Insurance Claims Resume Sample

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Mossie Leuschke
6603 Tatum Rue,  Detroit, MI
+1 (555) 813 6091

Work Experience


Insurance & Claims Manager
06/2015 - PRESENT
San Francisco, CA
  • Post-Secondary education/or equivalent experience
  • MBA or CPP designations would be an asset
  • Follow up on outstanding claims with patients or insurance companies by telephone, internet, and/or facsimile
  • Ensure that outstanding claims are followed up on at least every 28 days
  • Document detailed denial, rebill, payment plan, and collection follow-up notes accordingly
  • Ensure that all correspondence is reviewed and addressed in a timely manner
  • Consistently demonstrate an ability to work as a team player
  • Liaising with Philips business leaders, lawyers, Loss adjustors, brokers and insurers to secure the best outcomes
Insurance Claims Coordinator
02/2011 - 12/2014
Phoenix, AZ
  • Create accurate and timely reports for all departments
  • Work with other departments in improving and automating business functions
  • Proficient skills with Access or SQL
  • Grasp concepts quickly, pay attention to details, think through problems logically, apply college-level math skills, and make appropriate decisions
  • Strong work verification and related proofreading skills
  • Strong at follow-up
  • Excellent collaboration and team work skills
  • To apply directly email your resume to rodt065@kellyit.com
Insurance Claims Intern
11/2006 - 08/2010
Philadelphia, PA
  • Supporting and working closely with the regional insurance and risk managers in North America, Latin America and Asia Pacific
  • Working closely with the global head of the Insurance & Risk Management Department and the IRMD team in Amsterdam to review Company risks and to adequately transfer insurable risks to global insurance programs and/or alternative solutions
  • Involvement in the renewals of the global insurance policies and in defining the scope of work of the insurance brokers
  • Advising internal stakeholders in different countries on insurance and contract management matters
  • Assessing the risks and advice on the design of special project related insurances to facilitate business opportunities by participating in Large Scale Projects and Merger & Acquisitions
  • Produce analyses and audits as requested using MS Excel, MS Access, or MS SQL
  • Check and validate recurring reports

Education


Cabrini University
2001 - 2006
Bachelor's Degree in Business

Professional Skills


  • Proficient use of two electronic health record systems (EHR, an on-line claims submission and processing system, and an accounting software system, examples include, but are not limited to
  • Strong organisational skills and planning abilities with a strong eye for detail
  • Strong organizational and prioritizing skills
  • Computer skills, data entry skills, accuracy, and speed
  • Strong organizational skills, detail oriented to ensure accurate and timely completion of work products
  • Excellent verbal and written communication skills
  • Excellent customer service skills, and the ability to build rapport

How to write Insurance Claims Resume

Insurance Claims role is responsible for microsoft, excel, outlook, advanced, computer, software, research, grammar, analytical, word.
To write great resume for insurance claims job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Insurance Claims Resume

The section contact information is important in your insurance claims 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
  • Email
  • Telephone number

Work Experience in Your Insurance Claims Resume

The section work experience is an essential part of your insurance claims 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 insurance claims responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular insurance claims position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Insurance Claims resume experience can include:

  • Strong attention to detail is critical, as well as solid analytical and communication skills
  • Strong Microsoft Excel, Word, Powerpoint and Access/database management skills are essential
  • Excellent workload management skills
  • Be highly professional with excellent verbal and written communication skills
  • Handle multiples tasks and priorities effectively
  • Good interpersonal skills

Education on an Insurance Claims Resume

Make sure to make education a priority on your insurance claims resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your insurance claims 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 Insurance Claims Resume

When listing skills on your insurance claims 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 insurance claims skills:

  • Excellent communication skills with the ability to forge strong working relationships with key stakeholders at a range of levels
  • Excellent oral and written communication, including presentation skills
  • Outstanding Interpersonal Skills including assessing barriers and opportunities from personal characteristics and interpersonal dynamics
  • Planning, organizing and multi-tasking skills
  • Effective skill developing, coaching and motivating employees to achieve production results
  • Advanced organizational, planning, time management, and problem solving skills

List of Typical Experience For an Insurance Claims Resume

1

Experience For Insurance Claims Coordinator Resume

  • Advanced skill in exercising initiative and using good judgment to make sound decisions
  • Prior medical billing experience
  • Data Entry - significant data entry skills and Excel use required, reviewing large quantities of repetitious data
  • Strong attention to detail, persistent, and has excellent follow through
  • Demonstrates flexibility in a changing environment and shifting responsibilities
2

Experience For Insurance Claims Analyst Resume

  • This role can be filled as a T10 - Associate Claim Rep or T9 - Claim Rep depending on experience
  • Experience required
  • 6 months of customer service experience in a health care setting
  • Experience in
  • Reviewing incoming documentation and new complex claims notifications for large and/or complex and follows up with stakeholders
  • Maintaining regular contact with a portfolio of clients to build trust, internal expertise and ensure department accountability
  • Understanding of insurance coverages related to Worker’s Compensation, Auto Liability and General Liability coverages
  • Knowledge of process for making liability decisions, including obtaining relevant statements and reports
  • Knowledge in all areas of insurance, including but not limited to, the ability to analyze and compile insurance billing data on the UB-04 and HCFA 1505 forms
3

Experience For Insurance & Claims Manager Resume

  • Maintain daily reporting of all KPI’s identified for area of responsibility, including both automated and manual efforts - 5%
  • Coordinate the company’s handling and settlement of selected casualty insurance claims
  • Assist with selected property insurance claims, including builders’ risk
  • Participate in the Training and Education Programs presented by the Department
  • Research and resolve issues to meet customer needs. Uses problem-solving ability for various levels of issues
  • Collaborates with employees individually and as a unit to promote accurate and ongoing performance feedback and promote career development
  • Monthly tracking of travel vouchers issued, redeemed, and expired
  • Assist with the administration of the Group’s aviation and general insurance policies including close liaison with the Group’s insurance brokers
  • Assist with the preparation of the fuel accounts and other financial reporting obligations
4

Experience For Insurance Claims Manager Resume

  • Compiles data and prepares insurance claims for billing. Reviews and corrects appropriate adjustments to patient accounts
  • Reviews assigned insurance reimbursement and ensures correct account balance and generate appropriate secondary billing if applicable
  • Determine and report quarterly reserve information to accounting for reserve adjustment on the balance sheet
  • Establish, maintain, and update files, databases, records, and other documents for recurring internal reports
  • Undertake accurate downloads from systems and secure data necessary to facilitate accurate and timely reporting
  • Analyse performance trends and investigate and anomalies, advising key stakeholders accordingly
  • Calm and level headed under pressure, with a logical approach to problem solving
5

Experience For Supervisor Mortgage Insurance Claims Resume

  • Work from Reports and collaborate with each DCM regarding questions related to items on the Report
  • Assist the DCM in summarizing Medical Records
  • Proficiency in Microsoft Office Suite including Outlook, Excel, Word, and Visio are required
  • Knowledge of the filing practices for all third party payers
  • Work independently and see tasks through to completion, seeking guidance where needed
  • Familiarity with state and federal regulations, medical terminology and coding
6

Experience For Insurance Claims Intern Resume

  • Passionate about client’s and the business exceeding expectations
  • A warmth and empathy for clients when dealing with complex issues
  • Complete accident/damage report with all pertinent information needed including
  • Attractive remuneration packaging
  • Be willing and able to obtain Insurance Licence
  • Insurance claims adjusting, transportation or logistics management, g eneral administration
  • General understanding of vehicle damage and vehicle damage appraisal process
7

Experience For Head of Insurance & Claims Internal Audit Resume

  • General understanding of vehicles, related components and parts
  • Willingness to adapt to an ever changing business environment
  • Insurance claims adjusting, transportation or logistics management, general administration
  • Office Admin. beginning
  • Files insurance claims on the UB-04 and HCFA 1505 form for medical services
  • Computes insurance benefits, allowances, adjustments, and account balances
  • Processes tracers and verifies reimbursement from payers
8

Experience For Insurance Claims Processor Resume

  • Displays positive customer relations with all departments, outside companies, and patients
  • Assist with evaluation of liability and damage elements of large losses
  • Advise management on claim exposures and recommend action plans to control the company’s financial risk
  • Conduct in house research on insurance claim and insurance coverage issues where applicable
  • Tender claims to appropriate subcontractors or other responsible parties under contract or under additional insured status
  • Coordinate subrogation efforts on property damage claims against third parties
  • Assist with Annual District Claim File Reviews
9

Experience For Insurance Claims Consultant Resume

  • Maintain and update electronic claim files
  • Provide department assistance under department director’s guidance
  • Promote, model and manage to AMP's principles, philosophies and values through own actions and behaviours
  • Ensure decisions and activities, people and processes are aligned with principles of AMP's holistic claims management philosophy and core beliefs
  • Implement and support the maintenance of continuous improvement strategies within the team and as required across the Claims area
  • Produce loss runs from insurers’ on line systems. Review and interpret loss data relative to the clients’ insurance program
10

Experience For Senior Insurance Claims Analyst Resume

  • Administer agency required office practices and procedures. Maintain information in the agency’s database
  • Evaluation and oversite of medical only Workers’ Compensation claims (non-complex), to include working with TPA/Insurance Company to resolve claims in a timely manner
  • Manage and process the company’s General Liability Warranty insurance claims
  • Prepare the company’s insurance allocation
  • Assist VP and Director on various multi-line claim related responsibilities, included but not limited to maintaining claims files, claim reporting, running reports via various RMIS systems, conducting audits
  • Ensure data integrity by running various reconciliation reports and overseeing audit processes i.e. SOX reconciliation, SmartSearch homes closed (Seller Disclosure) documents
  • Assist Vice President and Director with any required daily functions of the Risk Management department, which can include coverage reviews, data analytics, reviewing contract documents, RMIS administration and reports, Subcontractor Insurance tracking, etc
  • Read and analyze EOB’s and make proper adjustments according to PDS claims processing criteria

List of Typical Skills For an Insurance Claims Resume

1

Skills For Insurance Claims Coordinator Resume

  • Proficiency in Microsoft Excel and Word (or equivalent) are required. Intermediate/advance keyboarding/typing skills are required
  • Critical thinking and investigative skills are required
  • Effectively steer communications (written or verbal) into alignment with concepts of holistic claims management; taking corrective action where required
  • Analytical and interpretive skills
  • Insurance industry experience, claims experience, or combination of both required
  • Professional oral and written communication skills are required
2

Skills For Insurance Claims Analyst Resume

  • Professional communication skills required
  • Communication and business writing skills
  • Problem solving and research skills PC proficiency to include Word, Excel, PowerPoint, Outlook and Lotus Notes
  • Displays interpersonal and time management skills
  • Professional verbal and phone skills
  • Advanced Excel skills essential, to include pivot tables, vlookup etc
3

Skills For Insurance & Claims Manager Resume

  • Experience of claims administration experience
  • Intermediate or better Microsoft Excel skills (Pivot tables, VLOOKUP and IFSUM formulas)
  • Providing excellent customer service through communications with our customers for the return of their deductibles
  • Implement policies to manage compliance requirements with claim handling guidelines and ensure good faith claim handling. Create metrics and monitor results
  • Personal lines claims adjusting, specifically Homeowner’s experience
  • Negotiate skillfully in challenging situations with other insurance carriers
  • Strong understanding of Insurance Claims industry
  • Strong understanding of Insurance Claims and its best practices and supplier operations
  • Direct experience procuring Insurance Claims service or related services
4

Skills For Insurance Claims Manager Resume

  • Three years’ experience in a fast-paced atmosphere
  • Knowledge of the basics of insurance; including utmost good faith, insurable interest, proximate cause, indemnity, subrogation and contribution
  • Excellent understanding of Super concepts and legislation specifically Group Life Insurance in Super (Death, TPD & IP)
  • Outlook, Excel, Microsoft Word experience
  • Previous experience in a professional work environment
  • Organized, attention to detail, strong work ethic, team player
5

Skills For Supervisor Mortgage Insurance Claims Resume

  • 5 years of NY specific experience
  • Microsoft Office experience: Word, Excel, and Outlook
  • Establish negotiation and disposition strategies in order to achieve appropriate and cost effective claim outcomes
  • Manage and set priorities on the daily operations of a large department. Manage employee performance to achieve unit, department and corporate company goals
  • Valid and current Insurance Broker license
6

Skills For Insurance Claims Intern Resume

  • Able to prioritize workload and meet deadlines without reminders
  • Creating, using, and maintaining Excel Spreadsheets
  • Planning, recommending and advocating our subrogation position to other insurance carriers
  • Achieving prompt and proper disposition of claim files involving established liability
  • Maintaining a risk matrix to include forecasting of potential risk exposures
7

Skills For Head of Insurance & Claims Internal Audit Resume

  • Tracking and Management of Payer Authorizations
  • Preparing files for arbitration & litigation
  • Operating within a team environment in order to maximize the team’s overall recovery results
  • Calculating monthly insurance premiums owed based on passenger manifests
  • Preparing various ad hoc analysis on claims paid data as requested
  • Scheduling of and attendance at file review meetings
8

Skills For Insurance Claims Processor Resume

  • Working knowledge of Mortgage Production and/or Mortgage Servicing Systems
  • Understanding of Insurance Claims processes within various jurisdictions
  • Understanding of Lean concepts and methodologies
  • Liaising with internal and external parties throughout the assessment of the claim
  • Working to achieve set key performance indicators
  • Securing pictures from the scene and witness statements
  • Review various types of insurance documents and update the hazard insurance lines on the clients servicing system according to established procedures
  • Follows client’s standard policies and procedures as a guide for accurately applying loss drafts processes and resolving customer inquiries
  • Appropriately use system for tracking/trending purposes
9

Skills For Insurance Claims Consultant Resume

  • Compile data to draft clients’ loss summaries following agency’s templates. Draft claim summary reports following agency’s templates
  • Monitors and documents ongoing performance utilizing objective data and subjective observations
  • Identify and develop opportunities for improving content and/or delivery of the management and operational reporting service
  • Management of Client Records (including payer changes and address updates, financial/eligibility documentation)
  • Submission of Payment Approval to the Manager of Centralized Billing
10

Skills For Senior Insurance Claims Analyst Resume

  • Make necessary outbound phone calls to insurance agents, and companies to update insurance policies and obtain needed (missing) information
  • PC literate, including Microsoft Office products
  • Research and analyze Medicare claims and related material including customer history
  • Keep abreast of all changes/updates regarding Medicare policy and departmental guidelines
  • Thorough understanding of life and annuity products required
  • Motivated self-starter with ability to think outside the box when problem solving

List of Typical Responsibilities For an Insurance Claims Resume

1

Responsibilities For Insurance Claims Coordinator Resume

  • Provide operational handling of the department including understanding, monitoring and improving work-flow and processes, assisting on day to day problem resolution and troubleshooting
  • Participating in internal and external audits, where applicable provides feedback & recommendations for operational improvements
  • Monitor all claims in “Open” status and ensure that they are being worked and progressing in a timely manner - 10%
  • PC literate including Microsoft Office products
  • Familiarity with auto estimating and/or insurance terminology
  • Work at a fast pace in a rapidly changing environment
  • Assessment and settlement of claims determining policy coverage
2

Responsibilities For Insurance Claims Analyst Resume

  • Direct investigation and resolution of general and auto liability claims arising out of sole work and sponsored joint ventures
  • Maintain a professional demeanor when dealing with associates, claimants, adjusters, and insurance carriers
  • Prepare reports and other analytical data as requested
  • Escalate issues to the appropriate parties and ensures complaints and issues are handled in a timely and professional manner
  • Provide claim advocacy based on service plan or as requested
  • A subject matter expert in workers compensation for internal colleagues and clients
  • Support the implementation of comprehensive risk control programs. Develop and support carrier claims relationships
3

Responsibilities For Insurance & Claims Manager Resume

  • Aggressively achieve a fair and equitable disposition of all damage disputes
  • Coordinate and manage a high caseload to ensure timely resolution of cases
  • Accurately assess collectible damages
  • Printing documents, creating files, calling lienholders for payoffs, data entry in Excel spreadsheets, creating and mailing compliance letters from templates, faxing paperwork to lienholders, emailing through Outlook
  • Mentors, coaches, and trains personnel to achieve desired goals and position objectives
4

Responsibilities For Insurance Claims Manager Resume

  • Proactively assesses claims processes and develop strategies to maintain or improve performance
  • Conducts daily diary reviews to evaluate claims representatives performance
  • Performs open and closed file evaluations
  • Set standards, monitor and report on performance of outside vendors
  • Proactively assess Claims Processes to develop strategies to seek continual process improvement
  • Participates in long-range departmental planning and provides input to operational decisions and to clarify or modify project plans, and/or schedule requirements
  • Receives and reviews incoming travel protection claims (200/week) for accuracy, comparing passenger provided information to our reservation records, and entering any additional data needed to complete the claim form so it can be transferred to our third party administrator/insurance carrier
  • Process travel protection refunds checks
5

Responsibilities For Supervisor Mortgage Insurance Claims Resume

  • Manage travel protection email inbox
  • Reconcile insured passenger count with ship manifests to verify each month that insurance has been purchased for all passengers, research and resolve any discrepancies
  • Work with our third party insurance administrator to address any insurance related business matters (new insurance products for new geographic regions, etc.)
  • Liaise with Group’s legal and technical advisers and third party claims handlers in relation to individual case management
  • Prepare management information on overall claims exposure and claims history
  • Assist with the preparation of the insurance reserves
  • Direct communication with brokers and underwriters
  • Email and phone correspondence with broker and underwriters
6

Responsibilities For Insurance Claims Intern Resume

  • Verifies and calculates payments, follows up on incorrect payments or denials in a timely manner and ensures proper status of accounts
  • Determine whether to re-file a claim, refund, or process an adjustment. Identifies Medicare and Medicaid combine messages on a daily basis
  • Manage workers’ compensation, automobile liability, general liability (to include the Facility Maintenance owner controlled insurance program(OCIP) and any project specific OCIP) claims from inception to closure including coordination of records retention
  • Provide support on renewal/placement of domestic US and Canada Insurance policies, Facility Maintenance OCIP and any project specific OCIP
  • Provide support on marine cargo and environmental liability claims as needed
  • Manage third party administrators and external legal counsel. Assist in-house legal counsel on claims in litigation
  • Conduct quarterly claim reviews and negotiate reserve amounts on open workers’ compensation, auto and general liability claims, including OCIP Programs, to ensure proper handling and reporting
7

Responsibilities For Head of Insurance & Claims Internal Audit Resume

  • Determine and report annual reserve information to auditors based on year end loss information
  • Communicate with multiple parties about claims representatives, complaints, new or modified coverage or laws, and general discussions on pertinent matters
  • Manage self-insured and mandated funded workers’ compensation programs in monopolistic states which include providing payroll reports, premium payments, third party administrator management, claims payments, account funding and reimbursements
  • Prepare weekly reports to Payroll for indemnity payment recovery on employees, quarterly claim analysis reports to HSE, and updates to Legal on claims in litigation. Update Human Resources as requested including the verification of appropriate NCCI codes to apply to various job titles
  • Manage the invoice process for all vendors associated with claims and settlements
  • Compile renewal underwriting data to support the Excess Liability, Domestic and International Casualty, Non-Owned Aircraft, and Environmental liability policies based on renewal plans
8

Responsibilities For Insurance Claims Processor Resume

  • Contribute and provide support in the development and administration of premium allocation models
  • Determine budget costs associated with claims
  • Develop, train and support appropriate Plant Mgmt, HSE, Site-Nurses and Human Resource personnel on claim reporting and administration processes. Work closely to ensure all regulations are adhered to
  • Shows control while managing multiple tasks and demands concurrently in a fast-paced, deadline driven, team environment with minimal supervision
  • Gather information and take each file from sale to closing
  • Verify insurance documents including income credit appraisal
  • Records billed items into the system and verifies aging accuracy
9

Responsibilities For Insurance Claims Consultant Resume

  • Manage insurance policy premium audits for US and Canada programs (i.e. workers’ compensation, general liability and automobile)
  • Train and support administrative assistant to address requests for documentation when proof of Lyondell’s commercial insurance is required via insurance certificates, auto insurance cards, etc
  • Manage updates on Elements website relative to domestic US claims reporting and handling procedures
  • Proficiency in the MS Office suite as well as SAP and Documentum is essential
  • Collect required documentation, review file documentation, and make sure all items needed are requested
  • Ensure that all policy documentation is complete, accurate, and complies with company policy
  • Act as a liaison between the policy holder and insurance agent
10

Responsibilities For Senior Insurance Claims Analyst Resume

  • Contact and communicate with clients by telephone, e-mail, or in-person
  • Basic knowledge in insurance industry
  • Participate in the ongoing development of business systems and procedures to ensure accurate and meaningful management information is available to support the business objective of Marsh and its client(s)
  • Effectively and efficiently merge and consolidate data, potentially in different formats from different sources, to provide visually compliant reporting to agreed requirements
  • Advanced Excel, with knowledge of VBA and Microsoft Access advantageous

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