LiveCareer-Resume

claims examiner resume example with 9+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
  • :
Summary

Meticulous Claims Investigator effective at collecting and analyzing data used to devise fair and cost-effective settlements.

Motivated and dependable professional with years of expertise in fast-paced environment utilizing excellent Client Relations and Service Satisfaction. Proficient in job execution and proven track record of success in compliance, claims processing and leadership. PERFORMANCE-DRIVEN TEAM PLAYER with excellent interpersonal skills and attention to detail, optimally utilizing all channels of communication to assist operations.

Skills
  • Result Execution
  • Customer Focused
  • Communications Skills
  • Time Management
  • Attention to Detail
  • Interpersonal Skills
  • Problem Solving
  • Team Management
  • Business Analytics
  • Process Improvement
  • Quality Assurance
  • Leadership
  • Microsoft Office
  • Critical Thinker
  • Customer Service
  • Litigation support
  • Claims Management
  • Sales Support
  • Reports/Documentation
  • Complex Problem Solving
  • Conflict Resolution
  • Client Interviewing
  • Information Confidentiality
  • Property Damage Assessment
  • Settlement Negotiations
  • Decision Making
  • Vehicle Damage Assessment
  • Complex Mathematics
  • File and Record Management
  • Regulatory Compliance
  • Legal Documentation and Reporting
  • Relationship Building
  • Coverage Assessment
  • Claims Evaluation
  • Claims Processing
  • Verbal and Written Communication
  • Liability Determination
  • Active Listening
  • Critical Thinking
  • Payment Processing
  • MS Office
  • Report and Records Review
  • Calm Under Pressure
Experience
Claims Examiner, 04/2022 to Current
Apex SystemsRichardson, TX,
  • Communicating with claimants, employers and various medical professionals through phone and e-mail to gather information regarding Short Term Disability Claims, Family Medical Leaves, and state benefits when applicable.
  • Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
  • Maintained thorough understanding of fraudulent and illegal practices.
  • Obtained necessary information to complete proper evaluation of injury claims.
CLAIMS ADJUSTER, 01/2014 to 05/2021
Suddath CompaniesRedmond, WA,
  • Identifies, investigates, evaluates, obtains and utilizes critical information required to accurately and objectively adjudicate complex auto claims
  • Made claim eligibility determinations based on the claimant's contract and other information provided at time of claim, as well as determined the need for additional information to properly determine risk
  • Effectively managed and prioritized a work queue and multiple job responsibilities in a fast-paced environment, frequently with aggressive deadlines
  • Recognized and worked within a structured environment with clearly defined SOP's to ensure consistency of claims practices and resolutions
  • Prepared files for litigation and insured all documents on file
  • Positively engages with team members and management to share perspective and support of company goals
  • Utilizes time management skills to ensure that all filings and requests from individual state agencies were completed in the allotted time frames
  • Drafted statement of loss to summarize damages, payments and underlying policy coverage.
  • Investigated potentially fraudulent claims with focus on thoroughness, quality and cost control.
  • Completed required investigations on referred files within established timeframes.
  • Analyzed and audited open claims to calculate additional payments owed.
  • Reduced loss ratios through fair and prompt processing of claims.
  • Negotiated and settled claims according to information presented through reports, research and data verification.
  • Conducted witness interviews to assist claim information gathering process.
  • Identified and obtained evidence to ascertain claim value.
  • Investigated questionable claims to determine payment authorization.
  • Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
  • Discovered occurrences of insurance fraud or criminal neglect to avoid workplace liability.
  • Decreased loss ratios through fair and timely claim processing.
Sales Associate, 11/2012 to 01/2014
Natixis Global Asset ManagementMiami, FL,
  • OFFICEMAX
  • JOBInteraTITLE:cted withCUSTOMERapproximateSERVICEly 30 customersREPRESENTATIVEdaily, building strong customer base through providing personalized product guidance, resolving issues, following up on purchases, and opening new accounts
  • Strived for quick complaint resolution; commended by supervisor for the ability to resolve problems on the first call and avoid escalation of issues
  • Performed daily department tasks including stocking, creating merchandise displays, remerchandising, pricing markdowns, transferring merchandise, inventory control, and processing transactions
  • Provided comprehensive follow-up, often going between customer and vendors to resolve issues, and tailoring resolutions to meet customer needs
  • Built rapport with customers by asking probing questions and utilizing effective listening skills
  • Multi-tasked between assignments, computer screens, and computer applications to complete
  • Managed cash register, communicated with customers and operated sales floor
  • Exceeded sales and promotional goals consistently
  • Provided recommendations to management for sales and service process improvement, and shared key knowledge to train and coach team members
  • Developed trusting relationships with customers by making personal connections.
  • Engaged customers in friendly, professional dialogue to determine needs.
  • Helped customers find specific products, answered questions and offered product advice.
  • Assisted teammates with sales-processing tasks to meet daily sales goals.
  • Built and maintained relationships with peers and upper management to drive team success.
  • Maintained knowledge of current promotions, exchange guidelines, payment policies and security practices.
  • Used technology resources to assist customers in locating and selecting items.
Education and Training
High School Diploma: , Expected in 05/2004 to Westlake High School - Atlanta, GA
GPA:
Additional Information
  • AWARDS| LICENSES PROPERTY & CASUALTY LICENSE

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Resume Overview

School Attended

  • Westlake High School

Job Titles Held:

  • Claims Examiner
  • CLAIMS ADJUSTER
  • Sales Associate

Degrees

  • High School Diploma

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