Insurance Claims Specialist Resume Sample

14 votes
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Kiarra Schaden
3014 Wolf Port,  San Francisco, CA
+1 (555) 776 4720

Work Experience

Insurance Claims Specialist
04/2016 - PRESENT
Houston, TX
  • Review, analyze and interpret all types of property and liability insurance policies, operating statements and property appraisals for commercial loans to ensure compliance with the loan documents, investor requirements and internal policies and procedures
  • Monitor and manage the disbursement of payment of all insurance premiums for the commercial mortgage loans for which there are escrow funds being held and any force place insurance premiums
  • Initiate and oversee any forced place insurance coverage that is required due to inaction of the borrower
  • Oversee and administer all casualty losses incurred on the commercial properties
  • This includes, but is not limited to, analyzing the severity of the loss by reviewing loss affidavits, engineering reports, etc., arranging property inspections, and processing disbursement requests from the loss proceeds
  • Correspond, either verbally or in writing, as necessary with borrowers, insurance agents, and insurance companies to resolve any issues or discrepancies related to insurance
  • Interact with internal departments as needed to resolve any issues or discrepancies related to insurance.Search Jobs US
  • Prepare instructions and advise clients on action to be taken in event of a claim (i.e. OSHA, Environmental Area, Products Liability, Professional Liability, etc.)
Insurance Policy & Claims Specialist
04/2011 - 10/2015
Boston, MA
  • Extend full courtesy and assistance to third parties reporting claims or providing claims information
  • Send notice of potential changes to the Client Managers on all changes relating to claims (e.g. deletion of vehicle on total loss)
  • Effective communication skills, organizational skills, and ability to respond to requests effectively and efficiently
  • Learn insurance agency automation systems
  • Handle high-pressured, fast-paced environment with significant telephone and personal disruption
  • Maintain high level of confidentiality in all matters
  • Travel required within WNY and across NYS
  • Travel percentage 25%
Health Insurance Services, Claims Specialist
08/2004 - 01/2011
Chicago, IL
  • Instruct and coordinate post-accident tests to be completed as required by Department of Transportation (DOT)
  • Processes Workers’ Compensation claims via the online system or through the insurance adjuster
  • Acquire health insurance producer’s license in state of residence within first six months in role
  • Ensuring that unit’s key performance targets are met
  • Fluent in Danish both written and verbal, English is strong advantage
  • Excellent call handling skills and comes across as confident orator who is able to remain patient when imparting complex information to others
  • Fresh graduates without previous work experience are also welcome
  • Actively manage claims to ensure the best possible settlement and protect the captive and the group’s claims experience


Ottawa University - Wisconsin Campus
2000 - 2004
Bachelor's Degree in Communication

Professional Skills

  • Excellent communication skills both verbal and written as well as organizational skills
  • Basic Computer & Microsoft Office skills
  • Responsible for notifying the patient of any significant gaps in coverage and/or high co-pays or deductibles prior to services being rendered
  • Experience as P&C Claims Adjuster
  • Processing in/out going mail, ordering supplies for copiers and office, data entry, training in other positions for back up
  • Responding promptly and accurately to telephone, written, and electronic inquiries from patients, providers, and in-house departments
  • Documenting authorizations or denied authorizations in appropriate systems as per protocol

How to write Insurance Claims Specialist Resume

Insurance Claims Specialist role is responsible for training, insurance, basic, travel, compensation, retail, automation, confident, organization, english.
To write great resume for insurance claims specialist job, your resume must include:

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

Contact Information For Insurance Claims Specialist Resume

The section contact information is important in your insurance claims specialist 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 Specialist Resume

The section work experience is an essential part of your insurance claims specialist 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 specialist 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 specialist position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Insurance Claims Specialist resume experience can include:

  • Partner with Customer Experience and Retail to identify training and/or process changes to limit ongoing claims exceptions
  • Verifying data in support of the public assistance eligibility determination
  • Working with team of 10-12 people
  • Working co-operatively with other teams internally to meet business needs
  • Coordinate and communicate client claims service needs, directing and assisting team members as needed
  • Involvement on Coverage Disputes along with establishing that Claim is being handled in a timely manner through the entire claim

Education on an Insurance Claims Specialist Resume

Make sure to make education a priority on your insurance claims specialist 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 specialist 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 Specialist Resume

When listing skills on your insurance claims specialist 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 specialist skills:

  • Troubleshoot and effectively resolve complex claims; strong research, analytical and problem-solving skills
  • Experience Required: Two (2) years customer service experience or insurance/claims background required
  • Excellent mathematical aptitude
  • Maintain and follow effective controls and processes to ensure risks are measured, monitored and controlled
  • Reviewing case information and preparing it for case disposition by the state eligibility consultant
  • Looking for VERY reliable and track records of great attendance individuals

List of Typical Skills For an Insurance Claims Specialist Resume


Skills For Insurance Policy & Claims Specialist Resume

  • Work with the Customer Care rehabilitation team in promoting and assisting claimants in returning to work
  • Property & Casualty Insurance License or willing to obtain it within one year of hire
  • Responsible for the accurate review, input and adjudication of claims using established payment policies and methodologies
  • Responsible for the identification and proper data entry of insurance detail
  • Prepare and review insurance claim forms and related documents for completeness
  • Make decisions in complex situations, ensure timely disbursement of funds, review policy to determine coverage, etc
  • Proficiency in the use of Microsoft Office programs (Office, Word, Data Entry)

Skills For Business Insurance Complex Workers Compensation Technical Claims Specialist Resume

  • Provide a high level of customer service at all times through the achievement of service standards and an awareness of customer expectations and perspective
  • Investigate all claims within an allocation, reaching a decision, proactively identifying and obtaining all information necessary to the validation of each claim
  • Communicate all claims decisions in a timely and appropriate manner and ensure that communication during the assessment process is regular, timely and clearly documented
  • Contribute to various short-term projects
  • Proficient knowledge of Mod-Master or other claims analysis system
  • Speed, flexibility, adaptability and ability to work under pressure

Skills For Health Insurance Services, Claims Specialist Resume

  • Processes complex and routine medical, dental, hospital and/or disability claims
  • Performs special projects as required
  • Acts as a resource for other claims positions
  • Identifies and reports process and plan management improvement opportunities and recommends changes that improve the quality of service and benefits delivered to participants and beneficiaries
  • Possess a strong work ethic and the ability to work effectively in a team environment
  • Accomplishes work independently with minimal supervision
  • Two years of experience processing all types of group medical, dental and/or disability claims; working knowledge of benefits, claims adjudication principles and procedures, medical and/or dental terminology and codes
  • Develop and own the payment reconciliation of carrier reimbursements
  • Quickly resolve exceptions related to claims submissions (claims that were denied, claims that were not submitted because they were missing information, claims that were not paid in full, etc.)

Skills For Claims Specialist Commercial Insurance Resume

  • Partner with our Managed Care Manager and our EDI Tech Lead to review key exceptions trends, identify next steps, and outline plans to get issues resolved in a more automated fashion
  • Partner with our Managed Care Manager and our EDI Tech Lead to establish and improve metrics related to claims processing and reimbursement (e.g., decreasing the OAT for insurance orders, increasing our claims reimbursement percentage, and decreasing our cash collection period)
  • Reviewing applications submitted
  • Identifying required client data
  • Reviews and analyses each billing cycle to ensure accuracy
  • Researches billing issues. Responds to telephone inquiries and complaints

Skills For Senior Insurance Claims Specialist Resume

  • Obtains supporting documentation when needed
  • Performs analyses and manages the day-to-day operations of the billing process
  • Represents Huntington Insurance as a Claims Expert by staying current of changes and trends within the industry
  • Meetings with the client to review current Claims, Claims Trends as well as providing solutions to help client if trends develop
  • Document correspondence, conversations and tasks in agency systems following agency procedures and workflows
  • Adhere to compliance requirements on an on-going basis

Skills For Insurance Claims Specialist Resume

  • Develop a carrier and customer outreach communications plan, communication protocols, and policies related to claims exceptions
  • Identify possible fraudulent orders and take action to mitigate them
  • Researches unpaid and denied claims to determine course of action
  • Checks the accuracy and completion of routine and complex claim forms
  • Maintains employee benefits records
  • Expert level with excel
  • Maintain and develop product knowledge through participation in educational opportunities

Skills For Insurance Policy & Claims Specialist Resume

  • Acts as a resource for review and suggestions of process improvement
  • Respond to internal and external Claims service inquiries within optimal time frames
  • Take ownership to provide problem resolution and respond to client inquiries in an optimal time frame
  • Reviews Policy for coverages as it pertains to Claims
  • Preparation of loss data analysis, claims reports as necessary for larger, high activity accounts
  • Maintain knowledge of risk-related changes that could impact assigned work functions and processes
  • Assist with the development and implementation of workflow changes required to support corporate initiatives

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