Claims Officer Resume Sample
Deven Weissnat
6963 Grayson Lake,
San Francisco,
CA
+1 (555) 668 6438
Work Experience
Chief Claims Officer
08/2015
-
PRESENT
Philadelphia, PA
- An eye for details and a desire to ensure team outputs adhere to procedures and standards
- A strong focus on applying your current skills to improve the performance of the overall end-to-end claims management function
- Availability to commence in mid-February
- Set overall strategic direction, policy, governance and objectives for claims and control and organizes the function in line with the business strategy, balancing efficiency, effectiveness and customer experience
- Take full ownership of financial impact of claims action as part of country/region/segment business plans
- Tertiary graduate with professional qualifications in insurance or related disciplines
- Relevant claims handling experience
- Strong analytical, negotiation and interpersonal skills
- Able to work independently and meet service standards
Claims Officer
02/2013
-
02/2015
San Francisco, CA
- Customer-centric and proactive attitude
- Proficiency in PC
- Experience in insurance
- Fundamental knowledge of insurance industry and claims processes
- Working knowledge and understanding of employees’ compensation and/or case management
- Maintaining current knowledge of insurance guidelines and policy changes and modifications
- Maintaining good client relationships with the insured, Brokers, agents, service providers and the general public
Claims Officer, Major Loss Property Claims
02/2009
-
10/2012
Detroit, MI
- Responding to client requests in accordance with service standards
- Providing information and feedback on claims activity and developing trends to underwriters/risk assessors to enable appropriate actions to be carried out
- Setting reserves and authorising payment within scope of authority, settling claims in the most cost effective manner and ensuring timely processing of payments
- Identifying suspicious or potentially fraudulent claims, notifying supervisor, arranging investigation
- Assist with training of other Claims Officer’s
- Resilient- able to work well under pressure
- The processing of claims in line with set procedures and policies, ensuring that claims are documented correctly, and resolved with a prompt and effective outcome
- Managing claims using the appropriate external and internal specialists to achieve the settlement outcome efficiently and effectively
Education
Southwest Minnesota State University
2004 - 2008
Bachelor's Degree in Management
Professional Skills
- Excellent analytical skills and technical skills
- Excellent time and case management skills
- Excellent interpersonal skills, tact and good judgment and the ability to interact with clients and employees at all levels
- Strong analytical and organizational skills, deadline oriented
- Have excellent stakeholder management and communication skills
- Good PC skills including Excel, Word and Chinese word processing
- Good problem-solving skills - ability to interpret technical / investigation reports to make sound business decisions
How to write Claims Officer Resume
Claims Officer role is responsible for interpersonal, insurance, customer, english, claims, finance, training, database, reporting, research.
To write great resume for claims officer job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claims Officer Resume
The section contact information is important in your claims officer 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 Officer Resume
The section work experience is an essential part of your claims officer 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 officer 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 officer position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Claims Officer resume experience can include:
- The ability to communicate effectively on all levels including Legal and Medical Profession
- Working experience in insurance industry, preferable with experience in Health Claims
- Strong Claims experience, ideally in CTP
- Good interpersonal skill with service attitude, numeric sensitive and attentive to details
- Customer centric mindset and good communication skill
- Good customer service skill to engage, influence, negotiate and inform customers on claims related matters
Education on a Claims Officer Resume
Make sure to make education a priority on your claims officer resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claims officer 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 Officer Resume
When listing skills on your claims officer 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 officer skills:
- Effective communication skills, particularly using telephonic or electronic methods
- Functional knowledge of law and insurance regulations in various jurisdictions. Demonstrated superior verbal and written communications skills
- Good command of both spoken and written English and Chinese & PC skills
- A proven ability to communicate effectively both verbally and in written format
- An individual who can critically assess and has excellent organisational skills
- Strong customer service experience - the ability to build rapport over the phone and handle varying customer expectations and demands
List of Typical Experience For a Claims Officer Resume
1
Experience For Chief Claims Officer Resume
- Previous experience as a Claims Officer – Property experience is highly advantageous
- Experience as a Claims Officer or a strong customer service background
- Excellent technical, product and industry experience for life & health benefits
- Experience in heavy vehicle motor or machinery claims is desirable but not essential
- Accurate completion and validation of claims
2
Experience For Chief Claims Officer, Liberty Mutual Benefits Resume
- Establish and maintain good client relationships with insurance agents, service providers and the general public
- Establish and maintain good client relationships with the insured, brokers, investigators, solicitors and the general public
- Experience in Total Loss Motor Claims is desirable but not essential
- Cooperate with other teams to meet the deadlines and expectation of services
- Recent experience in general insurance or claims
- A strong focus on customer service with the ability to build rapport over the phone and handle varying customer expectations and demands
- Previous experience as a Claims Officer and has managed Property Claims
- Experienced Claims Officer within Fire and Theft Claims
3
Experience For Senior Claims Officer Resume
- Previous experience in Property Claims would be advantageous
- Build and maintain strong client/customer relationships
- To develop good personal and business relationships with the Claims Managers
- Individual & group health claims experience
- Provide accurate feedback on claims activity and developing trends to underwriters/risk assessors to allow them to take appropriate action and
- Acts as escalation point for customer complaints and assisting with any escalated issues
- Provide technical expertise and mentoring to assist the team development
4
Experience For Technical Claims Officer Resume
- Provide information and feedback on claims activity and developing trends to the National Claims Manager – Liability
- The end-to-end management of Motorcycle Claims utilizing multiple claims systems and processes
- Timely and accurate input, processing, authorisation and payment of claims
- Proper documentation of claims processing and outcomes
- Highest professional approach to all aspects of claims handling
- Sound technical understanding and ability to manage a diversified portfolio of bodily injury, property damage and product liability claims
5
Experience For Claims Officer, Major Loss Property Claims Resume
- Conduct audits of policies and procedures, ensuring that “best practice” is met with regards to statutory, regulatory and ethical requirements
- The capability to work autonomously and as part of a high-functioning team
- Proficiency in conducting legal research
- Manage multiple competing tasks at one time
- Flexible working arrangements – healthy work/life balance
6
Experience For Claims Officer, Employees Compensation Resume
- An understanding of, and demonstrable application of, the General Insurance Code of Practice
- A fundamental knowledge of the insurance industry and claims processes
- The ability to promote a high level of customer service in line with QBE’s claims model
- Awareness of Legislative and Regulatory requirements
- Sound knowledge of legal proceedings and processes
- Exemplary customer service, with a real desire to do things differently to achieve positive outcomes for our claimants and QBE
- Interaction in a professional manner with third parties
- Efficient management of the claims process
7
Experience For Claims Officer, Accident & Health Resume
- Initiation and completion of any recoveries from third parties
- Ensure compliance with relevant statutory guidelines and standards
- Self audit of claims files to ensure positive internal audits
- Response to enquiries in an accurate, timely, professional and courteous manner within Privacy guidelines
- Works with team to complete Closed File Reviews, Open File Reviews and Quality checks as set out within the Claims Quality Management Framework
- Responds to critical issues and exceptions appropriately
- Work with team to develop strategies that directly impact and improve claims outcomes for both the customer and QBE
8
Experience For Dshs Claims Officer Resume
- Champion key business initiatives to deliver impact within Team i.e. Quality, Process, Real Time Management
- Contribute to employee PDP’s
- Manages, mediates and negotiates appropriate resolutions to high value, major loss claims cases
- Lodge new claims in a timely manner
- Appoint Loss Adjusters &/or Investigators
- Respond to client requests in accordance with service standards
- Identify recovery opportunities and refer in accordance with practices and procedures
- Direct conversation with customer over the phone or email by referring to customer specific claims handling protocol and/or customer proposition service charter to ensure that the needs and expectations of customers are fulfilled
- Act as a referral point for cases escalated by standard handlers
9
Experience For Claims Officer, Employee Compensation Resume
- Proactively monitor employees’ compensation claims to minimize claims settlement
- Timely determination of professional lines claims in accordance with company policies, industry standards and applicable legislation
- Manage complaints as per guidelines
- Relevant legal qualifications and/or some exposure to PL claims
- Pro-active and energetic team player
10
Experience For Claims Officer Motor Resume
- Contribute to employee PDPs
- Sound knowledge of employment related matters
- The processing of total loss and complex claims in line with set procedures and policies, ensuring that claims are documented correctly, and resolved with a prompt and effective outcome
- A great team atmosphere with a positive culture
- Identify key strengths and areas for improvement in U.S. operations
- Manage and contribute to projects on a range of claimant outcome issues, including the development of plans, timelines, and objectives, research and data management, tracking progress, resource management and evaluation of project effectiveness
- Provide strategic and technical advice and recommendations on building capability of internal staff as well as insurers, providers and other stakeholders within the system
- Resolve complex issues concerning return to work, injury management and case management, regulatory activities and initiatives for insurers and providers
List of Typical Skills For a Claims Officer Resume
1
Skills For Chief Claims Officer Resume
- We are looking for an individual who is switched on, driven and motivated to develop their current skills and develop within the business
- Mathematical skills in order to quickly and accurately calculate claims related figures
- Authorizing payment within scope of authority, settling claims in the most cost effective manner and ensuring timely issuance of disbursements and
- Ensuring the delivery of the highest quality customer service and developing strong working relationships with all customers and service providers
- Understanding of underwriting procedures for a diversified liability portfolio and a proven ability to understand and interpret relevant policy wordings
- Maintaining a good knowledge of insurance guidelines and policy changes including any modifications
2
Skills For Chief Claims Officer, Liberty Mutual Benefits Resume
- Managing claims using the appropriate external and internal specialists to achieve effective and efficient settlement outcomes
- Engineering, systems and/or MEP experience preferable
- Good knowledge of construction contracts and terms, contract law and planning/scheduling is preferable
- We are seeking candidates who have an understanding of general insurance and have experience in motor claims
- A proven track record in managing major and complex property claims that require a high level of technical expertise
- Recent experience working for a large/major Contractor
- Experience in pricing, valuation of works, contract administration, negotiation of Variations and contractual correspondence etc.
3
Skills For Senior Claims Officer Resume
- Excellent written and oral English, including ability to draft high quality letters and/or documents or Claims
- A proven track record in delivering on customers’ needs/requirements with the ability to empathise
- Demonstrated technical understanding and ability to manage a diversified portfolio of bodily injury, property damage and product liability claims
- PC literacy and experience in word processing and spreadsheet applications
- We are looking for individuals who are motivated to develop, driven and has a good attitude in the workplace
4
Skills For Technical Claims Officer Resume
- 2 - The department is a high volume work environment and the role of Claims Officer is required to manage competing priorities and deadlines
- Apply critical thinking and an evidence based approach to case management and claims settlement
- Experience assessing all major claim types
- Experience managing catastrophic injury/complex liability claims is required for this role
- Experience in managing relationships with service providers
- Negotiate settlements up to approved limits and settling claims in the most cost-effective manner
- Relevant working experience in insurance field
- Previous experience working to tight deadlines
- Extensive experience in a customer focussed environment with the ability to build rapport over the phone and handle varying customer expectations and demands
5
Skills For Claims Officer, Major Loss Property Claims Resume
- An individual who pride themselves on providing an exceptional customer experience at every point of contact
- Ideally previous workers compensation experience
- Strong customer service ethic and ability to execute client focused outcomes
- A strong network within the Property Claims market
- Provide recommendations and feedback to stakeholders in relation to skill gaps identified
- Previous workers compensation experience is highly regarded
- Previous workers compensation experience - highly regarded
6
Skills For Claims Officer, Employees Compensation Resume
- Receiving recording and processing all incoming insurance claims for your assigned area
- Interpreting basic policy coverage and determining if coverage is appropriate to the claim submitting or escalating any issues as needed
- Interpreting policy coverages and determining if coverages apply to claims submitted, escalating issues as needed
- Dealing and administering all relevant claims, commercial and/or contractual related correspondence
- Fostering an environment that promotes and rewards learning
7
Skills For Claims Officer, Accident & Health Resume
- Understanding of the NSW personal injury claims environment. Exposure to and understanding of other Australian Jurisdictions would be beneficial
- Considering a person’s ongoing unemployment or recovery from the illness or injury
- Setting reserves and authorising payments within scope of authority
- Managing enquiries in relation to new or existing claim
- Understanding of Personal Injury Proceeding Act (PIPA) legislation
8
Skills For Dshs Claims Officer Resume
- Providing assistance to Senior Claims staff in the preparation, evaluation, assessment and defence of claims and potential claims
- Monitoring of compliance by Claims Team with Alstom,, CJV, FAST and /or Contract regulations and procedures
- Rewarding achievement of business goals
- Utilising audit data and results to develop reports for the U.S.
- Assessing an Insured’s entitlement to cover under a CCI policy
- Working towards recognised industry standard, e.g. ANZIIF, CII, added advantage
- Responding to enquiries in an accurate, timely, professional and courteous manner within Privacy guidelines
9
Skills For Claims Officer, Employee Compensation Resume
- Reporting in accordance with relevant company service standards and manuals
- Ensuring compliance with relevant statutory and service standard guidelines
- A continuing improvement focus attitude towards implementation of new work practices and procedures, initiating and facilitating change and innovations
- A cover letter addressing the following
- Assistance with pricing, valuation and/or estimation of the components of Claims and/or Variations etc. including the measurement of works
- Desire to work well with a legal team located throughout the State, sharing ideas and working collaboratively
10
Skills For Claims Officer Motor Resume
- Provide additional management support to the Manager when required, including team management coverage during periods of leave
- A highly empathetic approach to dealing with customers, possessing the ability to be friendly yet professional
- An analytical approach to problem solving and a thoroughness in your exploration and assessment of factors contributing to a claims outcome
- An aptitude to solve problems and sound decision making capabilities
- Assess and process medical claims according to company’s claims guidelines
- Provide administrative support to group & individual medical / life clients through correspondence handling
- Engage, instruct and work with relevant providers including loss adjusters, lawyers and consultants
List of Typical Responsibilities For a Claims Officer Resume
1
Responsibilities For Chief Claims Officer Resume
- Demonstrate interpersonal skills with the knowledge of proper use of the English language, grammar and spelling; excellent oral and written communication skills in order to communicate with diverse groups of individuals
- Demonstrate problem-solving and analytical skills with skill in handling a number of projects or tasks simultaneously; while working under pressure and considering broad impacts in order to meet customer service expectations and regulatory deadlines
- Demonstrated commitment to delivering courteous, sensitive, and responsive service to all internal and external customers
- Previous experience improving process and workflows
- Use a personal computer including word processing and data management
2
Responsibilities For Chief Claims Officer, Liberty Mutual Benefits Resume
- A modern approach to improving the business and a willingness to embrace change
- Handle multiple and competing tasks to meet customer needs
- Available to work with a flexible rotating roster
- Communication with our underwriting and intermediary partners on claims and trends
- Industry leading technology
3
Responsibilities For Senior Claims Officer Resume
- Consistently acts with utmost integrity in all professional interactions
- Result-oriented, self-motivated, patient, cheerful and positive
- ANZIIF/ACII qualifications would be added advantage
- Knowledge of insurance principles, claims agreements, Employees’ Compensation Ordinance and legal procedure of Employees’ Compensation litigated case in Hong Kong
- Motivated and energetic individuals who are keen to challenge themselves
- General business and administrative knowledge
- The ability to interpret a variety of insurance policies and consider and communicate policy coverage
4
Responsibilities For Technical Claims Officer Resume
- Undertake reviews/audits of claims against a qualitative audit tool
- Utilise audit data and results to develop reports for the U.S.
- Coordinate provider performance frameworks and initiatives including approval models, fee structures, performance monitoring and reporting, and capability building programs
- Establish and maintain robust and collaborative relationships with stakeholders to optimise the quality and range of products/services and develop a dynamic exchange of ideas to meet growth and change opportunities
- Prepare detailed correspondence, recommendations and reports to senior management, the Board and Minister
- Lead and participate in cross-functional teams on projects that cross functional responsibilities
- Providing professional and proactive specialist claims management support to Return to Work Specialists, with a view to achieving safe and sustained return to work as early as possible – Claims Team
5
Responsibilities For Claims Officer, Major Loss Property Claims Resume
- Experience as a Motor Claims Officer, or a background in providing a world class customer service experience and the passion to grow and develop in to a motor insurance professional
- Experience as a Property Claims Officer, or a background in providing a world class customer service experience and the passion to grow and develop in to a property insurance professional
- Previous experience developing and implementing new strategies, policies and procedures
- Experience developing and implementing functions and services supporting reform objectives designed to increase accountabilities of participants in the schemes and foster effective regulation and support an efficient Regulatory Operating Model
- Knowledge of applicable legislation
6
Responsibilities For Claims Officer, Employees Compensation Resume
- A self-motivated individual who is eager to learn and grow on their current skills to maintain levels of excellence through times of change and show resilience in the face of a challenge
- Interaction in a customer focussed and professional manner with our insured claimants, their legal representative, brokers and Elders Insurance Authorised Representatives
- Proactively managing claims from notification through resolution
- Timely determination and communication of indemnity in accordance with company policies, industry standards and applicable legislation
- Proper documentation of claims management and outcomes
7
Responsibilities For Claims Officer, Accident & Health Resume
- Negotiation of claims settlements
- Attorneys who like to talk on the phone as DCS hearings are conducted by telephone
- Sensitivity and cultural knowledge to work well with diverse populations
- Competence to examine and analyze information to determine responsibility for support or debts
- Independent judgment to evaluate available judicial and administrative remedies to advise their use in specific support enforcement cases
- Determination, positive attitude and the drive to be challenged and succeed
- Use multiple systems at one time
8
Responsibilities For Dshs Claims Officer Resume
- Available to work the late shift hours
- Active Social club with regular events
- The opportunity to work for a company that gives back through our community and volunteer programs
- Managing claims handling enquiries including but not limited to coverage determination, quantum analysis and legal liability assessment, where appropriate and within authority limits
- Timely determination of claims in accordance with company policies, industry standards and applicable legislation
- The right attitude and would like to join a supportive team in a rare opportunity to lead by example within Major Loss Property claims
- Technical knowledge and product knowledge would be highly advantageous
9
Responsibilities For Claims Officer, Employee Compensation Resume
- Ensure accuracy and review the procedures for continuous improvement
- Ensure claims are processed within company service standard
- Sound knowledge of medical terminology and legal proceedings
- Contribute and support within a team environment
- Participate in alternative dispute resolution
- Technical knowledge of insurance and claims processes
- Broad exposure to claims management across all short tail products
10
Responsibilities For Claims Officer Motor Resume
- Provides opportunities to handle new challenges
- Arrange disbursement of reports and payments on claims settlement
- Reply enquiries from internal customers within in a timely manner
- Assess worker’s time lost and return to work possibilities
- To ensure the pricing, business development and underwriting teams fully understand the effect of a client’s claims practices and philosophies on risk assessment and pricing
- To assist in the development of claims assessment standards, procedures and controls
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