Senior Claims Representative Iii resume example with 12+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK Home: (555) 432-1000 - Cell: - resumesample@example.com - -
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.
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.
09/2013 to 09/2015
Casualty Representative IINational General Insurance Company – 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
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.
03/2010 to 09/2013
Bodily Injury Claims SpecialistAFA Claims / Nations – City, STATE,
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.
01/2008 to 03/2010
Special Claims RepresentativeFarmers Insurance Group – 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
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