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claims representative resume example with 20+ 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

Experienced Claims Specialist professionally handles minor to complex bodily injury and property damage claims for customers. Adept at working directly with customers and providing guidance throughout the claims process. Committed to successfully managing a complex and diverse caseload and ensuring each party is satisfied with the outcome. Detail-oriented Claim Specialist driven to resolve claims fairly while representing interests of employer. Conducts thorough and informed investigations, precisely evaluates losses and negotiates settlements that satisfy diverse parties. Builds and maintains professional and productive relationships and works to understand potentially conflicting points of view.

Skills
  • Claims Processing
  • Calm Under Pressure
  • Claims Evaluation
  • Critical Thinking
  • Verbal and Written Communication
  • Complex Problem Solving
  • Active Listening
  • Team Collaboration
  • Relationship Building
  • Property Claims
  • Settlement Negotiations
  • Sourcing and Compiling Information
  • Conflict Resolution
  • Coaching and Mentoring
  • Public Speaking
  • Liability Determination
  • Coverage Assessment
  • Information Confidentiality
  • File and Record Management
  • Property Damage Assessment
  • Legal Documentation and Reporting
  • Client Interviewing
  • Vehicle Damage Assessment
  • Insurance Fraud Expertise
  • Litigation Management
  • Fraudulent Claims Investigation
  • Reserves Recommendations
  • Report and Records Review
Experience
11/1982 to 08/1985
Claims Representative Genex Services Tacoma, WA,
  • Handled and processed variety of claims, including bodily injury and property damage.
  • Spoke to witnesses and claimants and interviewed for pertinent information.
  • Consulted, lawyers and physicians when needed.
  • Reviewed, evaluated and adjusted claims to promote fair and prompt settlement.
  • Investigated coverage questions.
  • Obtained necessary information to complete proper evaluation of injury claims.
  • Reviewed data to verify validity of claims and determine case management actions.
  • Completed required investigations on referred files within established timeframes.
  • Conducted witness interviews to assist claim information gathering process.
  • Gathered information from various third parties to determine claim acceptability.
  • Investigated claims, determined losses and reported findings.
  • Communicated with personnel and legal counsel on claims involving litigation.
  • Participated in the hiring process for new adjusters.
  • Kept up-to-date on changes in regulations.
  • Discovered occurrences of insurance fraud .
  • Managed more than 250 files.
08/1985 to 06/1990
Senior Claims Representative Country Financial Bloomington, IL,
  • Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
  • Provided legal support by assembling documentation for settlement action.
  • Processed claims daily and expertly handled an inventory of 250+ files with impeccable quality.
  • Delivered quality customer service to assigned, insureds and claimants throughout entire claims lifecycle to promote service times.
  • Verified details with policyholders and requested additional information.
  • Processed high volumes of bodily injury claims efficiently while working in fast-paced environment.
  • Negotiated settlements for uncomplicated claims in accordance with actual company liability.
  • Managed asset recoveries for claims, including salvage and subrogation.
06/1990 to 08/2019
Claims Specialist Lockton Salt Lake City, UT,
  • Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
  • Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
  • Documented specific claims by completing and recording forms, reports and logs.
  • Assessed and conducted negotiations within authority limits to settle claims.
  • Determined covered insurance losses by studying provisions of policies or certificates.
  • Provided legal support by assembling documentation for settlement action.
  • Communicated with other departments to establish action plans and manage open claims to closure.
  • Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
  • Conducted interviews with involved claims parties and witnesses to gather detailed information and arrange investigations.
  • Contacted injured parties and legal representatives to negotiate final settlements for claims.
  • Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims.
  • Investigated and analyzed requirements to improve timeliness of reports to customers.
  • Provided quality customer service to assigned, insured and claimants throughout claims process to deliver timely service to customers.
  • Verified details with policyholders and requested additional information.
  • Reviewed documentation and accounts to gain full picture.
  • Processed high volumes of bodily injury claims efficiently while working in fast-paced environment.
  • Managed asset recoveries for claims, including salvage and subrogation.
  • Planned and conducted investigations of claims to confirm coverage and compensability.
Education and Training
Expected in 05/1982
Bachelor of Science: Business Administration
Indiana State University - Terre Haute, IN
GPA:

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Resume Overview

School Attended

  • Indiana State University

Job Titles Held:

  • Claims Representative
  • Senior Claims Representative
  • Claims Specialist

Degrees

  • Bachelor of Science

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