Claim Examiner Cover Letter

In response to your job posting for claim examiner, I am including this letter and my resume for your review.

In the previous role, I was responsible for routine claim support including processing and data verification for Basic Life/Accidental Death & Dismemberment claims.

I reviewed the requirements of the job opening and I believe my candidacy is an excellent fit for this position. Some of the key requirements that I have extensive experience with include:

• Proficient Microsoft Word Skills
• Proficient Microsoft Outlook Skills
• Proficient Query or Business Objects skills
• Proficient knowledge of medical terminology and medical coding
• Documents claim file actions and telephone conversations appropriately
• Refers claim activity outside authority level to Supervisor/Manager for review
• Proactively communicates with claimants, policyholders and physicians to resolve investigations issues
• Utilizes most efficient means to obtain claim information

Please consider me for the claim examiner opportunity. I am including my resume that lists my qualifications and experience.

In the previous role, I was responsible for prompt and courteous handling of escalated and second-level calls routed from the Customer Service representatives including coverage questions, complaints related to benefit decisions and explanations of claim requirements providing clear, concise and accurate information to the caller.

Please consider my experience and qualifications for this position:

• Ensure key risks pertaining to policy servicing and front counter work are proactively identified and remediated
• Interpret GE policy provisions and manually adjudicate GE Death Benefit Transactions to make determinations
• Handles non-routine complex issues pertaining to claims complications and claims processes, escalating where necessary, to ensure application of pertinent policy and action calculation of claims rates
• Ensures incoming documentation from clients and underwriters, guidance and feedback to colleagues are filed to keep documentation organized
• Inspects receipt of documentation by mail or phone to ensure operational excellence and to maintain ongoing and professional communication with insurers, clients, and underwriters to ensure that client and insurer-related materials are catalogued, distributed, and readily available to the team
• Checks claim files and ensures files with missing information are properly flagged and follow up correspondence is sent to insured or other involved persons for missing or supplemental information
• Process, review, and adjudicate life claims in an accurate and timely manner
• Implement case management plan through communication with internal and external customers

Please consider me for the claim examiner opportunity. I am including my resume that lists my qualifications and experience.

Previously, I was responsible for claims technical expertise, claim file leadership & management (technical claims and medium-sized claims, including supervising delegated claims to the Technical Account department) for the India Branch under the target operating model of Global Claims which includes triage and segmentation model for effective claims operations.

Please consider my qualifications and experience:

• Collaborates with team members and management in identifying and implementing improvement opportunities
• Deliver superior customer service and satisfaction through effective interactions with insureds, claimants, agents, underwriters, and others
• Contribute to collaborative environment by consistently demonstrating teamwork, high motivation, behavior and effort to achieve goals and objectives
• Provide accurate and timely expense and loss assessments on Medical Only claims
• Timely and appropriately communicate with internal and external customers
• Consistently demonstrate fundamentally sound claim handling by achieving compliance in the areas of investigation, coverage, loss assessment, and case management
• Recognize and properly address coverage issues, potential fraud, and subrogation
• Keep all files on a current diary system in order to monitor new developments, follow up on requests, update management and respond to all other diary activities in a timely manner

I submit this application to express my sincere interest in the claim examiner position.

Previously, I was responsible for claims technical expertise, claim file leadership & management (technical claims and medium-sized claims, including supervising delegated claims to the Technical Account department) for the Beijing Branch under the target operating model of Global Claims which includes triage and segmentation model for effective claims operations.

My experience is an excellent fit for the list of requirements in this job:

• Interpret policy provisions and adjudicates Group Life claims to make claim determinations
• Respond to written and verbal inquiries from policyholders, beneficiaries, attorneys, and families of deceased employees
• Manage and organize work to meet multiple deadlines and competing priorities to ensure department metrics are met including turnaround, productivity, customer satisfaction and quality
• Assist in policy drafting / product development and coverage inquiries from underwriters and producers
• Collaborate and communicate with related internal and external stakeholders to ensure that the claim paid upon fulfillment of premium payment and to ensure the claim payment will be paid timely and accordingly
• Follow up claim recovery (subrogation’s and salvage)
• Explore opportunity for process improvement / efficiency / innovation
• Support and involve in company initiatives

Please consider me for the claim examiner opportunity. I am including my resume that lists my qualifications and experience.

In my previous role, I was responsible for exceptional service while investigating, evaluating, and resolving first party medical claims (No Fault - MedPay).

I reviewed the requirements of the job opening and I believe my candidacy is an excellent fit for this position. Some of the key requirements that I have extensive experience with include:

• Handles telephone inquiries from policyholders, beneficiaries, attorneys and families of deceased employees
• Maintain strong client focus by aggressively and proactively researching issues, providing support, and assuring client satisfaction in a timely fashion
• Support Underwriting team needs for claim information and consultation on coverage
• Set and maintain appropriate and timely indemnity and expense reserves
• Conduct claim reviews as necessary
• Interact with internal and external clients related to claim matters associated with assigned accounts
• Identifies claim and underwriting issues that might affect the claims process or administrative services
• Establishes, monitors and updates system with appropriate reserves or reserve assumptions