LiveCareer
LiveCareer
  • Dashboard
  • Jobs
  • Resumes
  • Cover Letters
  • Resumes
    • Resumes
    • Resume Builder
    • Resume Examples
      • Resume Examples
      • Nursing
      • Education
      • Administrative
      • Medical
      • Human Resources
      • View All
    • Resume Search
    • Resume Templates
      • Resume Templates
      • Nursing
      • Education
      • Medical
      • Human Resources
      • Customer Service
      • View All
    • Resume Services
    • Resume Formats
    • Resume Review
    • How to Write a Resume
    • CV Examples
    • Resume Objectives
  • Cover Letters
    • Cover Letters
    • Cover Letter Builder
    • Cover Letter Examples
      • Cover Letter Examples
      • Education
      • Medical
      • Human Resources
      • Customer Service
      • Business Operations
      • View All
    • Cover Letter Services
    • Cover Letter Templates
    • Cover Letter Formats
    • How to Write a Cover Letter
  • Jobs
    • Mobile App
    • Job Search
    • Job Apply Tool
    • Salary Calculator
    • Business Letters
    • Job Descriptions
  • Questions
  • Resources
  • About
  • Contact
  • 0Notifications
    • Notifications

      0 New
  • jane
    • Settings
    • Help & Support
    • Sign Out
  • Sign In
Member Login
  • LiveCareer
  • Resume Search
  • Senior Claims Representative III
Please provide a type of job or location to search!
SEARCH

Senior Claims Representative III Resume Example

Resume Score: 80%

Love this resume?Build Your Own Now
SENIOR CLAIMS REPRESENTATIVE III
Summary

Enthusiastic individual with superior skills in working in both team-based and independent capacities. Bringing strong work ethic and excellent organizational skills to any setting. Seeking position where I can utilize my extensive customer service and analytical skills in multiple dimensions of the insurance claims industry. Excited to begin new challenge with successful team.

Skills
  • Investigation management
  • Fraud identification
  • Claims file management processes
  • Complex claims experience
  • High-exposure claims background
  • Claims processing documentation
  • Complex problem-solving mastery
  • Complex negotiations
  • Complex coverage issues
Experience
AFA Claims / Confie / BluefireSeptember 2015 to May 2020Senior Claims Representative III
Irving, TX
  • Investigated and resolved liability and complex liability / Resolved coverage and complex coverage investigations for losses.
  • Reviewed and evaluated complex injury claims including limb loss / amputations, keloid and fatalities
  • Reviewed and evaluated medical bills / CPT Codes / ICD9 & 10 Codes
  • Compliance with HIPPA laws (where applicable)
  • Medicare Regulations and government entities were protected
  • Maintained heavy caseload and followed Fair Claims Act as set forth by the appropriate state department.
  • Developed settlement ranges / PEV (Pure Exposure Value) and accurate reserves
  • Handled both 1st and 3rd party claims represented and non-represented
  • Attended small claims / Attended and successfully negotiated mediation as needed
  • Multiple States ( WA, CA, TX, AZ)
  • Commercial General Liability (including but not limited to municipalities)
  • Earned reputation for good attendance and hard work.
  • Recognized by management for providing exceptional customer service.
National General Insurance CompanySeptember 2013 to September 2015Casualty Representative II
Ontario, CA
  • Reviewed and resolved liability and complex liability cases / reviewed and resolved coverage investigations; Reviewed and evaluated moderate to complex injury claims including fatalities
  • Reviewed medical bills / CPT Codes / ICD9 & 10 Codes
  • Compliance with HIPPA laws (where applicable)
  • Medicare Regulations protected
  • Developed settlement ranges / PEV (Pure Exposure Value) and accurate reserves
  • Handled 1st and 3rd party Bodily Injury claims both pro per and legal represented
  • Attended small claims as needed
  • States handled OR ; NV ; CA
  • Attended anti-fraud training courses, conferences, client SIU training and industry seminars annually
  • Managed a case load of 175-210 exposures at any one given time
  • Conducted interviews, gathered detailed information and completed field investigations.
  • Contacted injured parties and legal representatives to negotiate final settlements for claims.
AFA Claims / NationsMarch 2010 to September 2013Bodily Injury Claims Specialist
Anaheim, CA
  • Investigated and resolved liability and complex liability / Resolved coverage and complex coverage investigations for losses.
  • Reviewed and evaluated complex injury claims including limb loss / amputations, keloid and fatalities
  • Reviewed and evaluated medical bills / CPT Codes / ICD9 & 10 Codes
  • Compliance with HIPPA laws (where applicable)
  • Medicare Regulations and government entities were protected
  • Maintained heavy caseload and followed Fair Claims Act as set forth by the appropriate state department.
  • Developed settlement ranges / PEV (Pure Exposure Value) and accurate reserves
  • Handled both 1st and 3rd party claims represented and non-represented
  • Attended small claims / Added and successfully negotiated mediation as needed
  • Multiple States ( WA, CA, TX, AZ)
  • Commercial General Liability (including but not limited to slip and fall claims)
  • Earned reputation for good attendance and hard work.
  • Recognized by management for providing exceptional customer service.
  • Verified liability extent with reviews of police reports, medical treatment histories and other records.
  • Checked into questionable claims, interviewing agents and claimants to resolve errors and omissions.
Farmers Insurance GroupJanuary 2008 to March 2010Special Claims Representative
Orange, CA
  • Reviewed and resolved liability and complex liab / reviewed and resolved coverage for losses
  • Reviewed and evaluated moderate to complex injury claims including loss of limbs and fatalities
  • Successfully handled the following lines: Personal Auto / Personal Home / Commercial Auto / Commercial Auto Fleets; Occurrence basis claims; Premise Liability; Product Liability for self-insurance, public entities and municipalities – Commercial General Liability / Business Owners Policy
  • Reviewed medical bills / CPT Codes / ICD9 & 10 Codes
  • Reviewed regulations and health codes (USDA; FDA; Municipality Heath Departments)
  • Review updated building codes
  • Compliance with HIPPA laws (where applicable); Medicare Regulations protected
  • Maintained heavy caseload and followed Fair Claims Act as set forth by the appropriate state department
  • Developed settlement ranges / PEV (Pure Exposure Value) and accurate reserves
  • Identify resources for Risk Control
  • Attended depositions, mediations, arbitrations and small claims as needed
  • Explained loss coverage, assisted policyholders with itemizing damages and coordinated alternative living arrangements.
  • Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
  • Earned reputation for good attendance and hard work.
Education and Training
University of PhoenixJanuary 2008Bachelor of Science: Business ManagementCosta Mesa, CA
Additional Licenses
  • Independent Insurance Adjuster / Qualified Manager Dept of Insurance California 2C57578 Issued 6/18/2014 expiration 05/31/2022
  • Adjuster Property and Casualty Dept of Insurance Texas 1774666 Issued 11/6/2015 expiration 12/31/2021
  • Independent Adjuster License Dept of Insurance Washington 912371 Issued 2/16/2016 expiration 12/31/2021
  • Adjuster Dept of Insurance Arizona 2771676 Issued 4/1/2019 expiration 12/31/2022
Build Your Own Now

DISCLAIMER

Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.

Resume Overview

Companies Worked For:

  • AFA Claims / Confie / Bluefire
  • National General Insurance Company
  • AFA Claims / Nations
  • Farmers Insurance Group

School Attended

  • University of Phoenix

Job Titles Held:

  • Senior Claims Representative III
  • Casualty Representative II
  • Bodily Injury Claims Specialist
  • Special Claims Representative

Degrees

  • Bachelor of Science : Business Management

Create a job alert for [job role title] at [location].

×

Advertisement

Similar Resumes

View All
Multi-Line-Senior-Claims-Representative-resume-sample

Multi-Line Senior Claims Representative

BITCO Insurance Company

Olathe, Kansas

Senior-Claims-Representative-resume-sample

Senior Claims Representative

Rowlett, Texas

Claims-Examiner-III-resume-sample

Claims Examiner III

Landmark Healthcare/Health Net/Nationwide Insurance

Elk Grove, California

About
  • About Us
  • Privacy Policy
  • Terms of Use
  • Sitemap
Help & Support
  • Work Here
  • Contact Us
  • FAQs
Languages
  • EN
  • UK
  • ES
  • FR
  • IT
  • DE
  • NL
  • PT
  • PL
Customer Service
customerservice@livecareer.com
800-652-8430 Mon- Fri 8am - 8pm CST
Sat 8am - 5pm CST, Sun 10am - 6pm CST
  • Stay in touch with us
Site jabber winner award

© 2021, Bold Limited. All rights reserved.