective departments to accommodate needs.
  • Introduced change improvement plans to achieve goals, methodologies and initiatives.
10/2018 to 11/2021 Buisness Finance Operations Coordinator Birdeye | Chicago, IL,
  • Processed all Employee Liable Requests sent to the Business Finance Operations (BFO).
  • Accessed customers employer profile by using ECPD/EWI system.
  • Analyzed data on request to verify accuracy on the proof of employment.
  • Entered correct ECPD profile using Verizon systems such as EV-Care or ACSS.
  • Updated Verizon discount request and revalidation of discounts for End Users whose employers have an agreement with VZW.
  • Provided timely resolution for RYL escalation submitted by Customer Service or 3rd Party Vendor group after identifying the issue.
  • Issued credits on the account after reviewing credit information in ACSS and documented action taken.
  • Performed Audits on the Retail Channel on any Employee discounts added at Point of Sale (Retail Store).
  • Performed research via Info-Manager to stay informed of process and policy updates and to maintain a prominent level of accuracy on all work types.
  • Liaison between customers and management to ensure smooth operations delivery.
  • Managed daily functions of deskside support, including defining and implementing processes.
  • Acted with minimal direction in self-directed capacities to resolve issues and implement strategies.
08/2017 to 09/2018 Account Manager Birdeye | Denver, CO,
  • Educated clients on COBRA health insurance.
  • Developed strategic plan for client relationships, proactively consulting with senior individuals and anticipating needs.
  • Developed and implemented improved organizational tools to increase productivity.
  • Developed sourcing strategies and marketed maps to guide of their state regulations and educated hiring teams of how to complete the excel spreadsheets to transfer data into our software.
  • Partnered with HR managers to gather COBRA plan data and advised of State requirements and time frames for submission.
  • Identified, engaged, and developed candidates for both immediate and long-term hiring after receiving their list of terminated and retired employees eligible for COBRA.
  • Screened candidates who to qualified for COBRA and determine fit of healthcare plans.
  • Advocated for candidate placement.
  • Recommend and guide improvements that impact pipeline and candidate quality to prevent high turnover rates.
  • Developed strategic plan for client relationships, proactively consulting with senior individuals and anticipating needs.
  • Developed and implemented improved organizational tools to increase productivity.
  • Partnered with HR managers to gather COBRA plan data and advised of State requirements and time frames for submission.
  • Developed sourcing strategies and marketed maps to guide of their state regulations and educated hiring teams of how to complete the excel spreadsheets to transfer data into our software.
  • Identified, engaged, and developed candidates for both immediate and long-term hiring after receiving their list of terminated and retired employees eligible for COBRA.
  • Screened candidates who to qualified for COBRA and determine fit of healthcare.
  • Recommend and guide improvements that impact pipeline and candidate quality to prevent high turnover rates.
  • Optimized your workflows and communications for positive client experience.
  • Accounting/Cash Applications
  • Updated Account Information for Clients.
  • Provided solutions and updates for WageWorks accounts.
  • Serve as a liaison between clients and participants/carriers.
  • Supported WageWorks products and services.
  • Prepared journal entries to properly record or correct accounting data.
  • Reviewed confirmed enrollment actions from the WageWorks benefit administration platform.
  • Ensured the COBRA elections were transmitted accurately and within fourteen business days to participants.
  • Verified enrollment actions with insurance carriers via phone & carrier web portal
  • Provided enrollment/EDI team with info for carrier feeds.
  • Acted as main point of contact in matters relating to client concerns and needs.
12/2016 to 07/2017 Account Manager Birdeye | Houston, TX,
  • Managed warranty accounts for Volkswagen, Audi, and Ducati Brands.
  • Updated spreadsheets with current warranty information.
  • Manage and solve conflicts with clients face to face, over the phone and through email.
  • Interact with different departments to resolve needs for dealerships (Accounting, Claims.
  • Keep records sales, contracts, RAM, and ADM for dealers, along with dealer codes using excel spreadsheets.
  • Meet deadlines for dealer accounts.
  • Bill dealerships for contracts.
  • Answered calls for general warranty sales information.
  • Maintained & improve well-documented & clear process records, applicable to assigned clients and brand.
  • Resolved customer concerns.
  • Answering inbound calls from clients.
  • Educated customers on special pricing opportunities and company offerings.
  • De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
  • Fielded customer complaints and queries, fast-tracking them for problem resolution.
  • Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
  • Received, prioritized and responded to multiple points of customer communication.
  • Recommended and implemented solutions based on issue analysis and business implications.
  • Coordinated efforts with appropriate departments and personnel to promote customer satisfaction.
  • Used excellent verbal skills to engage customers in conversation and effectively determine needs and requirements.
  • Reviewed customer account information to determine current issues and potential solutions.
  • Asked probing questions to determine service needs and accurately input information into electronic systems.
  • Documented conversations with customers to track requests, problems, and solutions.
  • Oversaw multiple accounts and worked diligently to meet and exceed performance goals.
05/2015 to 11/2016 Account Manager Cbiz, Inc. | Hickory, NC,
  • Managed accounts for up to 12 Corporate Clients.
  • Kept records of pallets, shipments and payments for each client and company using excel spreadsheets.
  • Built and maintained productive relationships with customers and internal partners.
  • Collaborated with the Sales team to collectively drive growth and market share.
  • Acted as main point of contact in matters relating to client concerns and needs.
  • Developed successful customer relationships and quickly resolved service requests to increase sales.
  • Billed clients for pallets shipped using Accuplus.
  • Ensured general ledger accounts were maintained in accordance with Generally Accepted Accounting Principles (GAAP).
  • Developed productive relationships with business representatives and consulted closely to uncover needs and match available solutions.
  • Communicated with clients via email, phone, online presentations, screen-share and in-person meetings.
  • Oversaw multiple accounts and worked diligently to meet and exceed performance goals.
  • Increased revenue by cultivating and securing new accounts while providing value-added services to existing clients.
  • Grew customer base by identifying needs for relevant product solutions to fit client budgets and schedules.
  • Streamlined operational efficiencies by developing customer service protocols and standards.
  • Adjusted financial schedules and prices by applying supply management department cost information.
  • Oversaw multiple accounts and worked diligently to meet and exceed performance goals.
  • Kept accurate records pertaining to inventory and account notes, documenting any contract updates and renewals.
10/2014 to 04/2016 Billing Specialist Alteva | Denver, CO,
  • Collected insurance and medical information from patients
  • Ensured all cash accounts were properly reconciled to the appropriate bank statements
  • Third party billing
  • Updated patient accounts in Hospital Information System (HIS)
  • Listened to patient' needs and assisted with identifying and securing appropriate services
  • Offered clients knowledgeable and supportive assistance to meet needs and build loyalty
  • Used multiple resources and tools for evaluating and presenting solutions
  • Enhanced customer/patient satisfaction ratings by resolving difficult customer issues through completion
  • Adhered to guidelines and enabled compatibility through analysis and troubleshooting
  • Input information for clients
  • Documented conversations with customers to track requests, problems, and solutions
  • Assisted customers in making payments on accounts and setting up payment plans
  • Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions
  • Processed and sent invoices, adjustments and credit memos to customers
  • Answered customer invoice questions and resolved issues discovered during invoicing and collection process
  • Contacted insurance providers to verify insurance information and obtain billing authorization
  • Performed data import, scanning or manual keying processes to verify invoice accuracy
  • Investigated and resolved issues to maintain billing accuracy
  • Managed numerous client accounts to track and collect money owed
  • Completed billing audits in identified timeframes to report and investigate findings
  • Worked with team members and leadership to identify and develop process improvements
  • Leveraged integrated billing software to submit accurate claims
  • Recorded amounts due for items purchased or services rendered by preparing statements, bills or invoices
  • Input payment history and other financial data to keep customer accounts up-to-date in system
  • Submitted claims to insurance companies and researched and resolved denials and explanations of benefit rejections
  • Processed refunds on credit balances to maintain positive account relationships
  • Applied billing adjustments to resolve discrepancies in account receivable journals
  • Solved issues with well-organized and professional approach
  • Accurately and concisely documented notes in patient files in adherence with HIPAA regulations
  • Developed training materials to improve efficiency of new hire onboarding
  • Reviewed customer account information to determine current issues and potential solutions
  • Asked probing questions to determine service needs and accurately input information into electronic systems
  • Informed customers about billing procedures, processed payments and provided payment option setup assistance.
03/2013 to 09/2014 Account Specialist Cbiz, Inc. | Kalamazoo, MI,
  • Updated Customer Accounts by recording information.
  • Input repair orders.
  • Resolved customer complaints.
  • Trouble shoot to determine the cause of a problem.
  • Explain the best solutions to resolve issues.
  • Expedite repair technicians for clients.
  • Upheld compliance, quality, and service standards.
  • Established accounts for new customers and updated existing accounts with current demographic and order information.
  • Resolved problems by performing both routine and complex account updates.
  • Used networking, customer service and people skills to connect with potential customers and make sales.
  • Tracked customer desires and dislikes to help management understand needs and update offerings.
  • Scheduled appointments and entered customer orders.
08/2012 to 02/2013 Billing Specialist Alpine/AT&T | City, STATE,
  • Processed invoice payments and recorded information in account database.
  • Achieved client loyalty through quality, productivity, service and proactive management.
  • Collaborated with various departments to improve communication and deliver individualized customer solutions.
  • Advised and counseled customers on financing and related matters, courteously educating clients and responding to inquires.
  • Addressed inquiries from clients and department team members., Assisted customers with problems they have regarding services and payments.
  • Managed customer complaints and resolved customer issues.
  • Educated customers on AT&T products and services.
  • Negotiated and scheduled payment arrangements.
  • Managed customer credits and adjustments.
  • Built long-term relationships with lucrative clients by utilizing active listening, effective communication, and dynamic people skills.
  • Achieved client loyalty through quality, productivity, service, and initiative-taking management.
  • Collaborated with various departments to improve communication and deliver individualized customer solutions.
  • Maximized and maintained client satisfaction in all aspects of credit management.
  • Acted with minimal direction in self-directed capacities to resolve issues and implement strategies.
  • Reviewed and analyzed client financial data to plan proposals.
  • De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
  • Educated customers on special pricing opportunities and company offerings.
  • Fielded customer complaints and queries, fast-tracking them for problem resolution.
  • Upheld strict quality control policies and procedures during customer interactions.
  • Assisted customers in making payments on accounts and setting up payment plans.
  • Asked probing questions to determine service needs and accurately input information into electronic systems.
  • Built client rapport while accurately processing repair documentation and troubleshooting technical discrepancies through completion.
  • Made outbound calls to obtain account information.
  • Consulted with customers to resolve service and billing issues.
Education and Training
Expected in 12/2017 to to BACHELOR’S DEGREE | OF SCIENCE Kennesaw State University, Kennesaw, GA GPA:
Accomplishments
  • Maintained high accuracy audits, saving the company money annually.
  • Led team to achieve high compliance ratings, earning recognition from upper management and financial rewards.
  • Contributed to the ongoing effort to boost revenue while reducing costs.
  • Created highly effective new strategies that significantly impacted efficiency and improved operations.
  • Consistently maintained high client satisfaction ratings.
  • Created highly effective new program that significantly impacted efficiency and improved operations.

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Resume Overview

School Attended

  • Kennesaw State University

Job Titles Held:

  • Claims Adjuster
  • Project Coordinator
  • Buisness Finance Operations Coordinator
  • Account Manager
  • Account Manager
  • Account Manager
  • Billing Specialist
  • Account Specialist
  • Billing Specialist

Degrees

  • BACHELOR’S DEGREE

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