Claim Examiner Resume Sample
Napoleon Abshire
8048 Santos Burgs,
Los Angeles,
CA
+1 (555) 168 2158
Work Experience
Claim Examiner
01/2018
-
PRESENT
Dallas, TX
- Establish reserves, using independent judgment and expertise and authorizes payments within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements
- Analyzes claims activities and prepares reports for clients, carriers and/or management
- Interprets and makes decisions using independent judgment on moderate-to-difficult claims and policy coverages and determines if coverage applies to claims submitted
- Investigates claims to determine validity and verify extent of damage by telephone contact with clients, claimants, witnesses or other parties as required
- Settles claims promptly and equitably and issues company drafts in payments for claims within authority limits
- Manages all aspects of investigative activity on complex claims. Directs the discovery and litigation strategy with legal counsel
- Technical claims investigations/settling experience with 5-10 years’ experience in Claims or similar organization
Fmla Claim Examiner
09/2012
-
11/2017
New York, NY
- Workers Compensation (WC) Adjuster License required according to jurisdictional requirements
- California Certified Adjuster Designation and Post Designation, or a California Self-Insurer's Certificate
- Effective advanced interpersonal skills to effectively interact with all levels of internal and external clients
- Successfully contribute to the development and delivery of the team’s goals, objectives and results
- Interpret and consistently apply contract language and state statutory regulations
- Strong understanding of the life and disability insurance industry
- Understanding of ERISA, HIPAA and Privacy regulations
Insurance Claim Examiner
09/2008
-
08/2012
New York, NY
- Strong knowledge of Outlook, Word, Sharepoint, Filenet
- Identify priorities, manage time well and work under pressure to meet or exceed performance expectations
- Use multiple mainframe applications simultaneously and easily learn new systems
- Independently reviews and evaluates claims submitted on the Company’s life, annuity, health and disability products. Determines the Company’s liability using knowledge of policy provisions, medical terminology, disability duration, state regulations and tax requirements
- Reviews their own and other associates’ paid claims for accuracy and completeness. Verifies that all needed information was received, and codes statistical data regarding cause of death as required
- Evaluate complex injury claims and determine the appropriate settlement
- Attend internal and external training programs to advance knowledge in the area of insurance claims
- Identify and obtain missing information required to evaluate Group life claims and input information into a Windows based computer system (BIOS)
Education
Grand View University
2003 - 2007
Bachelor's Degree in Communication
Professional Skills
- Strong written and verbal communication skills demonstrated in previous work experience
- Excellent communication skills (communicate effectively with internal and external customers)
- Proven skills in positive and effective interaction with challenging customers
- Excellent organizational and time management skills
- Demonstrated analytical and math skills
- Outstanding customer service and communication skills both written and verbal
- Proficiency with Microsoft Office products including Word, Excel, and Outlook (and keyboarding skills)
How to write Claim Examiner Resume
Claim Examiner role is responsible for travel, insurance, research, reporting, compensation, litigation, recruiting, training, mainframe, outlook.
To write great resume for claim examiner job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claim Examiner Resume
The section contact information is important in your claim examiner resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Claim Examiner Resume
The section work experience is an essential part of your claim examiner resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous claim examiner responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular claim examiner position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Claim Examiner resume experience can include:
- Auto/GL – Technical Claims investigations/settling experience with 1-3 years experience in Broadspire Claims or similar organization
- Maintain good rapport with internal and external customers by taking ownership and projecting an attitude of service
- Manage multiple and changing priorities
- Posting the adequate reserve for each file is handling and ensuring the reserve is always updated based on the development of the claim
- Interpreting one or more lines of insurance contracts, determining policy coverage’s and establishing reserves
- Ensuring completion of all necessary forms and processing payment within a prescribed authority level and adjusting reserves
Education on a Claim Examiner Resume
Make sure to make education a priority on your claim examiner resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claim examiner experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Claim Examiner Resume
When listing skills on your claim examiner resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical claim examiner skills:
- Experience in effectively meeting/exceeding individual professional expectations and team goals
- Effective interpersonal skills to be capable of dealing with external sources and all levels of employees
- Good verbal or written communication skills
- Comprehensive claims investigations/settling experience with 1-3 years experience in Claims or similar organization
- Auto/GL – Technical Claims investigations/settling experience with 3-6 years experience in Broadspire Claims or similar organization
- Technical claims investigations/settling experience with 4-8 years experience in Claims or similar organization
List of Typical Skills For a Claim Examiner Resume
1
Skills For Property Claim Examiner Resume
- PC skills (i.e. Windows based environment)
- Comprehensive claims investigations/settling experience 1-3 years experience in Claims or similar organization
- Ensures timely, cost-effective closure via settlement or denial
- TD/FML experience
- TD/FMLA experience.
- Litigation experience with California claims required
2
Skills For Fmla Claim Examiner Resume
- TD/FMLA experience
- Specific experience with collaborative negotiations
- 2-Two years’ experience in a similar role
- Demonstrated ability to gather and analyze information, determine a course of action and implement the selected course of action
- Requesting investigations as required be appraisers, advisers and contractors, depending on the type and complexity of the loss
3
Skills For Individual Claim Examiner Resume
- Ensuring timely, accurately and adequately reporting of loss transaction into computer system
- Documenting fully all aspects of the investigation
- Analyzing loss details to determine liability
- Processing claims to ensure prompt and equitable settlements of small claims
- Reporting each and every law suit to the supervisor immediately based on the company procedure
- Critical thinking in activities requiring analysis, problem solving, investigation, and/or planning
4
Skills For Insurance Claim Examiner Resume
- Keep up to date on Group Life procedures by using the Institutional Life Claims Library and attending required training
- 1 -Process FNOL -Including registering in the claims system,open physical claim file
- Work independently while assimilating various technical subjects
- Review on monthly basis all outstanding claim files and recommend closure if necessary to supervisor
- Respond to informational inquiries from insureds, brokers and underwriters regarding claim status, development and disposition
- Evaluate life claims to identify claim situations requiring referral to Senior Examiner
- Paid parental leave and backup family care
5
Skills For Group Life Waiver of Premium Claim Examiner Resume
- Medical, dental, and vision care plans
- The position is available in Scottsdale, AZ or Portland, ME
- 2-Review loss information and determine coverage based on policy requirements and endorsements
- Negotiate and settle claims within prescribed authority
- Follow up the recovery cases as appropriate and report to the supervisor
- Report to the supervisor and follow up the salvage disposal as per company policy
- Exercise sound judgment
6
Skills For DI Claim Examiner Resume
- High level of flexibility to adapt to the needs of the organization
- Projects an attitude of service, empathy, and patience to all customers
- Shares information and engages in candid and open dialogue. Expresses self well in conversations and via written documents
- Takes personal accountability for follow through on customer commitments
- 1-Fluency in Arabic and English language
- Work periodic overtime when required
7
Skills For Claim Examiner Workers Comp-area Resume
- PC knowledge required. (Microsoft Word and Excel)
- Interpret policy provisions and manually adjudicate Group Life claims to make claim determinations
- Work directly with the customer and administrative staff to clarify plan provisions and resolve claim discrepancies
- Respond to written inquiries from policyholders, beneficiaries, attorneys and families of deceased employees. Provide guidance on claim processes and resolve customer issues swiftly and thoroughly
- Actively pursue and follow up on open claims within specified timeframe
- Provide high quality, timely service to policyholders, beneficiaries, attorneys, families of deceased employees and administration; resolve customer issues swiftly and thoroughly by offering recommendations and solutions
8
Skills For Living Benefit Claim Examiner Resume
- Handle outbound calls needed in regards to Group Life servicing
- Respond to telephone referrals submitted regarding claim issues, research the claim as necessary and provide a response to the customer
- Identify and obtain missing information required to evaluate GE Group life claims and input information into a Windows based computer system (BIOS)
- Handle inbound and outbound calls needed in regards to Group Life servicing
- Process claims within payment authority
9
Skills For Claim Examiner Resume
- Utilize multiple systems for claim determination
- Initiate investigations, employing both company and outside facilities to obtain information to determine validity of Group Life claims. (Such as autopsy reports, toxicology reports, accident reports, location of missing beneficiaries, medical reports, homicide investigations, etc.)
- Coach new Claim Examiners on Group Life procedures and workflow
- License Requirements: Per State or Jurisdictional requirements
- Interpret GE policy provisions and manually adjudicate GE Group Life claims to make claim determinations
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