Senior Claims Representative III Resume Example
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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
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Experience
NationwideSeptember 2015 to May 2020Senior Claims Representative III
Gallipolis , OH
Gallipolis , OH
- 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
City , STATE
City , STATE
- 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
City , STATE
City , STATE
- Investigated and resolved liability and complex liability / Resolvedcoverage 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
City , STATE
City , STATE
- 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 ManagementCity
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
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Resume Overview
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
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