Senior Claims Specialist Resume Example Company Name

Phillip

Bennett

Professional Summary

Leader with exceptional ability to build positive rapport, inspire trust and guide teams toward achievement of organizational goals. Strong facilitator adept at working cross-departmentally with co-management and top-level leadership. Excellent trainer and mentor. Big picture focus with excellence in communicating goals and vision to succeed. Problem solver, networker, and consensus builder.

Skills

Partnering and relationships
Records Research
Effective communication
Education and Training
Good listening skills
Microsoft Office
Project Management
Customer Service
Multitasking abilities
Case analysis
Investigation skills
Efficient researcher
Staff Management
Business Planning
Team Building
Training and mentoring
Leadership

Documentation Review
Settlement determinations
Claims
Reporting skills
Verbal and written communication
Adaptability
Sales and Marketing
Consulting
Good telephone etiquette
Planning and Organization
Call center transactions
Customer expectations management
Claims investigation and research
Compassion
Critical thinking
Organization and Time management

Education

Kaplan UniversityCity, StateBachelor Of Science:Business

Johnson & Wales University - CharlotteCity, StateBachelor Of Applied Arts And Science:Culinary Science

Work History

Company Name - Senior Claims Specialist
City, State05/2021 - Current

Investigates claims using internal and external resources including speaking with the insured or other involved parties, analysis of reports, researching past claim activity, utilizing evaluation tools to make damage and loss assessments.
Extensive and timely direct interaction with Insured's, Claimants, Agent's and Internal Customers.
Determines policy coverage through analysis of investigation data and policy terms. Notifies agent and insured of coverage or any issues.
Establishes claim reserve requirements and makes adjustments,as necessary, during the processing of the claims.
Determines and negotiates settlement amount for damages claimed within assigned authority limits.
Writes simple to moderately complex property damage estimates or review auto damage estimates.
Takes statements when necessary and works with the Field Appraisal, Subrogation, Special Investigative Unit (SIU) as appropriate.
Maintains accurate and current claim file/damage documentation and diaries throughout the life cycle of claim cases to ensure proper tracking and handling consistent with established guidelines and expectations.
Alerts Unit Leaders to the possibility of fraud or subrogation potential for claims being processed.
Acted as Team Lead subject matter expert, answering internal and external questions and inquiries.
Managed quality assurance program, including on-site evaluations, internal audits and customer surveys.
Developed and implemented performance improvement strategies and plans to promote continuous improvement.
Developed team communications and information for meetings.
Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.

Company Name - Pharmacy Medication Supervisor
City, State09/2013 - 04/2021

Communicated with all consumers of the mental health center regarding the medication services Genoa provides.
Recruited and enroll consumers utilizing enrollment forms and copy the consumer's insurance card.
Facilitated the collection of prescriptions to be faxed to the pharmacy for dispensing.
Ensured all consumer insurance information is up to date in the Pharmacy system and is properly charged for the medications dispensed.
Assisted consumers in contacting the pharmacist regarding all their medication questions and ensure a prompt response to their questions.
Assisted clinic staff and pharmacy with prior authorizations and Patient Assistance programs as needed.
Compliance monitoring by contacting the consumer at least monthly to ensure compliance and determine refill needs as applicable.
Prescription refill management by utilizing the no refill report and contacting the appropriate prescriber to ensure timely refills are completed and dispensed to the consumer.
Medication delivery when needed and appropriate. {Only applicable in states that are allowed.}
Checked for expiration dates (both on consumer's medications as well as house account products/standing order meds.)
Ensured that medications are stored properly (refrigerated drugs are kept in the refrigerator, pen-tips are not stored on insulin pens, etc).
Checked for discrepancies (dose changes, discontinued medications, etc).
Take back expired or discontinued medications for destruction (as long as they are clearly labeled by a pharmacy).
Trained pharmacy interns and newly hired pharmacy technicians.
Introduced and implemented new testing and interpretation procedures to maintain standards of care and meet quality assurance benchmarks.
Generated and reviewed incident reports, including employee write-ups, actualizing appropriate corrective action plans to mitigate ongoing and potential situations.
Fostered excellence by example by "setting pace" and being hands on mentor to clinical staff.
Conducted literature and coding reviews to adhere to state and federal standards.
Collaborated with national and international organizations to leverage industry connections.
Developed policies and procedures for effective pharmacy management.
Designed and introduced leadership development, coaching and team management model, resulting in promotion of employees into increased levels of responsibility.
Implemented procedures necessary for compounding, mixing, packaging and labeling.
Supervised team of 12 pharmacy technicians.

Company Name - Retail Assistant Manager (Part Time)
City, State07/2018 - Current

Recruited, interviewed and hired individuals which would add value to team while bringing wealth of experience.
Supported retail manager by identifying and leveraging partnerships that benefited community and store.
Enforced policies and procedures and administered disciplinary action to encourage quality performance of retail staff.
Monitored and identified store losses or inconsistencies and implemented solutions to successfully achieve company goals.
Upheld company customer service standards to provide customers with outstanding service and friendly environment.
Controlled operational compliance, safety and business standards to maximize efficiency and comply with corporate policy.
Handled customer service by dealing with complaints, organizing stock and answering customer questions.
Maintained, cleaned and organized store to provide positive shopping experience for customers and inspiring workplace for team members.
Acted as in-store sales leader and maintained strong presence on floor to build relationships with customers, support and develop team and increase revenue.
Modeled effective leadership to gain commitment to store goals and training to exceed industry standards.
Oversaw employee performance, corrected problems and increased efficiency to maintain productivity targets.
Multiplied earnings through sales goal achievement, customer service improvements and commitment to team objectives.
Exceeded sales goals and accomplished business objectives by inspiring staff and promoting target products.
Trained and developed new employees for ease of transition into team.
Completed daily paperwork and computer entry of sales data as established by management.
Created visual store strategy based on market trends.

Resume Overview

School Attended

Kaplan University
Johnson & Wales University - Charlotte

Job Titles Held:

Senior Claims Specialist
Pharmacy Medication Supervisor
Retail Assistant Manager (Part Time)

Degrees

Bachelor Of Science : Business
Bachelor Of Applied Arts And Science : Culinary Science

Senior Claims Specialist Resume Example

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