Claims Associate Resume Sample
Adrienne Rodriguez
5543 Collins Drives,
Philadelphia,
PA
+1 (555) 493 4680
Work Experience
Claims Associate
05/2015
-
PRESENT
San Francisco, CA
- Handling assigned cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers, and members
- Claim preparation, financial reconciliation and adherence to investor/insurer guidelines to recover advances incurred throughout the default process by completing claims for
- Audit and analyze work outputs by interpreting government, investor, insurer and/or agency, and department guidelines/standards
- Advanced analytical skills, ability to analyze problems and provide appropriate solutions
- Strong professional and interpersonal communication skills both verbally and through written correspondence
- PC skills including (but not limited to) advanced Word, Excel, Access, Internet, LSAMS LPS Desktop, LPS Invoice Management, FileNet, Remedy, Equator, Government and Insurer applications
- Proven ability to prioritize workflow during high volumes and within critical time frames
Group Claims Associate
09/2011
-
03/2015
New York, NY
- Self starter who is able to work in a fast paced, multi faceted environment
- Research issues and obtain proper supporting documentation in a timely manner and provide responses to internal and external auditors, investors, insurers and third party oversight entities
- Complete quality reviews of completed claims to identify shortfalls, accounting errors and/or guideline violations to aide in the perfection of claims prior to submission to investors/insurers
- Mentoring and support of the development of newer members of the team
- Experience preferably in a mortgage banking environment including servicing rules and regulations
- Strong preference for previous Default servicing experience
- Familiarity with FNMA, FHLMC, Private MI, Private Investor, VA, FHA and USDA servicing guidelines
- Knowledge of mortgage banking, familiarity with RESPA, FDCPA, GLBA, and federal and state laws related to foreclosure, loss mitigation and bankruptcy processes
Rcis Crop Claims Associate
04/2007
-
04/2011
Philadelphia, PA
- Experience preferably in a mortgage banking environment including servicing rules and regulations.Strong preference for previous Default servicing experience
- Handle cases in a timely manner to identify opportunities to resolve the issue by working with plan documents, carriers, providers and member
- Escalate as needed to supervisor or other levels of management for clarification and assistance
- Research billing issues to determine the possible cause of the error, and assisting with claims resubmission when needed to correct the issue
- Heavily working with these resources to analyze and resolve billing issues
- Experience preferably in a mortgage banking environment including servicing rules and regulations. Strong preference for previous Default servicing experience
- Receives and performs all functions related to the claims payment and voiding process
Education
George Fox University - Salem Center
2001 - 2006
Bachelor's Degree in Management
Professional Skills
- Effective interpersonal, written and verbal communication skills, strong negotiation skills
- Excellent Customer Service Skills with ability to explain complicated benefit issues to members and providers; and diffuse hostile encounters
- Excellent Customer Service Skills with ability to explain complicated claim issues to providers
- Computer experience with related claims and business software, knowledge and advanced skills in Microsoft Office
- Strong time management skills, and self-motivated individual
- Demonstrated problem-solving skills with the ability to formulate resolution initiatives. (desired)
- Demonstrated communication skills, verbal and written to communicate with clients and peers in a clear, concise and timely manner. (desired)
How to write Claims Associate Resume
Claims Associate role is responsible for microsoft, excel, negotiation, printing, retail, finance, training, integration, litigation, compensation.
To write great resume for claims associate job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claims Associate Resume
The section contact information is important in your claims associate 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 Claims Associate Resume
The section work experience is an essential part of your claims associate 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 claims associate responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular claims associate position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Claims Associate resume experience can include:
- Outstanding organizational skills and maintenance of diary system
- Utilize critical thinking and analytical skills to make sound claim decisions
- Effectively manages the quality review process
- Claims/legal experience or similar professional experience
- Excellent Office program experience
- Billing and Claims experience
Education on a Claims Associate Resume
Make sure to make education a priority on your claims associate resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claims associate 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 Claims Associate Resume
When listing skills on your claims associate 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 claims associate skills:
- Effective analytical skills to gather information, analyze facts and make recommendations
- Demonstrated understanding of claims payment, experience processing claims, and answering claims inquiries
- Contribute to quality and profitability by effectively implementing Claims Best Practices and meeting or exceeding Performance Guarantees
- Demonstrated experience liaising with stakeholders to elicit requirements and/or improvement opportunities using a broad range of technologies or frameworks
- Serve clients, effectively communicate verbally and in writing
- Prior experience with mortgage servicing
List of Typical Experience For a Claims Associate Resume
1
Experience For Group Claims Associate Resume
- Demonstrate ability to utilize analysis, experience and judgment to make effective decisions. (desired)
- Prioritizes workload and meets the expectations as per job description
- Provide excellent customer service to insureds, brokers, and underwriters
- Maintains effective communication with policyholder, provider, employee and beneficiaries
- Mortgage servicing experience
2
Experience For Claims Associate Manager Resume
- Experience in a production environment
- Claims vendor queries - reviewing claims on the various platforms, investigating processing queries and responding
- Determine liability by gathering relevant facts, utilizing applicable law and establishing basic principles of negligence
- Processes outgoing checks and correspondence
- Supports the Claims department with process and control identification, development, and testing. (CSM and SOX obligations)
- Responds to and resolves incoming issues related to checks, payments and when necessary redirects or escalates to appropriate personnel
- Assists in other Public Liability and Property Damage and Workers Compensation claim handling functions as requested
3
Experience For Rcis Crop Claims Associate Resume
- Updates claims system with Safety reports along with other documents through scanning
- Exhibits the following Claim Reconciliation coordinator Behaviors
- Medical, dental, vision, behavioral health billing and claims adjudication
- Correspond with doctors’ offices, hospitals, agent and policyholders for information to complete the underwriting application
- Ensure legal compliance by following state and federal laws and regulations and internal control requirements (KPI’s)
4
Experience For Claims Associate First Report of Injury Resume
- Ability and willingness to commit to extended schedules following significant catastrophe losses
- Confirm policy existence by identifying coverage on low complexity claims
- Handles all vendor payment setup obligations with Vendor Management and Accounts Payable departments
- Completes daily reconciliation of all payments processed
- Serves as SME and trainer of payment process
- Handles all CSPs invoice requests related to accident disputes
5
Experience For Temporary Credit Life & Claims Associate Resume
- Enters collection of company damages from third parties and their insurers
- Monitors the claims’ software system for mail errors and assigns to correct claim handler as needed
- Assists with off-site retrieval of claim files
- Manages a multi-functional unit of claim professionals and support staff
- Develops unit goals, objectives, processes, procedures and systems
6
Experience For Recovery Claims Associate Resume
- Identifies team staffing needs and takes necessary measures to ensure appropriate levels of service. Mentors employees and develops career paths with growth opportunities
- Participates in development of annual departmental budget, monitors budget and identifies budget discrepancies. Researches cause of discrepancies and makes recommendations
- Regularly communicate with fronting companies about reconciliation issues
- Management of provider payments - create/run a provider bordereau, check that all invoices match the provider
- Send claim payment report – daily/monthly
- Maintain Claim payment summary and update the status
- Maintain Claim reconciliation summary and update the status weekly
- Ensures all reconciliation completed in time
- Plan documents and plan benefits
7
Experience For Senior Claims Associate Resume
- Processes general liability claims by gathering information to determine liability exposure, assigns reserve values to claims, making claims payments as necessary, and settling claims up to the designated authority level
- Provider Contact – clarification on billing & records
- Weekly mailings, including checks, misc
- Investigate, evaluate and process claims
- Employer contact for documents
- Invoices – review with managed care organization
- Makes initial contact with insureds and claimants to verify claims information and advise them of the claims process
8
Experience For Claims Associate, PIP / Reinsurance Resume
- Obtains signed medical and investigation authorizations
- Obtains police and fire reports. Handles minor, undisputed claims on instruction from supervisor
- Authorizes rental cars on instruction from claims representative or when liability and coverage are not questioned
- Controls diary of all new liability claims for submission to supervisor
- Obtains medical reports from attending physicians or attorneys if claimant is represented; makes appointments for independent medical examinations; and compares treatment rendered with injuries described on loss report
9
Experience For Claims Associate Liability Resume
- Obtains loss reports from agents, insureds, and claimants and enters into FACTS
- Makes assignments under the direction of the CSC/BCO management
- Keys information into F.A.C.T.S. system. Opens and prepares files
- Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency
- Manages liability claims by gathering information to detemine liability exposure, assigns reserves values to claims, making claims payments as necessary and settling claims up tot he designated authority level
- Manages assigned claims and determines compensation due pursuant to the clieint contract and makes timely claims payments and adjustments.Processes assigned claims and determines benefits due pursuant to the client contract; makes timely claims payments and adjustments
10
Experience For Rcis-claims Associate Resume
- Request missing and track missing documents as needed
- Maintains a diary to ensure prompt processing and closure of issues
- Completes appropriate state and federal reporting
- Maintain or obtain necessary adjuster licensing within six months of hire
- Handles variety of office admin. tasks such as maintaining Business Continuity Plan (with direction from Management), office equipment, company vehicles, etc
List of Typical Skills For a Claims Associate Resume
1
Skills For Group Claims Associate Resume
- Prior experience with accounting
- Prior claims or related industry experience
- Prior experience with mortgage originations
- Experience in handling claims
- Customer service/claims handling experience
- Experience in a work environment requiring collaboration across work groups
- Insurance or claims work experience that includes understanding of auto
2
Skills For Claims Associate Manager Resume
- Customer service/claims handling experience
- Mortgage servicing and/or origination experience
- Experience using Microsoft Word, Excel, and Access applications
- Demonstrate commitment to meeting expectation of internal and external customers. (desired)
- Basic medical terminology / healthcare experience
3
Skills For Rcis Crop Claims Associate Resume
- Three to five years Life Claims experience
- Insurance or claims work experience
- Experience in a support role in a claims administration or claims operations function
- Previous phone experience required
- Work experience with disability claims and FMLA
- Experience in a production environment
- Extensive Claims administration experience
4
Skills For Claims Associate First Report of Injury Resume
- Scan, file and electronically store all prior authorizations and other CIC related documentation
- Obtaining statuses & following up with clients
- Assisting clients and their representatives in resolving any issues with adjusters & insurance companies
- Scanning claims to work-queues for processing across all operational platforms
- Working with these resources to analyze and resolve billing issues
- Obtaining loss information from clients
- Reporting claims on behalf of clients
- Obtaining information & statuses from adjuster
5
Skills For Temporary Credit Life & Claims Associate Resume
- Assembling Claims Manuals for new members
- Finance queries - including managing OFAC issues- investigating, resolving issues and liaising with finance and customer toresolution
- Payment report management - investigating processed payments pending (not paid) and identifying a solution to release the payment
- Ensure customer service by proactively communicating information, responding to inquiries and following customer protocols and Company best practices
- Meets daily claims goals by reviewing, analyzing, and obtaining appropriate documentation based on requirements and procedures
6
Skills For Recovery Claims Associate Resume
- Process incoming mail from fronting companies- Receives incoming mail, sorts by established schemes
- · Entrepreneurship- encouraging innovation and educate risk taking
- Triage and logging of incoming claims
- Follow up the outstanding cases from fronting company and settle the problems
- Research billing issues to determine the possible cause of the error, and assisting with claims re-submission when needed to correct the issue
- Two years in claims processing or customer service in an insurance environment
7
Skills For Senior Claims Associate Resume
- Knowledge of contract design, CPT-4 and ICD-9 coding, medical terminology and COB
- Knowledge of professional liability claims to assist with loss control coding
- Life at NTT Data means collaborating with dedicated professionals with a passion for technology
- Maintains communication with customer regarding benefit status and provides conversion rights information with Waiver of Premium reductions/terminations
- · Balance - balancing corporate duty with personal growth
- · Integrity – doing things right every time
- · Teamwork – working together to maximize results
- · Service -serving customers, communities, and colleagues
8
Skills For Claims Associate, PIP / Reinsurance Resume
- Advise clients of the claims process & assist them in achieving a positive claims result
- Triage all incoming phone calls and faxes
- E-claims reconciliation - Utilizing the recontool to investigate, identify, correct and manually remit where e-claim remittance has failed
- Communicates claim action/processing with claimant, client and appropriate medical contact
- Contacts medical service facilities regarding bills to determine if they are reasonable and related to the loss
9
Skills For Claims Associate Liability Resume
- Responds to telephone and written inquiries regarding status of claims assigned
- Develop the ability to analyze, evaluate and participate in the decision making process to determine case resolution/adjustment
- Determines insured eligibility by analyzing contract and claim information
- Contribute to the team effort by participating in projects
- Processes Texas Non Subscriber (ERISA) claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation
- Competence in using MS Word, MS Excel, MS Outlook and the ability to learn new IT applications such as carrier or TPA systems
- Claims facilitating workflow
10
Skills For Rcis-claims Associate Resume
- Handles requisitions and safekeeping of supplies
- Self-starter and goal oriented, familiar working as a team member
- Leads claim team in support of department initiatives and strategies in cost containment, case file handling, customer service and quality
- Analyze the reconciliation problems with different fronting companies
- Communicate with claim PSS or accounting team to settle the case and reconciliation problems
- Chase feedback of the payment report from the fronting companies
List of Typical Responsibilities For a Claims Associate Resume
1
Responsibilities For Group Claims Associate Resume
- Provide excellent customer service to all levels of stakeholders
- TPA experience an advantage
- Communicates claim action/processing with claimant and client
- Assist Claims personnel with check and letter printing as needed
- Assist office personnel with maintaining break room needs, inventory, etc
2
Responsibilities For Claims Associate Manager Resume
- Monitors incoming claims and promptly assigns them to the appropriate representative
- Assess damages by calculating applicable damages or range of damages allowed by law
- Under supervision, attends and observes mediations and arbitrations as appropriate
- Supports other claims representatives, examiners and leads with larger or more complex claims as necessary
- Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy and files necessary documentation with state agency
- Invoice and collect claims
3
Responsibilities For Rcis Crop Claims Associate Resume
- Correspond with physicians’ offices, hospitals, employers, agents or policyholders to audit claim
- Processes liability claims by gathering information to determine liability exposure, assigns reserve values to claims, making claims payments as necessary, and settling claims up to the designated authority level
- Intake of First Notice of Loss via Internet
- Telephonic Claim intake, as needed
- Adjusts and reviews accuracy and integrity of all data for Notice Only and Potentially Compensable Events (PCE) under close supervision
- Prepares monthly and quarterly ad hoc reports per client and/or manager's request
- Adjusts injury claims under close supervision
- Manages liability claims by gathering information to determine liability exposure, assigns reserves values to claims, making claims payments as necessary and settling claims up to the designated authority level
- Manages assigned claims and determines compensation due pursuant to the client contract and makes timely claims payments and adjustments
4
Responsibilities For Claims Associate First Report of Injury Resume
- Obtains police and fire reports
- Handles minor, undisputed claims on instruction from supervisor
- Inputs and/or computes estimates and inventories on instruction from claims representatives; prepares Insured Payment Authorizations
- Conducts investigation necessary to determine liability, including recorded statements based. Assigns necessary inspections of damages or scene. Identifies any legal liability issues and consults with supervisor
- Evaluate and settle bodily injury, liability and business interruption claims with minimal input from supervisor
- Receives calls -Assists employees and supervisors with questions regarding cases, benefit explanation and the integration of benefits. Works with the LTD Coordinator to resolve discrepancies in payments. Provides back up for LTD Coordinator position.
5
Responsibilities For Temporary Credit Life & Claims Associate Resume
- Makes assignments under the direction of BCO management
- Initiates first contact with insureds and all relevant parties to gather basic information and explains the overall claims process
- Prepare and file claims as assigned which includes but is not limited to researching and reading servicing notes from multiple mortgage servicing companies, accounting for all expenses incurred during default and eligibility of reimbursement, and reconciliation of funds sent or received
- Complete document/information requests for business partners
- Monitor claims to ensure all requirements are met until claim disposition
- Work with internal and external lines of business, which includes SLS approved vendors
- Monitor industry changes in the business climate
- Create and update files as well as utilize the Claims Systems (CMS/MFX). By learning through claims best practices and training, learns how to properly document files and how to identify existing claims that are appropriate to close
6
Responsibilities For Recovery Claims Associate Resume
- Provide comprehensive reports as required. Pull information from various systems, compile and format data for reports. Identify and communicate basic claim trends and account and/or policy issues to management and underwriting
- Investigate and evaluate initial policy coverage and how to communicate the interpretation of coverage
- Participate in the litigation management process
- As required, obtains and maintains insurance adjuster licenses
- Understands compliance statutory guidelines and requirements
- Create and update files as well as utilize the Claims Management System (CMS). By using checklists and guidelines, properly document files and identify existing claims that are appropriate to close
- Responds to inquiries and direct requests for status of claims to appropriate file handler
- Prepares loss runs, bordereau reports, and various claim reports
- Review independent adjuster reports for accuracy
7
Responsibilities For Senior Claims Associate Resume
- Support the claims team in all functions of the claims process
- This role requires communication with brokers, claimant’s, insured’s, independent adjusters, and attorneys
- Knowledge of claims and processes
- Claim related field such as insurance, auto, medical or legal
- · Discipline- focused on goals
- · Accountability– measure and take responsibility for outcomes
- Obtain and maintain required adjuster license within first 60 days
- Familiarity with auto claims/estimation/total loss process
8
Responsibilities For Claims Associate, PIP / Reinsurance Resume
- Extremely detail oriented, organized, self starter
- Work rejected real-time claims for all pharmacies supported by the CIC under the direction of the CIC pharmacists
- Basic Knowledge of MS Word and Excel required
- Experience in an office setting handling multiple phone lines, sorting/distributing mail, and email and fax document processing, as well as using multiple software
- Customer service experience, preferably in the retail industry
- Multi-task, meet deadlines, and thrive in a fast pace work environment
- Answer clients’ claims related questions
9
Responsibilities For Claims Associate Liability Resume
- Inputting and maintaining appropriate documentation in EPIC claim database, including but not limited to, loss payments, reserve changes, documenting conversations, correspondence sent and received etc
- Analyze the policy contract and work with adjusters in determining the extent of carrier’s liability concerning loss. When appropriate, take on the role of the customer’s advocate
- Provide any other assistance as needed
- Native level in Swedish, Norwegian and English
- Receives & releases claims documents & checks
- Records all claims received
10
Responsibilities For Rcis-claims Associate Resume
- Prepares check request & letters
- Attends to inquiries from advisors, clients and staff of other departments, over the counter, e-mail and telephone
- Maintain accurate electronic claims files by capturing and updating claims data/information in compliance with best practices for low complexity, low exposure personal or commercial line claims
- Work to have a timely resolution to claims by evaluating policy limits and coverage, evaluating damages and estimates, etc. and escalate issues appropriately while providing status updates to ensure overall customer satisfaction
- Knowledge of concepts, practices, policies and procedures related to claims environment
- Maintains annual eligibility information for open Waiver of Premium, Total and Permanent Disability, and Survivor Income benefit claims
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