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enhanced claims specialist resume example with 9+ years of experience

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

Accomplished and highly-trained Licensed Claims Adjuster, Administrative, and Customer Service Professional with over 9 years of experience servicing both internal and external customers for insurance and financial service providers within a fast paced environment. Areas of expertise include, but are not limited to: Investigating and processing insurance claims, determining liability, data entry, customer service, document processing, and research.

Skills
  • Knowledge of office practices and strong attention to detail
  • Proven ability to prioritize and handle multiple tasks in a challenging environment
  • Excellent organizational and communication skills
  • Learn new software applications quickly
  • Proficient in: Microsoft Word, Microsoft Excel, Microsoft Access, Microsoft PowerPoint, SharePoint, AS400, Guidewire, Xactimate 28, as well as proprietary company software applications
Experience
Enhanced Claims Specialist, 07/2019 to 03/2020
Frontline InsuranceCity, STATE,
  • Handle the adjusting of the entire claim, including collecting and reviewing all loss related facts, performing an analysis under the terms of the insurance policy to make a coverage recommendation, and issuing a payment with the applicable authority level.
  • Investigate, evaluate, and settle homeowner's claims.
  • Audit claim files and estimates for accuracy.
  • Compose claims correspondence.
  • Interact with Insured, Attorney, Public Adjuster, and Contractor throughout the claim handling process.
  • Maintain claims diary with an average of 100+ claims.
  • Utilize internal systems to record, track, and monitor claims.
  • Reject claims that do not adhere to policy limits, coverages, overpayments, etc.
  • Assist Property Adjusters with handling of complex claims and/or supplements.
  • Interview insured(s) and witnesses to obtain loss facts. Document all investigative actions in the claim file.
  • Analyze the policy to determine the coverage for the loss. Evaluate coverage and make a coverage recommendation on each claim.
  • Determine the total value of the claim. Request and disburse claim checks/payments within authority level. Make payment recommendation for amounts above authority level.
  • Check email daily. Respond to all questions in a timely manner.
  • Work each claim file to closure.
CAT Property Desk Examiner, 09/2017 to 07/2019
Team One Adjusting/Frontline InsuranceCity, STATE,
  • Investigate, evaluate, and settle homeowner's claims.
  • Audit claim files and estimates for accuracy.
  • Interact with Insured, Attorney, Public Adjuster, and Contractor throughout the claim handling process.
  • Investigate policy coverage and review insurance contracts.
  • Maintain claims diary with an average of 100 claims.
  • Utilize internal systems to record, track, and monitor claims.
  • Reject claims that do not adhere to policy limits, coverages, overpayments, etc.
  • Assist Property Adjusters with handling of complex claims and/or supplements.
  • Review claims that have been processed by Property Adjusters to ensure accuracy and that company policies and procedures have been followed.
  • Negotiate claim estimates with Public Adjusters and Attorneys to arrive at an agreed scope of pricing.
  • Draft denial letters for claims regarding flood, lack of coverage, etc.
  • Work with engineering firms to determine cause and origin of damages to loss location.
  • Reviewed recommendations for causation, approval/denial made by Independent Adjusters to determine whether to approve or deny claim.
  • Negotiate claim settlement amount.
Liability Claims Adjuster; PIP Examiner, 01/2011 to 09/2017
GEICOCity, STATE,
  • Handle an average of 40-60 calls daily.
  • Maintain claims diary with an average of 150 entries.
  • Utilize internal systems to record, track, and monitor claims.
  • Investigate and process both 1st and 3rd party claims filed.
  • Assist customers throughout the claims process.
  • Investigate policy coverage and review insurance contracts.
  • Take recorded statements from interested parties involved to gather pertinent information.
  • Examine photographs, police reports, and supporting documentation.
  • Investigate complex claims involving liability disputes using statements, witnesses, and police reports to assist with making liability decisions.
  • Handle property damage claims involving buildings and structures.
  • Interact with Policyholders, Claimants, Body Shops, Attorneys, Medical Providers, and other Adverse Carriers.
  • Investigate medical necessity and determine casualty.
  • Evaluate the validity of personal injury protection claims and monitor case files over the course of treatment.
  • Review insurance contracts, consult with involved parties, secure medical information, and review associated reports and billing documentation.
  • Negotiate amount of claim and settle.
Education and Training
Associate of Science: Business Management, Expected in 07/2011
Everest University - Lakeland, FL,
GPA:
Bachelor of Science: Business Administration And Management, Expected in 12/2022
Southern New Hampshire University - Manchester, NH,
GPA:

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Resume Overview

School Attended

  • Everest University
  • Southern New Hampshire University

Job Titles Held:

  • Enhanced Claims Specialist
  • CAT Property Desk Examiner
  • Liability Claims Adjuster; PIP Examiner

Degrees

  • Associate of Science
  • Bachelor of Science

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