Senior Claims Examiner Resume Example Company Name

SENIOR CLAIMS EXAMINER

Professional Summary

Hardworking Claims Administrator and Customer Service Representative bringing 25+ years of experience meeting customer needs via telecommuting roles. Skilled at listening to customers, meeting productivity targets and maintaining current knowledge of company offerings. Offering empathy, reliability and enthusiasm for satisfying customers.

Experienced Claims Examinerwith over 15+ years of experience in Insurance Claims processing. Excellent reputation for resolving problems and improving customer satisfaction.

Skills

Thorough claims reviews
Knowledgeable in Knowledgelake, Claims Databases, Excel, Storyline and web applications.
Telephone etiquette
Scrupulous records management
Data security procedures
Insurance claims processing
Excellent work ethic
Written Communication
Critical thinking
Good listening skills
Analytical skills

Customer Service
Clerical
MS Office
Multitasking abilities
Planning and Coordination
Teamwork
Interpersonal Communication
Training & Development
Flexible & Adaptable
Data management
Detail-oriented

Work History

Senior Claims Examiner04/2020 to Current
Company Name – City, State

Directed claims negotiations within allowable limit of $10,000.00 and supported successful litigations for advanced issues.
Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
Evaluated original investigation reports and documents to resolve secondary concerns.
Analyzed information gathered by investigation and report findings and recommendations.
Examined claims forms and other records to determine insurance coverage.
Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity.
Exceeded goals through effective task prioritization and great work ethic.
Delivered exceptional level of service to each customer by listening to concerns and answering questions.

Claims Trainer01/2018 to 04/2020
Company Name – City, State

Created curricula, instructions, documents and written tests for various types of training courses.
Created and implemented new training initiatives such as online modules, interactive software, language labs and online programs, assuring continuous training to employees to promote long-term excellence.
Liaised between executives and entry-level workers, facilitating smooth communication and successfully achieving quality claims production.
Used Storyline and Powerpoint to design training for new hire and existing claims examinernew hire and existing employees and increase company retention and productivity rates.
Developed curricula, instructions, documentation and written tests for refresher training courses.
Analyzed company training methods and made adjustments to rectify issues, increase efficiency and exceed training goals, resulting in higher quality claims production.
Developed lesson plans, instructional materials and written practice tests for Retail Sales and Customer Service training courses.
Verified proper tracking in newly created databases of all students and instructors leaves, attendance, scores and overall performance.

Claims Examiner07/2005 to 01/2018
Company Name – City, State

Researched claims and incident information to deliver solutions and resolve problems.
Investigated and processed travel insurance claims for policyholders.
Interviewed claimants and witnesses to gather factual information.
Finalized high risk files for insurance claim payment release.
Verified insurance claims and determined fair amount for settlement.
Consulted police and hospital records when needed.
Handled complaints and grievances using negotiating and problem-solving skills.
Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Ordered medical record information to complete trip cancellation files.
Reviewed and produced denial and appeal decisions to resolve Customer questions and issues.

Administrative Assistant to Director of Museum06/1998 to 07/2005
Company Name – City, State

Supported efficient meetings by organizing spaces and materials, documenting discussions and distributing meeting notes.
Coordinated bookkeeping activities including invoicing and accounts payable.
Developed and updated spreadsheets and databases to track, analyze and report on performance and sales data.
Composed internal memos and external correspondence for senior management and reviewed all documentation to eliminate errors.
Managed office inventory by restocking supplies and placing purchase orders to maintain adequate stock levels.
Executed record filing system to improve document organization and management.
Created detailed expense reports and requests for capital expenditures.
Coordinated travel arrangements, including booking airfare, hotel and ground transportation.
Welcomed office visitors warmly and alerted staff to arrivals of scheduled appointments.
Processed invoices and expenses to facilitate on-time payment.
Performed general office duties, including answering multi-line phone system, routing calls, delivering messages to staff and greeting visitors.

Education

Bachelor of Science: Business Management03/2002Friends University- City, State

Associate of Science: Organizational Leadership07/1998Friends University- City

Certifications

Missouri H&C Insurance Broker License - Valid since 2002
Missouri P&C Insurance Borker License - 2002

Resume Overview

School Attended

Friends University

Job Titles Held:

Senior Claims Examiner
Claims Trainer
Claims Examiner
Administrative Assistant to Director of Museum

Degrees

Bachelor of Science : Business Management 03/2002
Associate of Science : Organizational Leadership 07/1998

Senior Claims Examiner Resume Example

Resume Score: 80%

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