• Dashboard
  • Resumes
  • Cover Letters
  • Resumes
    • Resumes
    • Resume Builder
    • Resume Examples
      • Resume Examples
      • Nursing
      • Customer Service
      • Education
      • Sales
      • Manager
      • View All
    • Resume Search
    • Resume Templates
      • Resume Templates
      • Microsoft Word
      • Professional
      • Modern
      • Traditional
      • Creative
      • View All
    • Resume Services
    • Resume Formats
      • Resume Formats
      • Chronological
      • Functional
      • Combination
    • Resume Review
    • How to Write a Resume
      • How to Write a Resume
      • Summary
      • Experience
      • Education
      • Skills
        • Skills
        • Hard Skills
        • Soft Skills
    • Resume Objectives
  • CV
    • CV
    • CV Examples
    • CV Formats
    • CV Templates
    • How to Write a CV
  • Cover Letters
    • Cover Letters
    • Cover Letter Builder
    • Cover Letter Examples
      • Cover Letter Examples
      • Customer Service
      • Marketing
      • Sales
      • Education
      • Accounting
      • View All
    • Cover Letter Services
    • Cover Letter Templates
    • Cover Letter Formats
    • How to Write a Cover Letter
  • Questions
  • Resources
  • About
    • About
    • Reviews
  • Contact
  • 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

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
NationwideSeptember 2015 to May 2020Senior Claims Representative III
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
  • 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
  • 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
  • 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
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.

How this resume score could be improved?

Many factors go into creating a strong resume. Here are a few tweaks that could improve the score of this resume:

83Good
Resume Strength
  • Word choice
  • Strong summary
  • Typos

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

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

×

Advertisement

Similar Resumes

View All
Coder/Patient-Services-Representative-III-resume-sample

Coder/Patient Services Representative III

Cleveland-Cliffs Inc.

Columbus , IN

Benefits-Specialist-/Claims-Manager-III-resume-sample

Benefits Specialist /Claims Manager III

Bmo

Lincolnwood , IL

Director,-Corporate-Claims,-Enterprise-Services-resume-sample

Director, Corporate Claims, Enterprise Services

Meadowbrook Insurance Group, Inc.

Grand Rapids , MI

  • About Us
  • Privacy Policy
  • Terms of Use
  • Sitemap
  • Work Here
  • Contact Us
  • FAQs
  • Accessibility
  • EN
  • UK
  • ES
  • FR
  • IT
  • DE
  • NL
  • PT
  • PL
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

© 2022, Bold Limited. All rights reserved.