Claims Specialist resume example with 20+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000 - Cell: - - -

Having over 30 years in the insurance industry has provided my well-developed skills to succeed in customer service, investigation, and administration. My attributes of character, responsible, dedicated, adaptable, empathetic, and quick learner will help me in any job capacity.

  • Documentation review
  • Accident investigations
  • Coverage assessments
  • Settlement determinations
  • Outstanding clerical abilities
  • Background in insurance
  • Documentation skills
  • Reporting abilities
  • Insurance terminology
  • Medical terminology
  • Regulatory compliance understanding
  • Exceptional recordkeeping abilities
  • Insurance plan verification
  • Patient rapport
  • Electronic authorization processing
  • Account management expertise
12/2011 to 10/2021
Claims Specialist Liberty Mutual Bristol, CT,
  • Contacted policyholders, claimants and witnesses to determine liability in auto accidents.
  • Acted as intermediary between insurance companies and customers by researching and assessing information to determine claim validity.
  • Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
  • Investigated and analyzed requirements to improve timeliness of reports to customers.
  • Determined liability, compensability and benefits due on each claim.
  • Tracked and reported on patterns of claims and repeat offenders to help eliminate system abuse.
  • Managed asset recoveries for claims, including salvage and subrogation.
  • Negotiated settlements for uncomplicated claims in accordance with actual company liability.
  • Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
  • Delivered quality customer service to assigned, insured and claimants throughout entire claims lifecycle to promote service times.
  • Researched coverage and premium options and supplied clients with best coverage available for individual needs.
  • Reviewed documentation and accounts to gain full picture.
  • Consulted with field support team, claim manager and other entities to receive support specific to assigned claim.
08/2003 to 12/2011
Customer Service Representative Ibex Holdings Limited Dallas, TX,
  • De-escalated problematic customer concerns, maintaining calm, friendly demeanor.
  • Fielded customer complaints and queries, fast-tracking them for problem resolution.
  • Upheld strict quality control policies and procedures during customer interactions.
  • Provided outstanding service to new and long-standing customers by attending closely to concerns and developing solutions.
  • Assisted customers in making payments on accounts and setting up payment plans.
  • Exceeded company productivity standards on consistent basis.
  • Created and implemented process improvements to reduce workloads and bolster callback efficiency.
  • Reviewed account and service histories to identify trends and issues.
  • Secured client retention by driving service and product benefits, features and recommendations around clients' needs.
  • Asked probing questions to determine service needs and accurately input information into electronic systems.
12/1995 to 08/2003
Claims Processor Dentaquest Louisiana, MO,
  • Reviewed history records to determine benefit eligibility for services.
  • Researched medical claims for validity to resolve discrepancies.
  • Processed claims according to established quality and production standards and made corrections and adjustments to solve problems.
  • Coordinated benefits with medical insurance plans and Medicare providers.
  • Built rapport and trust with injured insureds through effective customer service techniques which involved fair and prompt processing of claims.
  • Complied with confidentiality regulations in handling customer information.
  • Checked documentation for appropriate coding, catching errors and making revisions.
  • Instructed clients on amounts covered under benefits plans in easy-to-understand terminology.
  • Processed claims for payment or forwarded to appropriate personnel for further investigation
  • Composed business correspondences for supervisors, managers and other professionals.
  • Modified, updated and processed existing policies and claims to reflect changes in beneficiary, amount of coverage and type of insurance.
  • Retained strong medical terminology understanding in effort to better comprehend procedures.
  • Handled modification and updating of policies.
  • Examined claims, records and procedures to grant approval of coverage.
11/1989 to 12/1995
Customer Service Clerk City Of Houston, Tx Houston, TX,
  • Researched resolutions, contacted necessary departments and responded back to customer back phone, mail or fax as follow up.
  • Maintained detailed knowledge of customer service initiatives to uphold high standards of service quality.
  • Reconciled accounts, posted daily entries and conducted financial analysis.
  • Delivered fast, friendly and knowledgeable service for routine questions and service complaints.
Education and Training
Expected in 05/1989
High School Diploma:
American School - Chicago, IL
Expected in
: Pharmacy Technician Certificate
Penn Foster Career School - Scranton, PA
Expected in
: Dental Assistant Certificate
Penn Foster Career School - Scranton, PA

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Resume Overview

School Attended

  • American School
  • Penn Foster Career School
  • Penn Foster Career School

Job Titles Held:

  • Claims Specialist
  • Customer Service Representative
  • Claims Processor
  • Customer Service Clerk


  • High School Diploma
  • Some College (No Degree)
  • Some College (No Degree)

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