LiveCareer-Resume

senior disability claims examiner resume example with 20+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Professional Summary
Self-motivated specializing in personal, property and casualty loss and damages. Negotiates peaceful resolutions of all claims with an emphasis on fairness and thoroughness. Trustworthy and dependable.
Results-oriented Claims Adjuster bringing hands-on law enforcement experience and exceptional leadership and communication skills. Background includes criminal investigation, insurance fraud and surveillance.
SUI Investigator successful at collecting and compiling information in line with the rules of evidence. Scrupulously fair and honest.
Work History
Senior Disability Claims Examiner, 10/2005 - Current
Crawford & Company Rochester, ,
  • Efficiently and effectively facilitating the technical aspects of long term disability claims needing more in-depth review, many claimants in which work part-time, and appropriately applying the legal and contractual provisions.
  • Heavy written and verbal communication with a diverse population of customers, including claimants with physical and mental impairments, physicians, attorneys, benefit representatives, other healthcare providers, and internal/external clients.
  • Calculate appropriate dates and payments amounts accurately. Develop and maintain effective working relationships with group clients.
  • Lead/participate in projects/activities such as Marketing presentations, Client meetings, Customer Action Teams, Claimant Visits, in-service training sessions and other projects related to claim management and staff development. Understand and correctly utilize the appropriate systems.
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims. Ran [Number] special projects and initiatives at both the local and regional level.  Answered questions posed by insured and attorneys.
Disability Benefit Specialist, 09/1996 - 10/2005
UNUM Group City, STATE, This position involves the handling of approximately 150 Long Term Disability files. It includes risk management, timely processing of claims, calculation of benefits, medical reviews, and strong customer service skills. Direct contact with management, CPA’s, attorneys, medical providers and claimants on a daily basis.
Senior Benefit Examiner—November 1998 to November 1999 This position requires strong attention to detail while managing a caseload of approximately 200 Partial Claims and the ability to identify claim discrepancies and utilize risk resources for appropriate claim resolutions. Created and enhanced partial packets and procedurals to implement proper handling of claims. Direct contact with management,CPA’s, Disability Benefit Specialists, and medical providers on a daily basis.
Disability Benefit Processor—October 1996 to November 1998 This position is responsible for the accurate handling of approximately 3,200 claims. It includes the timely calculation and issuance of benefit payments, customer service skills, and the ability to identify risk factors in claims that should be transferred to our Risk Unit for management. Processing of overpayments, offsets, and mail on a daily basis.
Foreman/Production Assistant, 04/1996 - 09/1996
College Pro Painting City, STATE, This position included the direction and delegation of daily assignments to co-workers, customer sales and service, and the reduction of overhead by 20% through purchasing materials from a variety of vendors. Strong customer relations and quality assurance on a daily basis.
Education
Bachelor of Science: Criminology, Expected in 1996
-
University of Southern Maine - Portland, ME
GPA:
Status -
High School Diploma: , Expected in 1989
-
Cony High School - Augusta, ME
GPA:
Status -
Accomplishments
Trainer – Senior Benefits Examiners – June 2000 to August 2000

Supervisor—Records Department—August 1999 to November 1999 This position included the overseeing of operations of three record analysts. This entailed streamlining procedures, working directly with the records and clerical assistant’s supervisors and supplying continuous feedback through one on one conferences on a daily basis.

Disability Benefit Processor Mentor—April 1997 to November 1998 This position included mentoring and training two classes of new Processors. The ability to teach procedures while monitoring the Processors work flow on a daily basis. This entailed being able to provide feedback in areas of strength and those areas that needed improvement to the Processors as well as to the management.

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

Resume Overview

School Attended

  • University of Southern Maine
  • Cony High School

Job Titles Held:

  • Senior Disability Claims Examiner
  • Disability Benefit Specialist
  • Foreman/Production Assistant

Degrees

  • Bachelor of Science
  • High School Diploma

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: