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Claims Adjuster Resume Example

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CLAIMS ADJUSTER
Professional Summary

Effective leader and problem-solver which excels at streamlining operations to decrease costs and promote organizational efficiency. Offering hardworking mentality and history of success coordinating and monitoring operations across various departments. Highly committed to ensuring quality of services and products. Results-oriented Customer Service Professional effective at uncovering customer needs, finding solutions and handling objections. Top performer with a consistent track record of meeting and exceeding goals. Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes. Results-oriented Claims Adjuster bringing hands-on law enforcement experience and exceptional leadership and communication skills. Background includes criminal investigation, insurance fraud and surveillance.

Work History
Claims Adjuster, 06/2019 - 08/2020Company Name, City, State
  • Maintained contact with claimants and attorneys to determine treatment status.
  • Maintained suspicious claims database and prepared reports on Weekly basis for supervisors.
  • Followed up with insured individuals regarding premium and deductibles payments.
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
  • Reconciled data in direct collection system with accounting system to address discrepancies.
  • Followed up on potentially fraudulent claims initiated by claims representatives.
  • Synthesized data into comprehensive quarterly written reports for management.
  • Established productive working relationships with public officials and law enforcement officers.
  • Collaborated with claims department and industry anti-fraud organizations to resolve claims.
  • Reviewed new files to determine current status of injury claim and to develop plan of action.
  • Directed and coordinated various investigations conducted by field investigation team.
  • Evaluated all evidence with ultimate goal of creating positive outcomes for client's claims.
  • Evaluated insurance policies and analyzed damages to determine coverage.
  • Examined claims forms and other records to determine insurance coverage.
  • Answered questions posed by insured and attorneys.
  • Investigated claims involving potential and suspected fraudulent activities.
  • Answered customer questions regarding deductibles.
  • Prepared summaries of damage, payments and policy coverage.
  • Eliminated claimant, premium and provider fraud.
  • Documented all investigation activity and presented reports to management.
  • Maintained suspicious claims database and prepared reports on weekly basis for supervisors.
  • Ran 9 special projects and initiatives at both local and regional level.
IT Administrator, 02/2019 - 08/2020Company Name, City, State
  • Interfaced with high-level client personnel, collecting performance feedback and integrating positive and negative evaluations into future IT policies.
  • Created remote service interaction scenario manuals, defining appropriate triage and response policies for common ticket types.
  • Led and assisted technical upgrade projects for clients by working and coordinating with consultants and developers for integrations.
  • Directed budgeting studies on current and proposed IT spending plans, determining maximally impacts business enhancements and minimizing wasteful spending.
  • Monitored networks and network devices to resolve technical problems quickly.
  • Diagnosed and executed resolution for all network and server issues.
  • Implemented, developed and tested installation and update of file servers, print servers and application servers in all departments.
  • Designed and evaluated WAN and LAN connectivity technologies.
  • Led server infrastructure development, quality assurance, staging and production systems.
  • Developed multi-site IT execution strategies, aligning work orders at 4 locations to effectively align available resources with historical service data.
  • Reviewed deficiencies based on internal audits and suggested remedies.
  • Optimized network operations by monitoring, troubleshooting and enforcing Department of Defense (DoD) security compliance.
Administrative Assistant, 01/2009 - 01/2019Company Name, City, State
  • Developed and updated spreadsheets and databases to track, analyze and report on performance and sales data.
  • Coordinated domestic and international travel arrangements, including booking airfare, hotel and ground transportation.
  • Managed office inventory by restocking supplies and placing purchase orders to maintain adequate stock levels.
  • Created PowerPoint presentations for business development purposes.
  • Composed internal memos and external correspondence for senior management and reviewed all documentation to eliminate errors.
  • Coordinated bookkeeping activities in QuickBooks and Lawson, including invoicing and accounts payable.
  • Supported efficient meetings by organizing spaces and materials, documenting discussions and distributing meeting notes.
  • Sorted and distributed office mail and recorded incoming shipments for corporate records.
  • Handled client correspondence and tracked records to foster office efficiency.
  • Maintained staff directory and company policy handbook for human resources department.
  • Welcomed office visitors warmly and alerted staff to arrivals of scheduled appointments.
  • Executed record filing system to improve document organization and management.
  • Monitored premises, screened visitors, updated logs and issued passes to maintain security.
  • Identified and recommended changes to existing processes to improve accuracy, efficiency and quality service.
  • Supported logistics for programs, meetings and events, including room reservations, agenda preparation and calendar maintenance.
- Manger, 06/2015 - 05/2018Company Name, City, State
  • Evaluated suppliers to assess quality, timeliness and compliance of deliveries, maintaining tight cost controls and maximizing business operational efficiency.
  • Established and administered annual budget with effective controls to prevent overages, minimize burn rate and support sustainability objectives.
  • Applied performance data to evaluate and improve operations, targeted to current business conditions and forecasted needs.
  • Coordinated site investigations, documented issues and escalated to executive teams as needed.
  • Developed improved filing systems for confidential client records and reports to increase operational efficiency.
  • Developed and implemented productivity initiatives, in addition to coordinating itinerary and scheduling appointments.
  • Boosted team member productivity by enhancing monitoring and motivational approaches.
  • Raised performance in areas of product, services, and accounting by identifying and targeting issues as well as areas in need of improvements.
  • Trained and guided team members to maintain high productivity and performance metrics.
  • Managed client correspondence and tracked records to foster office efficiency.
  • Reviewed performance data to monitor and measure productivity, goal progress and activity levels.
  • Evaluated suppliers by assessing quality, timeliness and compliance of deliveries to maintain tight cost controls and maximize business operational efficiency.
  • Controlled costs and optimized spending via restructuring of budgets for labor, capital assets, inventory purchasing and technology upgrades.
  • Adjusted job assignments and schedules to keep pace with dynamic business needs, factoring in processes, employee knowledge and customer demands.
Education
BBA, Business Management, 2017
Florida State University - City, State
  • Member of The Golden Key
  • Majored in Management
Skills
  • Subrogation expert
  • CCC Pathways
  • Accident scene investigations
  • Personal, casualty, and property loss
  • Travel Administration
  • Transporting Files
  • Routing Mail
  • Report Development
  • Training and Development
  • Client Account Management
  • Recruitment
  • Cost Analysis and Savings
  • Team Leadership
  • Scheduling
  • Invoicing
  • Technical issues analysis
  • Customer service expert
  • Staff education and training
  • Desktop support
  • Service Agreements
  • Sales Closing
  • Network Development
  • Sales
  • Windows 10
  • TCP/IP
  • Software Diagnosis
  • Mac Systems
  • Software diagnosis
  • Updates and Upgrades
  • Troubleshooting and Diagnostics
  • Software Debugging
  • System Provisioning
  • Documentation Review
  • Claims Adjustments
  • Insurance Knowledge
  • Settlement determinations
  • Claims investigation and research
  • Planning and Organization
  • Policy understanding
  • Coverage assessments
  • Loss Protection
  • Developing Policies
  • Data Analysis
  • Effective communication
  • MS Office
  • Familiar With Fraud Statutes
  • Insurance Policy Coverage Knowledge
  • Legal Proceedings Knowledge
  • Underwriting Knowledge
  • Policy Investigations
  • Valuation Knowledge
  • Personal, Casualty And Property Loss
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Resume Overview

School Attended

  • Florida State University

Job Titles Held:

  • Claims Adjuster
  • IT Administrator
  • Administrative Assistant
  • - Manger

Degrees

  • BBA , Business Management 2017

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