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Sr Claims Adjuster Resume Example

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JC
Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Professional Summary

Motivated Senior Claims Adjuster committed to diligently investigating, evaluating and negotiating Bodily Injury claims for policyholders. Adept at training and supporting new adjusters. Skilled in recognizing potential fraudulent claims. Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Adept at developing profitable and quality-focused processes. Motivated Sr. Claims Adjuster specializing in personal, property and casualty loss and damages. Negotiates peaceful resolutions of all claims with emphasis on fairness and thoroughness. Trustworthy and dependable.

Skills
  • Personal, casualty and property loss
  • Legal proceedings knowledge
  • Insurance policy coverage knowledge
  • Staff Training
  • Thoughtful writer
  • Claims files management processes
  • Microsoft Word
  • Healthcare Common Procedures Coding System (HCPCS)
  • Advanced oral and written communication skills
  • NC, SC, KY, GA Claims Adjuster License
  • Highly motivated
  • Advanced computer skills
  • Administrative background
Work History
08/2013 to Current Sr. Claims Adjuster Copperpoint | Meridian, ID,
  • Interviewed claimants and witnesses to gather factual information.
  • Investigated properties to determine extent of damage and estimate repair costs.
  • Examined claims forms and other records to determine insurance coverage.
  • Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
  • Established productive working relationships with public officials and law enforcement officers.
  • Reviewed new files to determine current status of injury claim and to develop plan of action.
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
  • Collaborated with claims department and industry anti-fraud organizations to resolve claims.
  • Evaluated all evidence with ultimate goal of creating positive outcomes for client's claims.
  • Examined photographs and statements.
  • Consulted police and hospital records when needed.
  • Maintained claims data in Metlife systems.
  • Trained other claims staff members on proper handling and evaluation of injury claims.
  • Answered questions posed by insured and attorneys.
  • Reconciled data in direct collection system with accounting system to address discrepancies.
  • Prepared summaries of damage, payments and policy coverage.
  • Drafted investigative reports covering all phases of investigation in each case.
  • Prepared File evaluation documents for managers or legal personnel.
  • Negotiated Bodily Injury settlement agreements to resolve disputes.
  • Verified insurance claims and determined fair amount for settlement.
  • Documented all investigation activity and presented reports to management.
  • Partnered with legal counsel on litigation cases.
  • Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
  • Followed up on potentially fraudulent claims initiated by claims representatives.
  • Evaluated insurance policies and analyzed damages to determine coverage.
  • Maintained contact with claimants and attorneys to determine treatment status.
  • Organized, planned, and documented materials for Bodily Injury claims.
  • SME for Mitchell Medical and Medicare
  • Completed training for Agent 360 (Guidwire)
04/2007 to 08/2013 No Fault Senior Adjuster, Litigation National General | Rome, GA,
  • Examined claims forms and other records to determine insurance coverage.
  • Testified on behalf of agency as part of criminal and civic proceedings.
  • Established productive working relationships with public officials and law enforcement officers.
  • Partnered with legal counsel on litigation cases
  • Negotiating settlement offers
  • Reviewed new incoming litigation to determine if claim should be settled or defended
  • Maintained good relationships with in house counsel
  • Documented all investigation activity and presented reports to management.
  • Trained other claims staff members on proper handling and evaluation of Litigation claims.
  • Assisted as Team lead while my supervisor was out completing Reserve Assignments, attendance tracking
  • Completed file reviews (EQAP) for Litigation team
  • Process Improvement team for NF, 2 years
  • Co-Champions of in house teams; LIAT and WOW
07/2002 to 04/2007 No Fault Claims Adjuster MetLife Auto And Home | City, STATE,
  • Examined claims forms and other records to determine insurance coverage.
  • Collaborated with claims department and industry anti-fraud organizations to resolve claims.
  • Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
  • Reviewed new files to determine current status of injury claim and to develop plan of action.
  • Evaluated all evidence with ultimate goal of creating positive outcomes for client's claims.
  • Organized, planned, and documented materials forNo Fault claims.
  • Maintained claims data in MetLife systems.
  • Answered questions posed by insured and attorneys.
  • Analyzed information gathered by investigations to report findings and recommendations.
  • Prepared summaries of damage, payments and policy coverage.
  • Substantiated legitimate claims and denied unjustified claims.
  • Investigated claims involving potential and suspected fraudulent activities.
  • Set up independent medical exams to determine current/further treatment and causality
  • Reviewed wage loss
  • Reviewed Medical bills and reports for proper ICD/9-10, cpt codes
  • Maintained contact with claimants and attorneys to determine treatment status.
04/2001 to 07/2002 Claims Assistant MetLife Auto And Home | City, STATE,
  • Prepared files, letters and notices.
  • Maintained contact with claimants and attorneys to determine treatment status for No Fault Claims adjuster
  • Completed initial reviews and handed files over to adjuster
  • Documented Metlife systems with all pertinent information for the beginning of claim.
  • Computed and analyzed medical bills for adjusters to review for payments
  • Managed over 50 customer calls per day
  • Logged new claims
  • Worked productively in fast-moving work environment to process large volumes of claims
Education
Expected in | General Studies Herkimer County CC, Herkimer, NY, GPA:
Expected in 06/2000 High School Diploma | Canajoharie High School, Canajoharie, NY , GPA:

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Resume Strength

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Resume Overview

School Attended
  • Herkimer County CC
  • Canajoharie High School
Job Titles Held:
  • Sr. Claims Adjuster
  • No Fault Senior Adjuster, Litigation
  • No Fault Claims Adjuster
  • Claims Assistant
Degrees
  • Some College (No Degree)
  • High School Diploma

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