Claims Adjuster Resume Samples

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C Ondricka

Concepcion

Ondricka

27414 O'Reilly Fork

Dallas

+1 (555) 262 1374

27414 O'Reilly Fork

Dallas

Phone

p +1 (555) 262 1374

Experience Experience

Phoenix, AZ

Claims Adjuster

Phoenix, AZ

Kuvalis Group

Phoenix, AZ

Claims Adjuster

Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments
Analyse loss and expense trends on loss portfolios and assist in the development and implementation of plans to improve results
Work with Team Manager/Senior Adjuster to ensuring effective vendor and litigation management on Complex claims within a personal allocation
Develop strong relationships with body shop owners, managers and technicians
Act as point of contact for shop relations, develops relationships with owners, managers and technicians
Make total loss determinations and establishes total loss evaluations
Developing excellent working relationships with applicant attorneys

Houston, TX

Casualty Claims Adjuster

Houston, TX

Hoeger-Kub

Houston, TX

Casualty Claims Adjuster

Work with and provide claim-specific guidance to Field Adjuster
Work with and provide claim-specific guidance to Field Adjusters
Select and manage experts with limited input from supervisor
Meet detailed quality assurance standards of performance
And maintain professional and technical knowledge through continuing company provided industry best education
Revise case reserves based on developments in the course of adjusting the claims
Interact successfully with co-workers

present

Philadelphia, PA

Senior Claims Adjuster

Philadelphia, PA

Howe LLC

present

Philadelphia, PA

Senior Claims Adjuster

present

Establishing timely reserves and performing ongoing reviews throughout the claims-cycle by estimating and validating the value of claims
Supporting Underwriting teams and key stakeholders in connection with claim trends, marketing and business development
Recognized as an internal resource providing technical guidance, assistance, and training to lower level associates
Determines value of the claim considering depreciation and actual cash value, negotiates and commits to the settlement, and moves claim to closure. Resolves complaints, and participates in arbitration and/or grievance procedures
Creates and documents claims file to comply with company guidelines and state regulations
Processing mail and prioritizing workload
We highly value the relationships we have with our brokers and you will be responsible for maintaining and developing such relations on the claims side

Education Education

Bachelor’s Degree in Accuracy

University of Tennessee

Bachelor’s Degree in Accuracy

Skills Skills

Adaptable to change, able to operate effectively in a highly evolving environment
Proficient in basic computer skills, including proficiency in using claims and estimating systems
Ability to grasp and apply technical knowledge, including litigation case management and adjusting skills
Ability to manage complex and highly confidential information
Excellent social skills, able to operate with diplomacy
Excellent interpersonal skills, including listening, verbal and written communication with the ability to communicate effectively
Good attention to detail
Strong analytical and mathematical ability
Proficient in basic computer skills
Good communication skills (verbal, listening, writing), including the ability to deliver difficult messages to customers and/or claimants

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General Liability Claims Adjuster Resume Examples & Samples

Daily receipt, review and contact of new claims entered into our internal claims software system
Management of non-litigated claims to include investigation, determination of Medicare eligibility, liability evaluation and settlement in accordance with General Liability Claims Handling Guidelines
Routine communication with store and regional team members, guests and/or legal representative via routine telephone calls and written correspondence
Obtaining, reviewing and evaluating medical bills, records and/or damage estimates for routine claims selected and assigned by Claims Adjuster for market
Maintaining routine diary (30 – 45 days) per the company’s adjuster guidelines to include, but not limited to: the documentation of initial 24 hour telephone contact; the documentation of all conversations and evaluations in notes; the documentation of reserves; the documentation of Medicare beneficiary; the documentation of proper reserve/settlement authority; and, the daily documentation of all contacts/required actions /status related to claim
Working with insurance carriers and third party contractors to transfer risk based upon contractual obligation; obtaining written acceptance; and/or, subrogating claims that we settled on behalf of a vendor or other third party contractor
3+ years of General Liability Claims Holding and/or Customer Service experience
Experience handling claim across multiple jurisdictions
Knowledge of civil torts to provide documented liability and damage evaluations
Exceptional negotiation skills
Solid time management and problem-solving skills
Bachelor's Degree in Business and/or Risk Management

CGL Claims Adjuster Resume Examples & Samples

Fully responsible for the analysis, investigation, evaluation and resolution of product liability claims involving bodily injury and property damage
Ensure claim files are appropriately documented and claim coding is accurate in the claim handling software
This position requires timely communication with Electrolux consumers, servicers and vendors via phone and email
Proactively manage relationships with third party administrators, independent adjusters, cause and origin experts, etc
Manage subrogation of claims and negotiate settlements
Communicate product liability trends to management
Proficient using various claims software and programs (STARS, ISO, Xactimate) is a plus
Professional insurance designation a plus. (CPCU, AIC, ARM, SCLA, etc.)
Ability to function independently as well as in an environment of teamwork and collaboration.Analytical skills and ability to establish strategies to resolve claims
Operates with a sense of urgency
Positive, can do attitude

Entry Level Claims Adjuster Resume Examples & Samples

Investigating, evaluating, and negotiating claims, in order to reach a fair and equitable settlement
Working well with others in a fast-paced, collaborative environment
Military candidates encouraged to apply

Inside Claims Adjuster Resume Examples & Samples

Four-year college degree preferred, plus one year experience delivering outstanding customer service
Strong organizational and computer skills
Ability to be a self-starter and work independently

Claims Adjuster Resume Examples & Samples

Evaluate damages and pay benefits as prescribed by law and/or Marriott policies and procedures
Secure necessary documentation to facilitate timely loss adjustment and maintain primary responsibility for settlement decisions up to individual authority
Minimum of 18 months claims adjusting experience
Ability to grasp and apply technical knowledge, including litigation case management and adjusting skills
Effective reasoning, analysis and decision making skills
Ability to prioritize work
Good communication skills (verbal, listening, writing), including the ability to deliver difficult messages to customers and/or claimants

Senior Claims Adjuster Resume Examples & Samples

Investigate claims promptly – taking statements as necessary – to determine liability/compensability
Monitor and actively manage WC medical treatment with the goal of minimizing disability. Consult Occupational Health Services as necessary
Participate in the Service Call Program and complete required Service Call reports detailing current case status
Manage increased settlement authority, beyond that of a Claims Adjuster II
Self-supervise on select cases
Manage more complex cases
Minimum of 3 years claims adjusting experience
Exhibit leadership, management and teamwork skills
Ability to meet quality and production standards
Strong hospitality skills
Possess a willingness to accept and respond positively to constructive criticism
Present oneself with a positive, professional demeanor
Communicate often with supervisor keeping him/her informed

Claims Adjuster Resume Examples & Samples

Manage litigation cases including controlling/directing outside attorneys, assisting in discovery/trial preparation and strategy; attend/monitor trials when applicable
Strong time-management skills
Intermediate knowledge of claims process

Senior Claims Adjuster Resume Examples & Samples

Investigate, evaluate and dispose of claims promptly – taking statements as necessary – to determine liability/compensability
Participate in and/or facilitate the Service Call Program and complete required Service Call reports detailing current case status
Self-manage select cases as directed by immediate supervisor
Administer claims of a more complex/high exposure nature
Minimum of 2 ½ years claims adjusting experience
Very good investigation skills

Liability Claims Adjuster Resume Examples & Samples

Summarizes documents and enters into claim system notes
Coverage, Liability and Evaluation
Determines applicable coverages in basic claims involving a single claimant and determines applicable coverage limits in basic claims involving multiple claimants
Negotiation and Settlement Guidance

Claims Adjuster Resume Examples & Samples

Analyzing, investigating and determining compensability
Establishing coverage and eligibility based on legal interpretation of employment, relationship, course and scope, and causation
Setting reserves
Identifying third-party liability and fraudulent claims
Calculating average monthly wage using the HRIS system to determine hourly rate and days worked and completes an excel report with findings; coordinates the activities of nurse case managers, attorneys, subrogation specialists, etc.,
Assigning cases to outside investigators, adjusters, vocational rehabilitation, attorneys, and other medical professional disciplines
Ensuring accurate and timely claims management and achieve positive and measurable results
Monitoring the paperless system, ViewCenter, for receipt of new information, updates the ViewCenter accordingly and updates the Envision system as appropriate
Monitoring changes to injured worker's diagnosis to ensure ICD codes are current for Medicare purposes
Signature Authority for this position is $10,000
With approval, settling a claim or lawsuit up to $250,000 and in excess of $250,000
Arizona's Workers' Compensation laws, rules and regulations, and claims management practices
Early return to work programs, medical and insurance terminology, ADA and disability management
Managed care environment, information systems/database for claims management
The operations of state government
"Litigation management" as necessary to adjust claims
Subrogation procedures, investigation techniques, and insurance coverage and adjusting principles
Legal principles and concepts
Reporting requirements for Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of 2007Arizona Revised Statutes, Arizona Administrative Code, Executive Order, and judicial protocol, intergovernmental agreements, contract law, investigations, and discovery procedures associated with litigation management and claims handling, confidentiality and preservation of evidence
Must be able to prepare detailed reports and plan of action on claims
Communicate and work well with top level agency personnel
Evaluating information from physicians
Active listening and reading comprehension
Negotiating with plaintiff attorneys
Organizational skills in order to balance caseloads
Investigative techniques; in calculating reserves, negotiating compromises and settlements
Customer service and time management
Analyzing, evaluating, research, organization and prioritization skills
Report status of investigations and research
Recognize and evaluate potential hazards, make appropriate recommendations and influence decisions that will result in a reduction of exposures
Handle confidential information with tact and discretion
Receive and understand complex data
Investigate and evaluate facts relating to claims
Negotiate and settle claims within authority level
Speak and write effectively at all levels and to various audiences
Efficiently and accurately use computers that relate to the position
Maintain good working relationships
Manage varied responsibilities with accuracy and speed under the pressure of time sensitive deadlines

Unrepresented Casualty Claims Adjuster Resume Examples & Samples

Researches and responds to moderately complex customer communications, concerns, conflicts or issues
Documents a claim file with notes, evaluations and decision making process
Takes recorded statements from claimants, insureds, witnesses, medical providers, etc., conducts investigations into moderately complex auto accidents, determines liability, and prepares summaries
Reviews medical reports in preparation for claims settlement evaluation
At least one year of claim handling exprience highly preffered. Bodily injury experience a plus
Persistence and the ability to work through and solve problems

Claims Adjuster, Risk Mgmt Resume Examples & Samples

Investigate claims promptly – taking statements as necessary – to determine liability/compensability
Evaluate damages and pay benefits as prescribed by law and/or Marriott policies and procedures
Secure necessary documentation to facilitate timely loss adjustment and maintain primary responsibility for settlement decisions up to individual authority
Complete and monitor timely WC payments/state filings
Monitor and actively manage WC medical treatment with the goal of minimizing disability. Consult Occupational Health Services as necessary
Manage litigation cases including controlling/directing outside attorneys, assisting in discovery/trial preparation and strategy
Evaluate claims for potential third party or subrogation recovery
Participate in the Service Call Program and complete required Service Call reports detailing current case status
Minimum of 18 months claims adjusting experience
Ability to grasp and apply technical knowledge, including litigation case management and adjusting skills
Effective reasoning, analysis and decision making skills
Effective influence skills
Strong hospitality skills
Demonstrate strong leadership abilities
Ability to meet deadlines and follow up in a timely manner
Good communication skills (verbal, listening, writing), including the ability to deliver difficult messages to customers and/or claimants
Good investigation skills
Basic knowledge of claims process
Strong computer skills
Ability to work well in a team, providing assistance to fellow associates and representing the mission of the unit
Possess a willingness to accept and respond positively to constructive criticism
Present oneself with a positive, professional demeanor
Communicate often with supervisor keeping him/her informed
Show dependability

Experienced Represented Casualty Claims Adjuster Resume Examples & Samples

Evaluates and determines potential use of experts; reviews reports and participates in selecting the expert
Determines claim value
Prior Casualty Claim handling experience preferred and experience working with attorneys is a plus
Strong organization skills and the ability to work independently
Bilingual candidates are encouraged to apply
Ability to interact effectively, and coach other on interacting effectively, with internal or external customers and act with empathy

Claims Adjuster Resume Examples & Samples

Reviews claims and makes payment determination with authorization limit to $9,999 per claim
Conducts research regarding medical appropriateness, coordination of benefits issues, fraud and abuse, and third party liability
Checks with lead and supervisor for any claim exceeding $9,999
Provides input to Supervisor regarding trends related to training, education to enhance department production and processes
Utilizes knowledge of government regulatory policies and procedures to ensure compliance with government regulations including but limited to CMS, DMHC, DHS and requirements of accrediting agencies such as NCQA
Proactively works to ensure claims are review & processed timely
Three (3) to five (5) years Medical claims processing experience in a HMO/Indemnity environment including technical research and analysis experience

Medical Payment Claims Adjuster Resume Examples & Samples

Achieve optimal customer satisfaction
Prior Medical billing and coding experience preferred
Advanced verbal, written, and telephone communication skills
Extensive negotiation skills
Full knowledge of Microsoft Office Suite
Moderate decision making responsibility
Ability to provide claim handling assistance to other unit members

Entry Level Medical Payment Claims Adjuster Resume Examples & Samples

Process bill payment according to state statutes
Completion of a Bachelor’s degree preferred
Prior Medical billing and coding experience is preferred, or claims experience is a plus
At least two years of prior customer service experience is required
Ability to organize workflow and manage claims in a timely and productive fashion
Schedule availability to work shifts within the business hours of 7:00AM-7:30PM and a rotational full day Saturday shift from 8:00AM-4:45PM

Claims Adjuster Specialist Resume Examples & Samples

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
General office equipment experience (i.e. photocopier, fax, calculator, ability to operate a PC and previous exposure to the Microsoft Windows environment)
Must have an excellent understanding of health and managed care concepts and their application in the adjudication of claims
Minimum of one year experience handling provider disputes/appeals preferably in a PPO, self-funded, and/or HMO setting preferred

Entry Level Medical Payment Claims Adjuster Resume Examples & Samples

Bill payment according to state statutes
One year of prior customer service experience required
Prior Medical billing and coding experience highly preferred
Prior RHIT and/or CPC Certification highly preferred

Senior Liability Claims Adjuster Qual-lynx Resume Examples & Samples

Understand concepts of coverage, policy interpretation, exposure recognition and liability determination to analyze and move claims toward resolution using Best Practices
Promptly investigate all assigned claims for coverage, liability assessment and damages
Investigate claims by interviewing claimants and witnesses, establish claim reserves, handle evidence, obtain evidence, obtain and interpret official reports and claim forms
Negotiate and settle claims, set reserves and manage litigation within client service parameters and authority levels by obtaining demands and making offers to claimants
May present evidence at legal proceedings
Direct appraisal and/or inspection of damaged property
Dispose of salvage and pursue subrogation when appropriate
Report all serious injuries/liability issues and potential large loss claims to the client and/or reinsurer based upon the criteria provided by the client
Document plan of action in the claim system and set appropriate diaries
Manage diary and complete tasks to ensure that cases move to the best financial outcome and timely resolution
Close all files as appropriate in a timely and complete manner
Maintain closing ratio as directed by management team
Attend/participate at mediation, trials or hearings
Routinely interact with clients, claimants, attorneys, investigators, experts and other vendors

Claims Adjuster Resume Examples & Samples

Make total loss determinations
Act as point of contact for shop relations, develops relationships with owners, managers and technicians
Provides continued updates to customers on the repair process
Bachelor's degree and one year of work experience in the automotive repair or insurance industry
In lieu of a degree, a total of five years of work experience, some of which must be in the automotive repair or insurance industry and must include
Paid training, tuition assistance and career development

Claims Adjuster Resume Examples & Samples

Decides coverage and liability issues
Estimates cost of treatment or compensation for those injured in accidents
Negotiates with customers, other insurance carriers, claimants or attorneys to settle claims
Annual Gainshare bonus of up to 16% of your salary! Progressive rewards each of us with an annual bonus based on company performance
Bachelor's degree and a minimum of 1 year injury claims handling experience
In lieu of a degree, a minimum of 2 years injury claims handling insurance experience
Demonstrated skills as a Claims Adjuster-Bodily Injury non-attorney represented
Effective team player
Knowledge of automobile damage and mechanics of injury
Ability to negotiate face to face or over the phone

Claims Adjuster Resume Examples & Samples

Interprets policies and analyzes details gathered to determine the best course of action
Gathers details on status and treatment needed of those injured in an accident
In lieu of a degree, a total of five years of work experience, some of which must be claims handling in the insurance industry and must include

Claims Adjuster Trainee Cincinnati Resume Examples & Samples

Cincinnati
Dayton
Bachelor's degree or 5 years of relevant work experience and/or postsecondary education

Claims Adjuster Specialist Resume Examples & Samples

Negotiates with attorneys to settle bodily injury (BI) claims
Determines liability (who’s at fault for the damages)
Interpret medical reports, follow-up with no fault parties and manage claims process to ensure efficient resolution
Bachelor's degree and one year of work experience in the insurance industry
Annual gainshare bonus of up to 16% of your salary; Progressive rewards each of us with an annual bonus based on company performance
Competitive salary and paid training
Potential for flexible work arrangements
Continued career development with tuition assistance
Inclusive culture with Employee Resource Groups

Field Claims Adjuster Resume Examples & Samples

Minimum of one year face-to-face customer service experience
Associate/Bachelor’s degree
Knowledge of construction basics
Claims adjusting experience with property claims experience preferred
Strong listening, problem solving, and negotiating skills
Poised and professional demeanor

Bodily Injury Liability Claims Adjuster Resume Examples & Samples

Three years of bodily injury liability claims handling experience
Excellent verbal and written communications skills and ability to draft business-level communications when responding to customers
Proven ability to work independently with minimal supervision to manage schedules and meet deadlines
Ability to type a minimum of 40 wpm
Detail oriented with a commitment to excellence

Claims Adjuster Resume Examples & Samples

Three years of property claims adjusting experience
Demonstrated proficiency with Microsoft Office and the ability to navigate and enter data on multiple screen
Bachelor’s degree highly preferred
Proven organizational and multi-tasking ability with an ability to adapt quickly in a fast-paced work environment

Claims Adjuster Levels Resume Examples & Samples

Clearly explain decisions on liability, negotiating settlement within authority level where appropriate
Support, train and develop less experienced staff
Detailed understanding and knowledge of general insurance principles
Detailed understanding and knowledge of legal liability principles and legal process

Claims Adjuster Levels Resume Examples & Samples

Assist in general office administration (eg post, printing, order supplies, maintaining equipment) to ensure smooth running of office.Comply with all GB and office procedures
Basic understanding and knowledge of general insurance principles
Basic understanding and knowledge of legal liability principles and legal process
Basic understanding and knowledge of all company specific procedures, including Service Instructions and Adjuster’s Manual
MS Excel (Advanced Level)
MS Access (Intermediate Level)

Motor Claims Adjuster Levels Resume Examples & Samples

Review and record claims on Risxfacs within product standards, check policy coverage and allocate appropriate codes and reserves
Evaluate quantum by gathering relevant evidence, adjusting reserves in accordance with GB realistic reserving philosophy
5 - 10 years experience in a similar role

Senior Complex Bodily Injury Claims Adjuster Resume Examples & Samples

Communicates with policyholders, witnesses, and claimants in order to gather information regarding claims, refers tasks to auxiliary resources as necessary, and advise as to proper course of action. Responds to various written and telephone inquiries including status reports
Responsible for managing the practices and billing activities of outside and in-house counsel
Strong written and oral communication skills required as well as strong interpersonal, analytical, investigative, and negotiation skills

Senior Bodily Injury Claims Adjuster Resume Examples & Samples

Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages
Evaluates claims for potential fraud and makes referrals to the Special Investigations Unit as appropriate
Strong interpersonal, analytical, negotiation and investigative skills required
Strong competency of legal liability, general insurance policy coverage and State Tort Law
The capabilities, skills and knowledge required is normally acquired through a Bachelor's degree or equivalent experience and at least 3 years of directly related experience

Bodily Injury Claims Adjuster Specialist Resume Examples & Samples

Prepares for and attends trials, hearings and conferences and reports to Home Office and local management on status. Confers with trial counsel and prepares trial reports
Strong written and oral communications skills required
The capabilities, skills and knowledge required is normally acquired through a Bachelor's degree or equivalent experience and at least 2 - 3 years of directly related experience

Claims Adjuster Resume Examples & Samples

Deliver a high quality, cost effective claims service to customers
Ensure effective and prompt settlement of claims in specialist areas
Promptly handle and positively resolve all enquiries from both customer and external contacts to ensure delivery of a focused claims service
Handle and execute all allocated claims workload in accordance with the companies laid down service standards
Communicate effectively with Underwriting team prior to either confirming or declining cover
Understand the coverage provided by the Pen Inc. OAMPS Scheme Policies
Additionally
Handle referrals/queries from Admin Assistants
Operate within the confines of the agreed personal delegated claims authority as defined
Assist other departmental staff with their allocated workload at the behest of the department manager, particularly in times of staff absence
Utilise company preferred insurance pool
Liaise with Insurers
Comply with AJG Professional Standards Manual in accordance with statutory requirements for role with specific attention, but not limited to Whistle Blowing, Treating Customers Fairly
Knowledge of market practices in settling third party claims, AD and total loss claims
Understand the principals and practice of insurance, specifically relating to motor and non-motor insurance as applicable
Effective use and understanding of technology required to transact business
Knowledge of MID procedures and requirements as applicable
Previous claims handling experience preferred
Excellent social skills, able to operate with diplomacy
Numerate with the ability to present and analyse data

Extended Handling Claims Adjuster Resume Examples & Samples

Investigate and evaluate claims using a lowest ultimate cost strategy
Negotiate timely and appropriate settlements with claimants, insureds and attorneys and issue appropriate payments
Recognize recovery opportunities in regards subrogation and salvage
Make offers to settle injury claims at first contact when appropriate and within company guidelines
Effective verbal and written communication, time management, negotiation, organization and investigative skills

Claims Adjuster Level Resume Examples & Samples

Recognize excess exposures and effectively communicate verbally and in writing to the insured(s)
Recognize potential exposure of injury and the ability to reach a settlement during the first contact
Establish and maintain appropriate diary of open claims following company guidelines
Minimum 2 years property claims handling experience
Proficient PC and Windows skills
Ability to perform basic math calculations (addition, subtraction, multiplication, and division) as well as the calculation of averages and percentages

Claims Adjuster Resume Examples & Samples

Annual Gainshare bonus of up to 24% of your salary! Progressive rewards each of us with an annual bonus based on company performance
Bachelor's degree and a minimum of 2 year injury claims handling experience
Ability to multitask and prioritize
Proficient in use of evaluating systems
Knowledge of the rules of civil procedures in terms of filing/answering suit, discovery deadlines, and venue
Knowledge of the rules of evidence, case law and significant rulings in the state
Some travel required both within local area and several outside counties
May work more than 40 hours a week

Senior Bodily Injury Claims Adjuster Resume Examples & Samples

Ensures adequacy of reserves. Recommends reserve increases on cases in excess of authority
May assist in the absence of the Claims Team Manager, representing the company on matters involving state or federal regulatory agencies. May be involved in special projects and/or mentoring at the direction of local management
Must be knowledgeable of state and federal laws in the adjuster's jurisdiction
A full working knowledge of claims operations and procedures is required

Claims Adjuster Resume Examples & Samples

Use strong customer service skills to negotiate with policyholders to settle the claim
Review vendor invoices for accuracy and identify potential fraud activity
Utilize your negotiation skills in dealings with contractors and vendors
Collaborate with claim representatives and program vendors
Contact customers and vendors by phone and e-mail
Identify how coverage applies to a particular loss
Enjoy interacting with a wide variety of people including policyholders, claimants, agents, witnesses, and fraud investigators

Outside Casualty Claims Adjuster Resume Examples & Samples

Examines claims forms, policies and endorsements
Prepares reports by collecting and summarizing information required by client
Settles claims by determining insurance carrier’s liability, client’s instructions and authority levels
Recommends litigation when appropriate

Associate Claims Adjuster Resume Examples & Samples

Review factual information to determine coverage and/or liability of all parties to the claim
High school diploma/GED; Bachelor’s degree preferred
Excellent time management skills and attention to detail

Associate Field Claims Adjuster Resume Examples & Samples

Have strong customer service skills
Self-Motivated
Work independently with little supervision
Organizational skills to effectively prioritize work
Analytical and problem solving skills necessary to make decisions and resolve conflict
Valid driver's license with a safe driving record
Knowledge of residential construction
Must be able to make physical inspections of property loss sites
Must be able to climb ladders, balance at various heights, stoop, bend and/or crawl to inspect structures
Must be able to work out-of- doors in all types of weather and extended and/or non-standard hours as required

Claims Adjuster, General Liability Resume Examples & Samples

Conducting telephone interviews/investigations with customers, store associates and witnesses relating to customer accidents
Researching and assessing legal liability and estimating potential financial exposure
Analyzing and summarizing medical records, bills and other claim documentation
Development of claim values, negotiating points and strategies for resolution
Proactively negotiating resolutions with customers and attorneys and processing related legal paperwork
1-2 years prior liability claims adjusting experience preferred
Prior experience with negotiations beneficial
Ability to read, write, and interpret instructional documents and reports
Prior success in providing excellent customer service in a professional environment
Ability to conduct interviews, gather investigative information, summarize findings, and write reports and letters
Ability to diffuse adversarial discussions
Must have above average mathematical skills, including the ability to compute rates, ratios, and percentages, and the ability to work with mathematical concepts such as probability and statistical inference
Must possess problem solving, critical thinking and decision making skills; Demonstrated ability to overcome obstacles in order to gather sufficient information to make sound decisions
Ability to maintain focus on completing job requirements during stressful situations
Proficient with Microsoft Office products (Word, Excel, etc) and Outlook; Adhere to Best Practice Standards

Claims Adjuster Resume Examples & Samples

3+ years of casualty claims handling experience preferred
Proficiency with typing and computer skills required
California claims handling experience is a plus
Non-standard auto experience is a plus

Senior Claims Adjuster Resume Examples & Samples

Interviews insureds, claimants and other parties to determine the facts of the claim
Creates and documents claims file to comply with company guidelines and state regulations
Reviews factual information to determine coverage and/or liability of all parties to the claim
Determines value of the claim considering depreciation and actual cash value, negotiates and commits to the settlement, and moves claim to closure
Bachelor’s Degree of equivalent business experience
3-5 years related business experience

Claims Adjuster, License Resume Examples & Samples

Knowledge of legal liability related to workers' compensation
Excellent research and investigation skills
Demonstrated attention to detail with excellent organizational and prioritization skills

Claims Adjuster Resume Examples & Samples

Ability to analyze data and reports for trends, pattern analysis and financial exposure
High level of knowledge of the worker's compensation industry and claims processes, reporting and regulatory requirements
Ability to clearly express and synthesize case facts, decisions and rationale
Maintains confidentiality as well as a high degree of professional integrity

Claims Adjuster Resume Examples & Samples

Knowledge of legal issues and liability related to workers' compensation injuries
Excellent research and investigative skills
Ability to clearly express and synthesize case facts, decisions, and rationale

Claims Adjuster Senior Resume Examples & Samples

Investigate, analyze and determine Progressive’s liability concerning loss or damages
Investigate claims including multiline losses involving motorcycle, watercraft, recreational vehicle, mobile home, snow mobile or commercial vehicles
Minimum 5 years prior Multiline/Special Lines estimating experience, which must include

Senior Claims Adjuster Resume Examples & Samples

Paid training, tuition assistance and career development
Diverse, welcoming culture with Employee Resource Groups
Wellness program with discounts & rewards
Earning paid time off after first two weeks and the standard benefits (medical, dental, vision, 401k)
5+ years of related work experience in a repair facility handling commercial vehicles, truck dealership, or body shop management or comparable commercial insurance adjusting experience
Excellent organization, problem-solving and creative resolution skills
Self-motivated, ability to work independently
Proficient in use of physical damage estimating systems
Mechanical aptitude including knowledge and hands-on experience related to commercial vehicle repairs

Claims Adjuster Summer Intern Resume Examples & Samples

Receive new claim calls, enter the claim into our automated system, and assign them to the appropriate Claim Adjuster. Follow-up for additional information as needed. File initial Bodily Injury indexes. Monitor new losses with unpaid premium or other coverage issues and set up in a timely fashion as coverage becomes available
Process and handle low severity claims to include limited investigation, composing of correspondence, processing of payments and creation of diary for follow-up
Review all incoming mail through our paper-less imaging system. File and import emails, letters and other correspondence received from outside sources for low severity claims they handle (Claim Adjusters handle most of their own imaging)
Respond to agent status requests and handle routine inquiries from others such as claimants, insureds, and agents
Special projects and perform other duties as assigned which will provide the student with additional experience
Currently in their Junior or Senior year of college
Majoring in Risk Management and Insurance, or Finance, or other business major concentration, or Criminal Justice
Serious about considering a career in Commercial Insurance
Cumulative GPA of 3.0 or greater preferred
Problem-solving and analytical skills
Proficient with spreadsheet and word processing software
Attributes we seek include: excellent relationship builder; open-minded and team-oriented with collaborative work style; flexible mindset; and ability to thrive in a dynamic environment

Senior Claims Adjuster Resume Examples & Samples

This role focuses on the handling of North American losses which are predominately healthcare and lifescience based.We are a recognized Lloyd’s lead market for Healthcare risks and as such you will handle the majority of these claims on a Lead basis, with responsibility for setting reserves and strategy
We highly value the relationships we have with our brokers and you will be responsible for maintaining and developing such relations on the claims side
You will be responsible for the management and oversight of any TPA’s ensuring that they meet the XL Catlin standards. You may be required to perform onsite audits
The Claims Service we offer is a key differentiator between us and our competitors – therefore you will be required to attend Client meetings, and Industry Conferences alongside Underwriters, in order to help sell and market the XL Catlin claims proposition. You may also be required to give presentations at these events outlining the claims commitments, and describing the service Clients can expect to receive when they purchase an XL Catlin policy
We undertake to understand the nature of a new claim as quickly as possible to ensure that there are no surprises, and within that establishing the potential exposure of a claim and communicating this to appropriate stakeholders is key. You will be responsible for recognising at the earliest opportunity what XL Catlin’s possible and likely financial exposure will be on any large loss
Our insurance policies are bespoke to our Clients and every policy is different. It will be your responsibility to undertake and document coverage analysis on these cases, and undertake the necessary enquiries and investigations with our Underwriters
Ensuring the right investigation method is used, and managing the cost of that is important to us. You will be responsible for conducting & overseeing loss investigations, ensuring that the appropriate investigative method is used at the right cost, utilising the right people
Our larger losses can have a major effect on XL Catlin’s financial performance. As such being able to establish and update reserves in line with our reserving philosophy will be a key responsibility. You will ensure reserves on your cases are accurate at all times and changes communicated to appropriate stakeholders
We consider strong claims skills revolve around an early settlement strategy. In your role you will devise, implement and document a settlement strategy with the collaboration and assistance of other relevant stakeholders. You will also be responsible for revising that strategy as matters progress and thinking of alternative methods to resolve the claim
Being responsible for your cases is of paramount importance and you will maintain accountability for all assigned claims until resolution is reached
We expect our handlers to collaborate with others so that we can share views, knowledge and experiences with the aim of achieving quality outcomes on our cases. Additionally we seek to provide information to our internal and external customers on claims to assist them with their roles in the insurance process. A key responsibility will be to seek appropriate guidance and authorisation if the settlement value exceeds personal or file authorisation limits and be able to report to various stakeholders by a variety of methods to ensure that this authorisation is obtained
Technical Knowledge: Significant experience of working in a liability claims environment. Have extensive knowledge of US claims, both primary and excess, Lead and Follow. US Medical Malpractice / Healthcare / Life Science experience highly desirable. We would be willing to consider high calibre candidates who do not meet all these criteria, but who possess transferable knowledge i.e. UK/international healthcare and/or lifescience experience, extensive US casualty experience etc
Strategic Thinking: Early identification of exposure, ability to plan and consider a resolution strategy, identify and implementing variances in strategy, the ability to find pragmatic business solutions
Mental Agility: Innovative thinker, inquisitive mind, willing to turn ideas on their head. Bright and can handle highly complex situations. Show the ability to investigate, question, explore and innovate. Be able to question stakeholders, discuss alternative views and agree a strategy
Strong Communication: Strong oral and written communication skills. Be able to present views in a professional way to a variety of stakeholders who have differing needs with regard to content and level of detail. Be able to formally present to a group, either internally or externally and express views concisely, accurately and with conviction
Market Awareness: Demonstrable experience and knowledge of dealing with other industry parties, a good market network and being able to show market intelligence
Collaboration: Sharing knowledge, showing a team approach to claims settlements, involving as required internal and/or external stakeholders in information exchange
Ability positively to sell: the XL Catlin Claims Service to Brokers and Clients, either individually or as part of a combined marketing strategy with Underwriters
Wllingness to travel: to industry conferences, key client meetings or audits when required, and in order to support other functions of the business such as Delegated Authority or Quality Assurance
Credentials: ACII qualified or equivalent, educated to degree level. Significant technical claims handling experience
Be able to handle claims via ECF, and internal claims systems
Passion for results: Work tenaciously to achieve outstanding results. Set high standards for self and others. Act with a sense of urgency

Field Claims Adjuster Resume Examples & Samples

Assess vehicle damage and controls the damage repair process
Act as point of contact for shop relations, develops relationships with owners,
Bachelor's degree and one year of work experience in the automotive repair or

Senior Claims Adjuster Resume Examples & Samples

Licensed adjuster (as appropriate by jurisdiction) or qualified to sit for licensing exam following at least 1 year in house training
Minimum of 3 years claims management experience
Thorough knowledge of legal procedures and processes involved in handling claims
Thorough knowledge of rules, regulations, statutes and procedures pertaining to workers' compensation and general liability claims
Knowledge of coaching principles and practices
Knowledge of medical terminology involved in complex claims
Knowledge of customer relations principles and techniques
Ability to follow legal procedures and processes in the handling of complex claims
Ability to mentor less experienced associates

Commercial Lines Claims Adjuster Resume Examples & Samples

Earning paid time off after first two weeks and the standard benefits (medical, dental, vision, 401k)
Annual Gainshare bonus of up to 24% of your salary! Progressive rewards each of us with an annual bonus based on company performance
5+ years of related work experience in a repair facility handling commercial vehicles, truck dealership, or body shop management or comparable commercial insurance adjusting experience
Self-motivated, ability to work independently
Proficient in use of physical damage estimating systems

Claims Adjuster Commercial Lines Resume Examples & Samples

Paid training, tuition assistance and career development
Annual Gainshare bonus of up to 16 of your salary! Progressive rewards each of us with an annual bonus based on company performance
Bachelor's degree or a combined total of five years of work experience and/or college education
Two or more years prior experience working in a claims environment required, auto claims experience preferred
Ability to multi-task and prioritize
Ability to think critically and problem solve
Ability to quickly build rapport and successfully effect settlements
Excellent negotiating skills
Excellent organization and problem-solving skills

Claims Adjuster Resume Examples & Samples

Identify and assess related and unrelated (prior) auto damage and set clear expectations on timeline for repairs and outcome
Inspect vehicles and write estimates, documenting claim related information and making decisions consistent with claims standards and local laws
Complete timely estimates, documenting updates
Make total loss determinations and establishes total loss evaluations
Develop strong relationships with body shop owners, managers and technicians
Stay connected with customers, providing timely updates on repair process
Evaluate and handle payments of claims and resolution of claims without payments
Review and determine validity of any supplement requests
One year in the automotive repair/appraisal or insurance industry
Ability to work independently and manage inventory while adjusting claims
Structured support system that encourages continued career development
Paid training and tuition assistance
Inclusive, friendly culture with Employee Resource Groups

Field Crop Claims Adjuster, Rcis Resume Examples & Samples

6 or more months of experience in the agricultural area
Reliable personal transportation and travel within territory
Strong organization and prioritization skills

Total Loss Claims Adjuster Resume Examples & Samples

Receive claim assignments and verifies/investigates coverage and documents all appropriate information
Determine claim approval and or denial up to $7,500 per exposure or $10,000 per file
Establish an investigative plan; initiate investigation by gathering facts and evidence with all interested parties; complete appropriate reports; take recorded statements when necessary; and review loss reserves and adjust or open hidden exposures as necessary
Evaluate and adjust claims within limit of authority
Evaluate settlement alternatives by reviewing regulatory compliance and fair claims practices; make decisions on best option
Make appropriate contacts to discuss a settlement; extend an offer to appropriate party; documents all file activity and payment/settlement information in file notes clearly outlining basis for settlement
Determine subrogation or fraud potential and refer to Unit when potential exists or handles to conclusion
If handling PIP may participate in investigations of medical providers and attend EUOs
May work with attorneys in resolving lawsuits
Conduct negotiations and settlements within authority level, using independent judgment, or within discretionary levels granted above individual authority level
Track and document the quality of service provided by defense counsel and manage litigation and recovery costs
May assist in training of Claims Representatives
Is proficient in using all systems and technology used within the company
May be required to make personal appearances on behalf of the company when requested
Identify customer needs and works to meet those needs using appropriate customer service skills
Successfully completes Claim Representative trainee program, or equivalent external training program
Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
Demonstrate the capability of consistently handling aggregate file exposures of at least $2,500
Demonstrate proficiency in file audits to agreed standard of efficient claims quality
Has a solid command of the claims policies and procedures; exhibit basic interpretation of policies & procedures in resolving claims, but may still need some assistance from supervisor
Demonstrate the ability to interpret and apply written coverage accurately to establish claim and determine an action plan, and often requires assistance on more complex files
Demonstrate a solid understanding of the repair and replacement of property damages, to include mechanical components of a vehicle, homeowner damages and other potential exposures
For claims involving injuries, has solid understanding of how to review, evaluate, and negotiate injury claims
Demonstrate ability to handle litigation in accordance with company guidelines, and be able to recognize legal issues and will utilize ADR when appropriate
Ability to resolve conflicts and empathize with customers is critical
Demonstrate professional oral and written communication skills
Organization and time management skills are critical for this position
Demonstrate an understanding of insurance law as it relates to claims
Begin to develop effective leadership skills in order to mentor other adjusters, function as a team leader, handle projects, etc
Demonstrates a thorough understanding of the NGIC Insurance brand and ability to exhibit the behaviors
Demonstrates an understanding of the functions of other departments, such as Policy Ops and Marketing

Liability Claims Adjuster Resume Examples & Samples

Maintains diary system to ensure claim files are up to date, and that required follow-up is taking place
Investigates and evaluates claims to determine liability and compensability
Communicates with vendors, producers, policy holders, clients and insurance companies to communicate claim status
Negotiates settlements with claimants and insureds
Reports to authorities as applicable, providing updates on litigated claims, serious injuries, and claims over the adjuster’s authorization limits
Sets and manages reserve accounts, and ensures that adequate levels are maintained
Analyzes and reviews invoices for payment
Provides producer inquiry assistance
Provides set-up of rental vehicles as needed
Creates and maintains reports and worksheets as needed
Travels as necessary to attend appeal hearings, trials, and perform on-site investigations

Casualty Claims Adjuster Trainee Resume Examples & Samples

Examine claims forms, policies and endorsements, client instructions and other records to determine coverages
Investigates claims by interviewing claimants and witnesses
Sets loss reserves
Prepares reports
Settles claims by determining insurance carrier's liability
Controls claims costs
Maintains company reputation and integrity of insurance products
Strong analytical and mathematical ability
Strong PC/laptop skills including MS Office products
Previous insurance experience a plus
Experienced adjusters must be licensed as required by state and local jurisdictions

Claims Adjuster, Specialty Resume Examples & Samples

Handle a high volume of claim traffic, including telephone calls and electronically submitted claims
Gather appropriate information and details to understand the customer’s issues or claim
Approve or deny claims based on the information given by the customer and terms and conditions of the program/contract
Research and analyze documents for accuracy regarding the type of claim and program
Educate the customer on policies, procedures and programs
Communicate the need for additional information and explain claim payment or denial, using direct customer contact by phone and/or written correspondence
Document solutions and other information in computer system
Receive escalated customer calls from customer service representatives regarding claim status; resolve concerns and update customer on process
Ensure completion of claim by remaining focused on the claim and displaying enthusiasm, sincerity and professionalism when responding to the customer’s requests and questions
3+ years of experience in a customer service related role
Previous experience in a call center preferred
Experience in the insurance, banking, or financial services industry a plus
Property and Casualty Adjuster license a plus; Must obtain license within 30 days of hire (training provided)
Previous experience with computer systems and data entry
Ability to communicate effectively and professionally, strong verbal and written communication skills
Excellent active listening skills
Ability to solve problems to acceptable resolution
Ability to type 30+ wpm

Senior Claims Adjuster Home Ops-field Resume Examples & Samples

Quality Work Product – Attention to detail that satisfies our guidelines and protocols along with state regulations
Production – The ability to work in a fast paced environment and manage a claim file from start to finish. Pay what we owe in a timely fashion
Inclusive – Our culture is that of being one team, working together without walls
Minimum 3 - 5 yrs. related property claims experience
General knowledge of insurance theory and practices
Strong communication skills (verbal, nonverbal and written)
Strong homeowner policy knowledge
Ability to work as a part of a team
Ability to establish repair estimates for property losses utilizing Xactimate
Must be able to make physical inspections of property loss sites
Must be able to work out-of- doors in all types of weather and extended and/or non-standard hours as required

Claims Adjuster Pip-mi Resume Examples & Samples

Must have or secure and maintain appropriate states adjuster license(s) and continuing education credits as required by the state
Uses discretion and independent judgment in claim handling
Possesses basic functional knowledge and skills reflective of fully competent practitioner
Investigates, analyzes, evaluates and negotiates personal and/or commercial lines claims of minimal to moderate complexity
Supervisor guidance is provided on items above/outside of adjusters authority level

Claims Adjuster Resume Examples & Samples

Examines claims forms Investigates claims by interviewing claimants and witnesses
Settles claims by determining insurance carrier’s liability
Maintains professional and technical knowledge through company provided education
Good attention to detail
Must have a valid drivers’ license with a clean driving record
Must complete designated continuing education courses while in position in order to advance

Senior Claims Adjuster Resume Examples & Samples

At least 3 years’ experience in P&C insurance
Attain ANFI certification within one (1) year of hire. Apply for and obtain FCN within two (2) years of hire
Basic knowledge of systems and procedures

GAP Claims Adjuster Resume Examples & Samples

Gathers and assembles pertinent claim information by contacting lenders, auto dealers, borrowers and/or agents and ensuring the completeness and accuracy of documentation for processing
Calculates claim proceeds in accordance with the Master Policy coverage by analyzing and reviewing borrower’s loan history, MSRP/NADA valuations and primary carrier’s coverage documentation
Prepares and distributes claim checks and supporting documentation to lender
Enters and maintains claim records on the AS400 system and documents necessary claim information to the claims files
Requests additional documents to assist in the determination of a claim
Produces monthly and ad hoc claim reports for carriers, SWBC sales staff and management
Establishes accounting records and reports claims check register to the carrier
Refers non-payable claims to insurance carrier as necessary and completes appropriate documentation for each file

Senior Liability Claims Adjuster Resume Examples & Samples

Under limited direction, works within broad limits and authority on highly complex assignments requiring specialized knowledge in order to analyze claim forms, policies and endorsements, client instructions and other records to determine whether the loss falls within the policy coverage
Deny any claims that are not covered or do not meet compensability criteria and successfully defending that decision if challenged
Manage a diary, completing tasks and applying creative solutions to ensure that cases are resolved timely and at the right financial outcome
Properly setting claim reserves
Identify and direct the assignment and coordination of expertise resources to assist in case resolution
Exhibit a natural curiosity

Claims Adjuster Resume Examples & Samples

Under moderate supervision, works within specific limits and authority to analyze claim forms, policies and endorsements, client instructions and other records to determine whether the loss falls within the policy coverage
Investigate claims promptly and thoroughly
Manage claims in litigation, under close supervision and guidance
Identify, assign, and coordinate the assignment and coordination of expertise resources to assist in case resolution
Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Group and our customers’ ability to be profitable)
Prior related work experience required (generally six months to three years) to be able to exercise discretion and independent judgment in order to manage a caseload without detailed oversight by a manager
Ability to prioritize workload and handle multiple tasks

Temporary Claims Adjuster Resume Examples & Samples

Process mail and prioritizing workload
Responsible for telephone calls from various parties (insured, claimant, etc.)
Have an appreciation and passion for strong claim management
Prior related work experience required (generally seven years) to be able to exercise discretion and independent judgment in order to manage a caseload without detailed oversight by a manager
Ability to articulate the financial value of your work at multiple responsibility levels inside our clients’ business which may include the CEO
Desire to work in a fast paced environment
Must demonstrate a desire for continued professional development through continuing education and self-development opportunities

Casualty Claims Adjuster Resume Examples & Samples

Properly set claim reserves
Responsible for telephone calls and written correspondence to/from various parties (insured, claimant, etc.)
5 or more years of experience adjudicating complex third party property claims and desire to learn construction defect claims with intent to adjudicate construction defect claims
Prior related work experience required (generally three to five years) to be able to exercise discretion and independent judgment in order to manage a caseload without detailed oversight by a manager
Strong claim negotiation skills a must

Claims Adjuster Resume Examples & Samples

Investigating the claim - this requires calling the claimant, insured employer, healthcare provider, and witnesses to determine compensability issues, status of claims (medical only or indemnity), and subrogation potential
Actively managing medical only claims to ensure only medical bills appropriate to the claim are paid on a timely basis
Negotiating settlements
Responsible for telephone calls from various parties (insured, claimant, medical facilities, etc.)
Bachelors degree strongly preferred (but not required)
Ability to travel, sometimes overnight, approximately 10% of the time. Employees are expected to have sufficient credit available to incur travel expenses (i.e. airfare, lodging. meals, rental car) for duration of the trip and be reimbursed by the company

Associate Claims Adjuster Resume Examples & Samples

Under moderate supervision, works within specific limits and authority to analyze claim forms, policies and endorsements, client instructions and other records to determine whether the loss falls within the policy coverage
Investigate the claim - this requires calling the claimant, insured employer, and witnesses to determine compensability issues, and subrogation potential
Deny any claims that are not covered or do not meet compensability criteria and successfully defending that decision if challenged
Actively managing claims to ensure only expenses appropriate to the claim are paid on a timely basis
Manage a diary, completing tasks and applying creative solutions to ensure that cases are resolved timely and at the right financial outcome
Properly setting claim reserves
Identify and direct the assignment and coordination of expertise resources to assist in case resolution
Negotiate settlements
Prepare reports for file documentation
Process mail and prioritizing workload
Responsible for telephone calls from various parties (insured, claimant, etc.)
Have an appreciation and passion for strong claim management
Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Group and our customers’ ability to be profitable)
Prior related work experience required (generally six months to three years) to be able to exercise discretion and independent judgment in order to manage a caseload without detailed oversight by a manager
Ability to prioritize workload and handle multiple tasks
Ability to articulate the financial value of your work at multiple responsibility levels inside our clients’ business which may include the CEO
Exhibit a natural curiosity
Excellent evaluation and strategic skills required
Strong claim negotiation skills a must
Must possess a strong customer focus
Must work independently and demonstrate the ability to exercise sound judgment
Proficient in MS Office Suite and other business-related software
Polished and professional written and verbal communication skills
The ability to read and write English fluently is required. The ability to read and write Spanish fluently is strongly preferred but not required
Must demonstrate a desire for continued professional development through continuing education and self-development opportunities

Homeowner Claims Adjuster Resume Examples & Samples

Determines and advises of all applicable coverage for the loss
May be required to transfer claim to Senior Homeowner Claims Specialist
Arranges all emergency services required to protect the property from further harm; accommodates the needs of the insured
This includes resolving all questions of coverage associated with the claim
Analyzes applicable state's policy and endorsements to determine appropriate coverage

General Claims Adjuster Resume Examples & Samples

Analyzes insurance and appealed claims to ensure compliance with organizational and government guidelines
Consistently maintains knowledge of current claims trends and legislated requirements and programs
Conducts analysis of current claims trends and investigates means to improve claim processes
Recommends improvements and implements same as approved
Researches and investigates claims systems to evaluate potential impact to organization
Recommends adjustments or changes to systems as appropriate
Analyzes claims financial reporting practices and reconciliation for client companies
Identifies issues and recommends alternative courses of action
Travels to catastrophes to direct, review and coordinate field staff and subcontractors or adjusters
Minimum 10 years’ experience in claims management
Experience working with claim adjusting software, MS Office and National Flood Insurance rules, regulations, guidelines and best practices
Experience with investigating appeals, audits and overall claims practices
Experience working with appropriate claims processing procedures and documentation, administration procedures, legislative requirements, and property/flood principles as they relate to adjustment, examination and approval of all levels and types of flood insurance claims
Ability to stay focused and manage workflow in a crisis
Good human relations skills to provide leadership and work guidance to less experienced personnel
Ability to keep sensitive and confidential matters private
Ability to work independently or in a team environment
Ability to publicly represent company with internal and external clients

Inside Homeowners Claims Adjuster Resume Examples & Samples

Obtains and records first notice of loss
With close supervision, investigates, evaluates, negotiates and settles homeowner 1st-and 3rd-party property claims
Claims range from low-to high-complexity claims up to $100,000
In territories without field staff, will be required to review and adjust contractor estimates
Recognizes and prepares file for subrogation

Liability Claims Adjuster Resume Examples & Samples

Florida adjuster's license required
7 years of claims field liability experience
Must be able to pass a driving history application
Bilingual preferred
Candidate must have ability to meet and deal with all segments of the public
Good customer service skills
Strong attention to detail, time management and decision-making skills
5% Travel

Claims Adjuster Resume Examples & Samples

Handle Casualty line of commercial claims
Prepare regular and ad-hoc reports to Claims Manager
Keep contact with outside consultants, supervise their activity
Keep contact with clients, insurance brokers and other partner companies
Substitute Claims Manager for commercial claims
Trend analysis for underwriters and management
Take part on renewal or new business meetings
Hold presentations, seminars to brokers, insureds
Participation in product development

A&H Claims Adjuster Resume Examples & Samples

To work with integrity, able to work independently or as part of a team to achieve personal and business objectives
Good numeracy, literacy and attention to detail
Able to self-reflect/ analyze, actively seek feedback to identify strengths and personal development areas

Consumer Lines Claims Adjuster Resume Examples & Samples

Ensuring effective vendor and litigation management on Complex claims within a personal allocation
Broader internal / external stakeholder communication where required
Contribute to maintenance of best practice procedures for (LoB) intermediate to high value Complex claims, consistent with global best practice
Timely, accurate and customer focused claim resolution, minimizing indemnity exposure and mitigating vendor and legal expense for claims of medium to high complexity
Effective communication and key medium to high Compexity claims and (LoB) portfolio messages to internal stakeholders and external stakeholders
Some experience in negotiation, mediation, arbitration and ADR skills
Strong experience in negotiating on intermediate to high complex claims and knowledge and experience in mediation, arbitration and Alternative Dispute Resolution
Experience in effectively following up on recommendations from technical claims audits and continuous claim handling improvement

Complex Casualty Claims Adjuster Resume Examples & Samples

Managing key claims handling enquiry; coverage determination, quantum analysis and legal liability assessment, where appropriate within authority limits and providing a high standard of customer service
Work with Team Manager/Senior Adjuster to ensuring effective vendor and litigation management on Complex claims within a personal allocation
Internal stakeholder communication where required
Contribute to maintenance of best practice procedures for (LoB) Complex claims, consistent with global best practice
Demonstrate a basic standard of technical claims competence for handling moderate to lower complexity complex claims

Complex Casualty Claims Adjuster Resume Examples & Samples

Managing key claims handling enquiry; coverage determination, quantum analysis and legal liability assessment, where appropriate within authority limits and providing a consistently strong standard of customer service
Demonstrate a high standard of technical claims competence. Demonstrate a strong standard of competence in handling intermediate to advanced complex claims in Line of Business
Timely, accurate and customer focused claim resolution, minimising indemnity exposure and mitigating vendor and legal expense for claims of medium to high complexity
Effective communication of key medium to high Complexity claims and (LoB) portfolio messages to internal stakeholders and external stakeholders
Accurate and consistent policy interpretation against claims of intermediate to high complexity
Good specialist knowledge in (LoB) technical claims topics
Policy language skills enabling accurate and consistent policy wording interpretation
A strong knowledge of legal / regulatory and litigation / procedural requirements for their line of business

Notice of Loss Crop Claims Adjuster Resume Examples & Samples

Triaging first notice of loss claims that have been transmitted through the RCIS claims system
Develop and maintain a strong working knowledge of regulatory and RCIS policies and claims best practices and procedures
Contact insureds (farmers), primarily by phone, to gather and document crop loss information and route claims cases accordingly
Understand and discuss detailed crop procedures as related to specific crop situations
Maintain effective communications with field adjusters, Area claims Supervisors, Managers, and agencies as required
Accurately document required information in RCIS tracking systems when contacting insured and when staffing the phone queue
High School Diploma or Equivalent and 2 or more years of experience in a customer service area
Agriculture or crop experience
Ability to complete Crop Adjuster Proficiency Program Certification (CAPP) must be obtained within 180 days of hire date
Successful completion of basic insurance course work
18 or more months contact center experience
Insurance industry knowledge

Claims Adjuster Specialist Resume Examples & Samples

Strong negotiation skills
May have to use personal vehicle to perform job
Non-traditional - may work weekends and/or evenings

Liability Claims Adjuster Resume Examples & Samples

Exercises proper judgment and decision making to analyze the claims exposure to determine the proper course of action and to appropriately settle the claim
Interacts extensively with various parties involved in the claim process
Handles claims consistent with clients' and corporate policies, procedures and "best practices" and also in accordance with any statutory, regulatory and ethics requirements

Crop-claims Adjuster Resume Examples & Samples

Contribute to a positive work environment by demonstrating cultural expectations and influencing others to reward performance and value “can do” people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun
Applied knowledge of agriculture and crop farming
Basic knowledge of Microsoft Office Suite
Collaborate with internal staff and external customers
Use relevant information and individual judgment to comply with organizational and legal regulations
Complete tasks attentively and thoroughly

Senior Claims Adjuster, Audit & Quality Resume Examples & Samples

Significant technical expertise in all aspects of Motor & Liability claims handling
Excellent understanding of Motor & Liability claims processes including in & outsource claims models and all aspects of Lloyds London market
Excellent Word, Excel and PowerPoint skills and ability to analyse/report upon data
Excellent presentation and communication skills with ability to communicate at all levels
Ability to work and deliver outstanding results to tight deadlines
Able to negotiate, persuade and influence at all levels
Auditor role experience
Professional approach to all key stakeholders and the ability to present to Senior Managers

Associate ARC Claims Adjuster Resume Examples & Samples

Manage pending claims to meet company quality criteria
Negotiate and commit to the settlement, and move claim to closure
Resolve complaints, and participate in arbitration and/or grievance procedures
Strong verbal/written communication skills

Claims Adjuster Resume Examples & Samples

100% Paid Training
Short-term Incentive Plan
401K with Company Match up to 6%
Company funded retirement plan
Tuition assistance
Medical, dental, vision, and life insurance
Company paid Short-term Disability
Tremendous opportunity for growth and upward mobility
Performance is rewarded – you drive your own success

Claims Adjuster Resume Examples & Samples

Have the ability to interpret policies and apply fact sets to determine coverage
Ability to investigate and determine liability
Evaluate and negotiate bodily injury claims
Bachelor’s degree or equivalent business experience. 2-5 yrs related business experience
Adaptable to change, able to operate effectively in a highly evolving environment

Claims Adjuster With German Resume Examples & Samples

Handling newly reported motor claims via the telephone
Ensuring that full and relevant data is recorded from the outset to enable the Claims Handler’s to deal with the cases with no requirement to obtain further data wherever possible
Recording new claims directly onto the AIG system that are received via telephone, post, fax or e-mail
Assessing liability and informing the file handler a new claim has been raised against their Fleet and confirming to them the details of the claim
Creating the Incident Report Form and acknowledging receipt of the new claim. Arranging repairs of the vehicle and inputting data into the computer system in accordance with the fraudulent checks required and assessing whether a third party capture is necessary and arranging the repairs to the third party vehicle if required
Take pro-active steps to effectively manage Customer expectations in order to achieve overall customer service proposition
Contribute to ensuring the Unit’s Key Performance Targets are met and that own objectives are achieved
Ensure that all allocated work is handled within the Key Performance Targets of the Motor Department
Promote compliance with best practice for all aspects of claims assessment across the motor department and be aware of bespoke practices for specified clients
To follow agreed internal and external processes, policies and procedures to ensure quality and service standards are met and leakage minimised
Take personal and collective responsibility to ensure compliance with the Legal & Regulatory framework within which motor claims handling sits. This is to include, but not limited to, carrying out all accountabilities and objectives within the framework of the AIG TCF policy; ensuring FSA & DPA compliance; being aware of the implications of POCA and the Terrorism Act

Complex Claims Adjuster, Accident & Health Resume Examples & Samples

Well developed negotiation and dispute resolution skills
Time management - Ability to handle multiple priorities, organise work and meet deadlines
Strong administrative and report writing skills
The ability to problem solve and develop new ideas to improve working practices
Lateral thinking

Inside Home Owners Casualty Claims Adjuster Resume Examples & Samples

Determines and explains coverage limits and policy conditions in complex claims involving single or multiple claimants
Sets initial reserve, updates reserve, documents rationale and claim summary notes
Takes recorded statements from insured’s, claimants, agents, witnesses, medical providers, etc., conducts investigations, determines liability and prepares summaries
Serves as a subrogation or arbitration panelist
Refers Serious Injuries to CSA via comprehensive Alert conference file note
Maintains organized dual suspense on all pending cases
Participate in Telephone Alert Conferences regarding complex claims referred to Home Office
Assists in reviewing files and making recommendations to refer files to Home Office for escalation
High School Diploma/General Education Diploma (GED) and/or Bachelors Degree with a current Texas adjuster license and at least 3-5+ years of bodily injury claims experience (Unrepresented and/or Represented)
Experience with insurance policy, coverage, and regulation
Knowledge of claim processes, policies, procedures, claim systems, coverage, liability, damage estimating, and/or settlement, and adherence to applicable legal compliance standards
Broad industry knowledge to discipline practices, including best practices, to support the business unit
Strong computer skills with proficiency in Microsoft Office
Strong organization skills and the ability to work independently under minimum supervision

Claims Adjuster Resume Examples & Samples

Performs detailed research and reprocessing of AHCCCS, Medicare (Special Needs Plan) and commercial claims using a back out function in IDX. The back out function takes the original claim and produces a replacement claim number. The claim is reprocessed on the replacement claims according to the nature of the request
Reviews and reprocesses AHCCCS, Medicare, and Commercial Provider requests via Customer Care Calls
Trouble shoots, identifies, and resolves special handling requirements related to pricing, contracting, and system issues
Serves as liaison with between departments such as Network Development, Medical Management, Finance and IS to research and rework projects submitted
Reviews and reports all types of claims that are reprocessed into the claims adjustment database. Information is used to identify trends and to implement front end processes that will reduce rework
Coordinates and submits projects to the Claims Systems team that can be reprocessed by auto adjudicating the claims through an electronic process in IDX
Researches and/or reprocesses special, high profile, expedited projects from Grievance and Appeals, finance and Network Development

Seasonal Crop Claims Adjuster Resume Examples & Samples

) Investigates and maintains claims
Great American Insurance is searching for organized individuals with excellent customer service and communication skills. Job entails inspecting fields, appraising for yield potential, measuring bins and gathering information to determine settlement
2+ Crop Insurance experience preferred
Agricultural background/knowledge highly preferred
Competitive wage and bonus incentives available

Claims Adjuster Resume Examples & Samples

Communicates with insured’s, claimants and other parties to determine the facts of the claim
Documents claims file to comply with company guidelines and state regulations
Reviews factual information to determine coverage of all parties to the claim
Performs medical bill audit, analysis and reviews medical records
Resolves complaints, and participates in arbitration and/or grievance procedures
Recommends subrogation and/or SIU referral
Manages pending claims to meet company quality criteria
Ability to work within a team environment which requires strong communication skills
2-3+ yrs. related business experience
Insurance Experience
Claims Experience
Strong Computer skills

Claims Adjuster Resume Examples & Samples

Minimum 2+ years of progressive residential property claims experience required
Advanced writing and reading comprehension skills required
P&C License required
Xactimate experience preferred

Seasonal Crop Claims Adjuster Resume Examples & Samples

Complete claims assignments to ensure claims are paid timely and correctly. Reports to Claims Supervisor and/or Profit Center Claims Manager on claims status, claims problems, appropriate loss reserves and adjusting workload
Maintain professional relationship with agents, insureds, adjusters, and other crop insurance companies to ensure understanding of policies and procedures
Participate in industry training schools; maintain knowledge of changes in current FCIC and Crop Insurance Industry policies and procedures; keep abreast of industry crop adjusting trends that affect loss adjustment procedures
Agriculture or farming experience preferred
Ability to make sound judgment regarding policies and procedures
Ability to interact with diverse people and handle conflict and difficult situations
Ability to communicate clearly and effectively in a written or verbal manner
Ability to comprehend basic written and/or verbal instructions
Ability to perform intermediate arithmetic

Senior Claims Adjuster Resume Examples & Samples

Following Claims best practices, standards and procedures
Managing relationships with key Vendors
Acting as a technical expert within the Claims function liaising with relevant internal and external parties
Using judgement to determine liability by gathering and analysing relevant facts
Ensuring a timely resolution to claims by developing case strategy, developing case evaluation and escalating issues as appropriate
Establishing timely reserves and performing ongoing reviews throughout the claims-cycle by estimating and validating the value of claims
Negotiating claims settlements by establishing an appropriate negotiation strategy and utilising available tools and resources within authority limits

100

Commerical Claims Adjuster Resume Examples & Samples

Verifies coverage information, gathers loss information such as statements from parties involved, witnesses, police reports, etc in order to make an educated liability decision
Recognizes subrogation as necessary
Recognizes SIU exposures and is able to implement appropriate procedures
Co-ordinates all claim file activity, including large loss reporting as necessary
Works with outside vendors including appraisers, independent adjusters, attorneys, etc
Possess strong analytical, problem-solving, and organizational skills
Have strong decision making ability
Provide a high degree of customer service
Ability to work in a fast-paced, growing and changing environment with shifting priorities

101

Claims Adjuster Resume Examples & Samples

Interview with claimant and witnesses as well as gather information i.e. police and hospital records, estimates to determine injuries
Conduct a thorough analysis of liability and damages
Good knowledge of claim procedures, policies, technology, state and federal laws and insurance regulations
Ability to communicate effectively and clearly, both orally and in writing
Ability to carry out detailed written or verbal instructions, ability to respond to requests effectively and efficiently and exhibit good common sense
Ability to work independently with self-initiative
Time management skills, organizational skills and ability to prioritize issues and tasks
Ability to effectively operate computer equipment and applications

102

Claims Adjuster Resume Examples & Samples

Under general direction, process to conclusion commercial, 1st and 3rd party claims
Handles moderate exposure bodily injury claims up to and including litigation
Bachelor’s degree or equivalent in work experience
4+ years of claims handling experience
Texas Adjusters Liscense and ability to obtain any other liscenses as necessary
Knowledge of Microsoft Office Applications, and ability to learn new software programs
Ability to prioritize work, organizes time, and balances multiple responsibilities

103

Commercial Liability Claims Adjuster Resume Examples & Samples

Responsible for handling moderate-to-high complexity Construction Defect, Commercial Auto, and General Liability claims, including litigated claims
Makes timely and appropriate contacts with interested parties, including, but not limited to the insured, claimant/attorney, witnesses and producers
Determines, reviews and analyzes coverages that may or may not apply to the claim; Plans, executes and reviews investigations-coverage, liability and/or damages – including the securing of a signed or recorded statement of the insured, claimant and/or witnesses
Manages all aspects of litigated claims, including development of a litigation plan with counsel, tracking and controlling legal expenses, and reaching a cost-effective resolution is required
Applies facts, as determined by contacts and investigation, to the law of a particular jurisdiction to properly and accurately evaluate exposure
Establishes indemnity and expense reserves as the claim transpires
Controls and manages claims-related expenses; determines and executes plans of action to resolution, including the avoidance/minimization of litigation
Works with and actively monitors and manages defense counsel
Minimizes losses through identification of subrogation and prompt disposition
Determines and fulfills reporting requirements to supervisor/manager, Home Office, SIU, client companies and reinsurers
Accountable for compliance with the states within the Southeast Region
Recognizes SIU exposures and is able to implements appropriate action plans
Works with outside vendors including Attorneys, Experts, Appraisers, Independent Adjusters, etc
Attend Mediation and Settlement Conferences as necessary
Be ready, willing and able to undertake additional duties and responsibilities as assigned by Management
Prepare Large Loss Reports and maintain ongoing claim updates
7-10 years of liability claim handling experience
Insurance coursework (e.g. IIA, CPCU, SCLA and AEI) is beneficial
Maintain valid adjusters’ license(s) in states assigned (Southeast Region) or an ability to obtain same
Ability to manage relationships in a fast paced environment, while demonstrating persistence along with problem solving and decision making skills to work with customers through a variety of challenging situations
Knowledge of Microsoft Office Applications and ability to learn new software programs
Ability to multi-task and handle large volumes of work in a short period of time
Time management skills, organizational skills and ability to prioritize issues and tasks

104

Claims Adjuster Resume Examples & Samples

Provides quality service to all customers
Receives claim assignments from the Team Manager and or works the intake queue for self assignments
Verifies liability and negligence scenarios for the jurisdiction in question
Places all viable adverse parties, their legal representatives and insurance companies on notice of our lien
Coordinates additional investigation as needed by gathering all pertinent information and determining the extent of possible recovery. Does additional liability investigation as determined by the needs of the file and request of the unit leadership
Records the claim in the appropriate subrogation log or subrogation screens and sets follow-up diaries as needed
Negotiates liens with adverse parties, attorneys and carriers
Obtains investigative material such as police reports, investigative reports and assigns experts as needed
Controls loss adjustment expenses
Documents all correspondence, reports, discussions and decisions
Works closely with the primary claim analyst to coordinate the subrogation investigation with the underlying file needs
Notifies the primary claim analyst of any situations which may affect the underlying claim
Does queries in appropriate databases to develop additional recovery sources
Any other tasks or responsibilities assigned
Good understanding of liability and negligence, multijurisdictional exposure preferred
Excellent computer skills including are needed due to multiple claim systems and automated recovery tools such as ISO, Arbitration Forums, etc
Sound command of the English language--its grammar, syntax and style, including an understanding of the conventions of punctuation and capitalization
Excellent spelling ability and proofreading skills
Effective communication skills; ability to obtain information from others and deliver information to others orally and in written form
Ability to carry out detailed written or verbal instructions; ability to respond to requests effectively and efficiently
Ability to work effectively with supervision and direction and exhibit good common sense
Knowledge of claims handling and state laws and insurance regulations
Minimum of three years prior adjusting experience in an insurance-related claims field is required
Exceeds expectations in current position
Attained or working toward the CSRP designation (Certified Subrogation Recovery Specialist)

105

CNH Claims Adjuster Resume Examples & Samples

Investigate, handle and settle first and third party mechanical breakdown claims (extended warranty)
Manage designated heavy/agriculture equipment breakdown claims with varying degrees of complexity and severity depending on coverage issues
Good knowledge of claims procedures and computer systems
Ability to take direction and make decisions

106

No Fault Claims Adjuster Resume Examples & Samples

Handles automobile claims involving NF exposures in an efficient and professional manner
Thoroughly investigates claims including coverage, liability and severity of injury and treatment
Evaluate exposures and maintain accurate and timely reserves on all files
Evaluate claims for resolution
Document claim files and keep them updated at all times
Ensure accuracy and timeliness of all payments
Handle arbitration and litigation associated with assigned cases
Maintains diary control that insures timely and proper claim handling and compliance with applicable regulations
Experience with New York and/or New Jersey No Fault/Personal Injury Protection (PIP) programs
Multi-state commercial claims experience
Experience investigating, monitoring and resolving NF claims
Obtain and maintain all necessary adjuster licenses
Time management skills and demonstrated ability to manage multiple priorities with accuracy and efficiency
Ability to provide professional and friendly customer service
Proficient knowledge of Microsoft Office suite

107

GAP Claims Adjuster Resume Examples & Samples

Calculates claim proceeds in accordance with the Gap Contract coverage by analyzing and reviewing borrower’s loan history, MSRP/NADA valuations and primary carrier’s coverage documentation
Must be able to communicate professionally with customers, co-workers and management
Must have a working knowledge of Microsoft Word and Excel
Administers claims of numerous ancillary products that are financed when a customer purchases a vehicle; primarily Guaranteed Automobile Protection (GAP)
Starts the claims process and is responsible for recognizing the required documentation that is sent in by a request
Claims processing and GAP contract support

108

VSC Claims Adjuster Resume Examples & Samples

Demonstrated ability to understand automotive service contract and/or insurance coverage; multi-task; strong organizational skills; excellent verbal and written communications skills; strong computer skills, specifically Microsoft applications
Strong interpersonal and customer service skills with the ability to communicate clearly; resolving questions or issues for customers in sometimes difficult situations
Working knowledge of mechanical failures, parts and labor repair costs, experience in interpreting contracts and coverage
Good negotiation skills with the ability to make decisions with little or no supervision. Takes initiative, self-starter, and team player
Creative problem solver, results oriented, strong analytical skills

109

Claims Adjuster Resume Examples & Samples

Submits claims calculations and supporting documentation to management for payment approval
Must have at least one (1) year of claims adjusting or related experience in the automotive field (Dealer/Lender)
Must have excellent organizational and communication skills (verbal and written)
Must be able to type 40 WPM accurately
Must be able to use basic office equipment including a copy machine and fax

110

Commerical Claims Adjuster Resume Examples & Samples

Assess insurance coverage based on the policy and claims report to determine if claim can be accepted as being within coverage
Document all correspondence, reports, discussions and decisions
Commercial trucking experience is required
Good analytical abilities to review, exercise judgment and evaluate claims in order to make sound decisions
College degree is not a prerequisite for this position; however, employee should possess such skill and knowledge as are normally gained in the successful completion of a four-year college program
Good knowledge of insurance theory and practices; insurance contracts and their application
Minimum of 5 plus years of experience in job-related functions or equivalent

111

Commercial Claims Adjuster Resume Examples & Samples

Under general direction, process to conclusion commercial, 1st and 3rd party claims
Verifies coverage information, gathers loss information such as statements from parties involved, witnesses, police reports, etc in order to make an educated liability decision
Handles moderate exposure bodily injury claims up to and including litigation
Recognizes subrogation as necessary
Recognizes SIU exposures and is able to implement appropriate procedures
Co-ordinates all claim file activity, including large loss reporting as necessary
Works with outside vendors including appraisers, independent adjusters, attorneys, etc
Bachelor’s degree or equivalent in work experience
4+ years of claims handling experience
Texas Adjusters Liscense and ability to obtain any other liscenses as necessary
Possess strong analytical, problem-solving, and organizational skills
Have strong decision making ability
Knowledge of Microsoft Office Applications, and ability to learn new software programs
Provide a high degree of customer service
Ability to work in a fast-paced, growing and changing environment with shifting priorities
Ability to prioritize work, organizes time, and balances multiple responsibilities#LI-Post

112

Claims Adjuster Resume Examples & Samples

Process a minimum 625 claims per week; average 125 claims per day
Process aging report daily and suspend claims with appropriate suspension code if unable to pay/deny
Determine division of financial responsibility according to Health Plan matrix
Process provider appeals and resolve in a timely manner
Process special assignments/projects; as well as seeking and building partnerships with other departments in the company to finish them in a timely manner
Retrieve messages twice a day from your voice mailbox; morning and evening; including timely responses to emails within 24 to 48 hours
Answer Provider Inquiry calls
Three (3) years managed claims care experience, including medical and hospital claims payment and/or billing required; Certificate preferred
Demonstrate knowledge of DMHC/Medicare policies and CPT, ICD-10 & HCPCS and suspension coding by passing a test
Basic computer skill proficiency with ability to pass alpha-numeric test at 8,000 keystrokes
Strong critical thinking skills and the ability to make timely, professional and ethical decisions
Quality provider and customer service skills
Positive team spirit

113

Senior Casualty Claims Adjuster Resume Examples & Samples

Evaluate insurance coverage based on claim report, the insurance policy, applicable statutes and case law to determine if a claim can be accepted as within coverage
Meet detailed quality assurance standards of performance
In-depth knowledge of multi-jurisdictional claims handling issues

114

Senior Casualty Claims Adjuster Resume Examples & Samples

Litigation claims handling experience
7+ years Commercial Casualty experience primarily focusing on Commercial Auto and General Liability Experience
Strong background in the investigation of liability and damages, as well as the interpretation of coverage, including the authoring of ROR's and declination letters

115

Casualty Claims Adjuster Resume Examples & Samples

Obtain and keep in effect all required licenses and certifications and meet all continuing training and certification requirements
Revise case reserves based on developments in the course of adjusting the claims
Ability to work in a fast paced TPA environment
3+ years personal and or commercial lines automobile experience
Experience working in a paperless system is a plus

116

Senior Claims Adjuster Resume Examples & Samples

Knowledge of legal concepts
Decision making
5 to 8 years handling general liability claims

117

Senior Casualty Claims Adjuster Resume Examples & Samples

7+ years Commercial Casualty experience primarily focusing on Commercial Auto Liability
Multi-state adjusting experience
Experience in a paperless system is a plus

118

Senior PIP Claims Adjuster Resume Examples & Samples

Identify key issues and investigation required
Interact successfully with co-workers
Solid interpersonal skills

119

Casualty Claims Adjuster Resume Examples & Samples

Obtain and maintain all required licenses and certifications and meet all continuous training and certification requirements
Determine extent of the client’s financial exposure with respect to claims; set case reserves for use by clients and regulatory authorities
Select and manage experts
Review and analyze medical records
Minimum of 5 + years of industry experience in Property and Casualty Claims

120

Claims Adjuster Senior Resume Examples & Samples

Able to recognize and pursue excess insurance recoveries
Incumbents will have the ability to handle a full case load, with proven ability to handle cases of increased severity
Extensive knowledge of accepted industry standards and practices

121

Claims Adjuster Resume Examples & Samples

Conduct a thorough analysis of liability and damages; continually assess exposure and evaluate for accurate reserves
Maintains appropriate financial accountabilities (reserving) and controls loss adjustment expenses
2 years’ experience in job-related functions or equivalent

122

Associate Claims Adjuster Resume Examples & Samples

Participates in ongoing training sessions, both formal and informal, to include York requirements and state-specific statutory requirements
Completes 2-point contact on new claims within 24 hours in order to obtain information necessary to make a coverage and liability decisions on the claim
Completes coverage, liability and damages evaluations
Establishes appropriate reserve levels based on financial exposure and updates reserves upon receipt of new information
Utilizes assistants or support pool to complete administrative tasks
Annotates, categorizes and addresses incoming mail on a daily basis
Responds to questions and requests from the client and customers
Ensure claim files are properly documented
Maintains professional client relationships and provides superior customer service
Each Trainee must successfully complete all State mandated continuing education hours and must also obtain the necessary license or certification in accordance with State regulations
Evening or weekend courses/seminars might be required in order to meet certification/licensing requirements
Two-point Contact
Investigations
Denials
Reserving
Notification of coverage
Resolution of claims
CMR Compliance
Diary Compliance
Excess Reporting Compliance
Closing Ratio/Inventory Reduction
Significant Claims Activities
Regular File Reviews
Statutory Requirements
Client Relations
Client Training
Ability to prioritize multiple tasks and meet deadlines
Ability to work in a fast paced environment, prioritize and multitask
Casualty principals, policies and procedures
Microsoft office (word, excel)
Proficient in paperless environment, systems

123

Senior Claims Adjuster Resume Examples & Samples

Under limited management direction, adjudicate highly complex claims requiring specialized knowledge and expertise
Recognized as an internal resource providing technical guidance, assistance, and training to lower level associates
Interview involved parties
Manage diary timely and complete tasks to ensure that cases move to the best financial outcome and timely resolution
Applying creative solutions which result in the best financial outcome
A minimum of seven years’ experience adjudicating first party property and time element claims with extensive experience with exposure of $100,000 or more
Extensive experience in on-site investigation of property claims
Must current possess or have ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims

124

Claims Adjuster Resume Examples & Samples

Strive for continuous improvement on claim file handling with feedback and support through the
Quality Assurance Review processes
Contribute to maintenance of best practice procedures for Bodily Injury Complex claims, consistent with global best practice
Demonstrate an excellent standard of technical claims competence for handling moderate complex claims
Handle complex claims allocated within agreed level of authority limit
Effective communication of key Complex claims and Bodily Injury Claims portfolio messages to internal stakeholders
Strong specialist knowledge in Motor – Bodily Injury technical
Personal Lines claims handling. Road Traffic Accidents / Auto Liability, Auto
Adjusting experience
Must have a formal insurance qualification
Must meet Central Bank of Ireland minimum competency standards for Claims

125

Claims Adjuster Resume Examples & Samples

Complete field inspections, reviews and adjustments by reading maps and aerial photos, measuring fields and storage bins, and appropriately administering company crop insurance policies
Ensure compliant and cost effective application of crop policies by leveraging knowledge of basic insurance statutes and regulations and complying with state and federal regulatory requirements
Working knowledge of crop insurance regulations, policies, procedures and best practices
Working knowledge of investigative techniques and legal research methodologies
Communicate outside the organization and share information as a positive aid to achieve best practices and objectives

126

Casualty Claims Adjuster Resume Examples & Samples

Previous experience in handling EL/PL claims essential
Previous experience working in a customer service environment
Broad understanding of the insurance market
Outstanding communication and influencing skills
Strong investigative skills
Ability to work as a team player
Ability to use Microsoft Office applications

127

Temporary Casualty Claims Adjuster Resume Examples & Samples

Evaluate insurance coverage based on claim report, the insurance policy and applicable statutes and case law to determine if a claim can be accepted as being within coverage
Interviews, telephones, and/or corresponds with claimant and witnesses; obtains and reviews police hospital records, appraisals and repair estimates to evaluate injuries property damage; Reports to client as required by contractual account instructions; utilize appropriate methods of investigation according to type of coverage
Identify key coverage, damage and liability issues and plan investigation as required in accordance with contractual obligations and prevailing professional standards
Select and manage experts with limited input from supervisor
Work with and provide claim-specific guidance to Field Adjuster
Involve client in decision-making as appropriate and/or follow client-specific requirements for escalation when client decision-making and/or notification is required
Excellent written and verbal communication skills, and a strong customer service focus
Ability to work in a fast paced TPA environment with experience in a paperless system are a plus
Spanish fluency is a plus

128

VPS Claims Adjuster Resume Examples & Samples

Ensures compliance with ISO, SOX, PCI and other applicable internal and external audits and/or contractual obligations
Adjust and document all claims within departmental standards and in accordance to applicable laws and policy provisions to ensure compliance with all Department of Insurance Regulations
Process claims with accuracy to confirm coverage by reviewing all available tools including contract and web based applications to resolve complex issues and refer any issues as necessary to senior level adjusters or supervisor
Adjudicate claims with accuracy, by working directly with the repair facility, inspection and parts vendors and multiple other resources to ensure proper claims adjudication within departmental standards
Document reasons for denial or authorization of claim in accordance with policy conditions and quoting policy language to the correct parties in a timely manner within authority level and seek approval when above authority
Bilingual (English/Spanish)

129

Senior Claims Adjuster Resume Examples & Samples

Resolves complaints
Recommends subrogation and/or SIU referral. Manages pending claims to meet company quality criteria
1-5 yrs. related insurance or claims experience
Must hold current adjusters license
Bachelor's degree preferred or equivalent business experience
Xactimate experience a plus

130

Senior Causalty Claims Adjuster Resume Examples & Samples

Select and manage defense and coverage counsel
Work with and provide claim-specific guidance to Field Adjusters
Be alert to insurance fraud and implement special procedures if fraud is suspected
Review and analyze expert’s reports

131

Experienced Casualty Claims Adjuster Resume Examples & Samples

Determines and explains minimum coverage limits in moderately complex claims involving single or multiple claimants
Obtains photos and/or conducts scene investigation
May serve as an agent advocate in training

132

Claims Adjuster Resume Examples & Samples

Identify and assess related and unrelated (prior) auto damage and set clear
Inspect vehicles and write estimates, documenting claim related information and
Bachelor's degree or a combined total of five years of work experience and/or

133

Claims Adjuster Resume Examples & Samples

Under limited management direction, adjudicate highly complex Professional Liability claims requiring specialized knowledge and expertise
Adjust Professional Liability claims including claims on Directors and Officers, Financial Institutions, and Employment Practices Liability policies
Report to senior management and underwriters regarding claims trends and developments
Experience handling Securities and Employment Litigation Claims
Bachelors degree, or equivalent relevant experience required. JD/Law Degree Preferred
A minimum of five to ten years’ experience adjudicating management and professional liability claims with extensive experience with exposure of $100,000 or more
Must possess or have ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims

134

Claims Adjuster Resume Examples & Samples

University Graduate,
ACII or Diploma in Insurance
Good technical knowledge of property/casualty insurance
Over 2 years’ working experience in an insurance company
Over 1 years’ working experience in a claims environment
Compliance & Regulatory knowledge
Investigative Execution

135

Complex Claims Adjuster Resume Examples & Samples

Handle and investigate allocated medium complexity claims against policy conditions and in accordance with best practice requirements within agreed operating authority limit
Develop and maintain technical and soft skills to enable accurate assessment and reserving of temporary total disablement, permanent disablement, fatal accident and private medical insurance claims
Promote best practice for handling personal accident and private medical insurance claims across all products,knowing the specific procedures and processes that are applicable to Direct and Corporate policies within agreed Service Levels
Develop and maintain knowledge to moderate level of medical terminology and demonstrate translation in to layman terms on a day to day basis. Review and assess medical reports to determine the eligibility of the claim in addition to the appropriate loss of function
Ensure compliance with Legal & Regulatory framework which directly affects the claims function including FCA
Well developed negotiation and dispute resolution skills
Strong administrative and report writing skills
The ability to problem solve and develop new ideas to improve working practices
Lateral thinking
Complaint handling would be an advantage.1
Medical knowledge with an understanding of medical terminology

136

Senior Casualty Claims Adjuster Resume Examples & Samples

Evaluate pool coverage based on claim report, certificate of coverage, applicable statutes and case law
Interview, telephone, and/or correspond with members, claimants and witnesses; obtain and review police and medical records, appraisals and repair estimates to evaluate injuries and property damage pursuant to client instructions; varying method of investigation according to type of coverage
Work with and provide specific guidance to independent field adjusters
Determine extent of the client’s financial exposure with respect to claims; set appropriate case reserves
Revise case reserves based on developments obtained during the course of adjusting the claim
Handle complex litigated claims with limited input from the Unit Manager
Attend mediations/settlement conferences when necessary
Report claims to the regional office when required by client instructions
Effectuate prompt payment to claimants and service providers within assigned levels of authority, as set forth within detailed client account instructions
Possess knowledge of and comply with all statutory and regulatory requirements in all applicable jurisdictions
Be alert to fraud and implement special procedures if fraud is suspected
Ability to interact well with employees, coworkers, clients, defense counsel and service providers
Ability to properly prioritize job duties
Knowledge of claim handling principles and legal concepts
Knowledge of Iowa, Illinois and Nebraska governmental immunities and tort claims acts
Experience handling workers compensation claims a plus

137

Senior Claims Adjuster Resume Examples & Samples

Determines value of the claim considering depreciation and actual cash value, negotiates and commits to the settlement, and moves claim to closure. Resolves complaints, and participates in arbitration and/or grievance procedures
5 plus years of casualty claims experience
Ability to handle complex claims to resolution
Ability to travel up to 15%
5 plus years of claims litigation experience
Licensed in multiple states

138

Claims Adjuster Resume Examples & Samples

Investigates facts surrounding claims and determines damages
Evaluates liability of company and communicates outcomes and strategies with field partners
Negotiates settlements with claimants
Processes accounts payable check requests
Summarizes all activity in claims database and resolves claims in a timely fashion
Responsible for taking initial reports of new incidents and claims; as well as determining the appropriate level of handling among Risk Team members
Makes timely assignments to external claims service providers when appropriate
Builds and runs reports from claims database
Bachelor's degree in a related field
Experience or prior training in customer service
Efficient keyboarding skills
Must be detail oriented and possess organization skills
Excellent Microsoft Office skills
Enhanced computer skills; SAP knowledge preferred

139

Casualty Claims Adjuster Opportunities Resume Examples & Samples

Obtain, review and evaluate medical records
Comply with all statutory and regulatory requirements of all applicable jurisdictions
Determine extent of the client’s financial exposure with respect to claims; set case reserves for use by clients and applicable regulatory authorities
Be alert to insurance fraud and implement special procedures if possible fraud is detected
Settle claims within assigned levels of authority as set forth in client account instructions

140

Senior D&O Claims Adjuster Resume Examples & Samples

Ensure effective and prompt settlement of D&O claims in FL business areas
Setting of accurate case reserves
Contribute to high level technical output from team
Contribute to a positive and supportive Team Culture
Promptly handle and resolve all claims enquiries from customers, brokers and third parties
Advise & Coach less experienced claims adjusters as appropriate
Solid proven experience of working within the FL technical claims environment with a particular emphasis on international and domestic D&O
Excellent understanding of London Market Insurance Environment
Numeracy and literacy skills (to A level /degree level/equivalent)
Good Technical knowledge of all products and services offered by FL Team
High Level market, risk and business awareness
Strong understanding of legislation and legal liability

141

Claims Adjuster With German Resume Examples & Samples

Handling newly reported claims via the telephone
Creating the Incident Report Form and acknowledging receipt of the new claim
Ensure that all allocated work is handled within the Key Performance Targets of the Department
Promote compliance with best practice for all aspects of claims assessment across the department and be aware of bespoke practices for specified clients
Take personal and collective responsibility to ensure compliance with the Legal & Regulatory framework within which claims handling sits. This is to include, but not limited to, carrying out all accountabilities and objectives within the framework of the AIG TCF policy; ensuring FSA & DPA compliance; being aware of the implications of POCA and the Terrorism Act

142

Claims Adjuster General Liability Resume Examples & Samples

Manages mid-level 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 designated authority level
Manages subrogation of claims and negotiates settlements
Ability to meet or exceed Service Expectations

143

Claims Adjuster Resume Examples & Samples

Ability to read, understand, and apply policy terms
Minimum of 3 years Ocean Marine claims adjusting experience
TPA experience may be considered
Insurance designations preferred

144

Bodily Injury Claims Adjuster Resume Examples & Samples

Demonstrated proficiency in all areas of claim handling including bodily injury
Prior completion of Advanced BI class and the AEI Legal Law of Damages course and proficiency in the use of Colossus
Must complete Advanced BI, Colossus and AEI Law of Damages within one (1) year of assignment to position
Ability to effectively handle claims via an on-line claims system
Must have excellent planning and organizing skills
Must have excellent written and verbal communication skills. Some positions may require specific
Must have the ability to deal with conflict in an effective manner
Must possess on a timely basis all licenses required by the state(s) assigned and participate in state required continuing education courses

145

General Liability Claims Adjuster Resume Examples & Samples

Investigate reported customer incidents
Complete 3-Point contact with the team member, manager, and witnesses within 24 hours of notice
Interview guest(s), restaurant management and witnesses to gather all facts regarding the event
Assess information gathered for early identification of potential high-severity claims
Evaluate liability and damages exposure and establish proper indemnity and expense reserves
Take recorded statements as appropriate, conduct interviews of witnesses
Preserve evidence chain of custody as appropriate
Review cases for subrogation potential and pursues as directed by supervisor
Review cases for potential 3rd party tender
Run claim index reports
Create and maintain case files in an organized, systematic manner
Prepares appropriate correspondence in approved format including contact and denial letters
Maintain effective diary management system to ensure that all claims are handled in a timely manner
Communicate with the assigned insurance broker and/or carrier as directed
Responsible for management of non-liquor related litigated claims
Resolve non-litigated claims within applicable settlement authority levels, obtaining releases per claim handling guidelines
Inform claimants of denials when applicable
Utilize Be Our Guest certificates to resolve guest incidents as appropriate
Establish rapport and build relationships with both internal and external customers
Explain claims adjustment process to manage guest expectations
Return calls for assistance within 24 hours
Identify claims requiring notice to carrier and facilitate in conjunction with insurance broker
Provide feedback as appropriate to Loss Prevention on potential safety opportunities identified during investigations
Complete additional projects and assignments as requested by supervisor
Texas Property & Casualty Adjuster’s license required
Risk or Insurance professional designations preferred but not required
Possesses strong oral and written communication skills
Handles multiple tasks with competing and conflicting requests
Pleasant and clear telephone speaking voice
5-7 years Casualty claims handling experience required

146

Senior Claims Adjuster Resume Examples & Samples

Typing ability required (25 correct wpm)
Knowledge of CMS 1500 and UB04 claims forms and data elements
Knowledge of medical terminology and a working understanding of Claims Processing
Knowledge of EmblemHealth’s PPO contracts preferred
Minimum of (1) year experience in varied and responsible clerical work
Ability to interpret and apply written procedures
Ability to be trained to evaluate Medical claims within the Medical Claims System
Must pass CBT Testing/Claims Processing Assessment

147

Claims Adjuster Resume Examples & Samples

Under technical direction, works within significant limits and authority to actively manage a caseload of complex lost time cases in the Arkansas, Iowa, Michigan, Nebraska, South Dakota, and Wisconsin jurisdictions
Actively manage cases involving complex medical, legal and vocational rehabilitation issues
Manage diary and complete tasks to ensure that cases move to the best financial outcome and timely resolution. This includes properly scrutinizing both the propriety and efficacy of medical treatment
Analyze coverage issues and determine exposure to properly set claim reserves
Developing excellent working relationships with applicant attorneys
Minimum of three years of successful workers’ compensation claim management experience
Bachelors degree and/or multiple industry designations strongly preferred
Current Workers’ Compensation Claims license in Arkansas upon date of hire or ability to attain such license within 60 days of hire date
Proficient jurisdictional knowledge of workers’ compensation law and ability to adjudicate claims in the Arkansas, Iowa, Michigan, Nebraska, South Dakota, and Wisconsin jurisdictions either upon date of hire, or ability to attain such knowledge within the first several months of employment. Strong preference given to candidates with proficient knowledge of Wisconsin jurisdiction upon date of hire
Must have strong litigation management skills and excellent knowledge of applicable case law
Must be innovative in assisting injured workers in finding alternative employment opportunities
Must be experienced in managing rehabilitation issues and identifying and implementing innovative rehabilitation programs

148

Claims Adjuster Resume Examples & Samples

Makes prompt contact with insureds, claimants and witnesses involved in the loss or accident
Conducts investigation necessary to determine compensability and/or liability, including recorded statements based on Department processes and procedures. Assigns necessary inspections of damages or scene. Reviews any estimates or receipts for consistency with description of loss as well as appropriate scope and pricing. Identifies any legal liability issues and consults with supervisor
Ensures regular and timely follow-up and brings claims to prompt and appropriate conclusion
Evaluate and settle workers’ compensation, bodily injury, liability, business interruption, or structural claims with minimal input from supervisor
Maintains electronic records that accurately and thoroughly document all file handling activity
May be called upon to perform additional duties as directed
3 years or more claims handling experience preferred
Basic computer skills and Microsoft applications

149

Life Claims Adjuster Resume Examples & Samples

Bachelors’ Degree or minimum 2 years' experience adjudicating Life, Health, Medical or Disability Claims
Excellent interpersonal and team building skills
Excellent judgment, research, and organizational skills
Ability to multi-task, prioritize and handle high volumes
Detailed-oriented with the ability to work well independently and with others

150

Claims Adjuster Resume Examples & Samples

Ensure effective and prompt settlement of claims in Marine and Fine Art and Specie business areas
Investigate and negotiate claims within defined authority limits
Management of external counsel and experts both locally and internationally
Some knowledge of products and services offered by Marine and Fine Art and Specie Team
Market, risk and business awareness
Understanding of legislation and legal liability
Understanding of London Market Insurance Environment
Interpretation of policy covers
Experience of working within technical claims environment

151

Claims Adjuster Resume Examples & Samples

Evaluating, developing, reporting on and resolving complex and/or higher value individual claims
Approving financial transactions on claims within his/her authority
Collaborating and assisting in account management, often with other internal department representatives
Analyse loss and expense trends on loss portfolios and assist in the development and implementation of plans to improve results
Assisting in the preparation of claim reviews and visits under the instruction of Senior Claims Manager, providing detailed oversight of the cedants claims process and advised losses together with marketing support relating to clients and brokers
Anticipate client needs and expectations and deliver superior customer service
Work effectively with others within the claim department, particularly with other Claim Experts/Managers, Claims Operations and those within the Technical Accounting, to ensure prompt turnaround and response to clients
Close liaison with Technical Accounting and Underwriters, ensuring clients’ needs are fully understood and met, and that, together with the Claims Team, there is a close alignment of interests and a strong collaborative working relationship between all parties
Work closely and effectively with other internal stakeholders including Underwriters and Actuarial, providing support and insight when required and appropriate
Liaise and support the claims departments in other SCOR EMEA hubs/branches as required and appropriate
Perform detailed research and analysis on individual topics, as directed by Senior Claims Management, and produce report/s detailing findings and making recommendations when required and appropriate
Assist in the analysis and reporting of large complex losses and events, including assisting in the co-ordination / production of LLNs, ensuring accuracy of advised figures especially where an accumulation of exposures has been identified
Assist in broad analysis of the claims portfolio, including monitoring of potential exposures (‘watch list’) and reviewing appropriateness of historical reserves (‘statics’)
Monitoring and quarterly testing of ICS controls
Keep abreast of claim and industry developments/trends in order to maintain a high level of expertise
Assist in ensuring that globally aligned processes and procedures are adhered to, identifying opportunities for improvements, thereby enabling a move towards a more aligned and efficient operating environment
Demonstrate commitment for achieving team objectives and plan and adjust work activities accordingly
Participate in projects as required
Manage company resources responsibly and effectively
Has enough vocabulary for simple conversations. Understands simple text and notes. Participation in a meeting is not yet possible
Can attend but not participate in team meetings and engage in simple, short telephone conversations. Can write short memos and simple messages
Can take part in discussions on familiar subjects in meetings. Can write memos, simple letters and reports
Can actively participate in meetings and group conversations. Can lead negotiations. Writes complex business letters and reports
Can lead discussions and negotiations at the highest level. Writes complex reports. Rarely makes grammatical mistakes

152

Senior Claims Analyst / Claims Adjuster Resume Examples & Samples

Evaluating, developing, reporting on and analysing individual claims and events
Approving financial transactions on claims within his/her authority
Analyse loss and expense trends on loss portfolios and assist in the development and implementation of plans to improve results
Anticipate client needs and expectations and deliver superior customer service
Work effectively with others within the claim department, particularly with other Claim Experts/Managers , Claims Operations and those within the Technical Accounting, to ensure prompt turnaround and response to clients
Close liaison with Technical Accounting and Underwriters, ensuring clients’ needs are fully understood and met, and that, together with the Claims Team, there is a close alignment of interests and a strong collaborative working relationship between all parties
Work closely and effectively with other internal stakeholders including Underwriters and Actuarial, providing support and detailed insight on individual claims and the portfolio when required and appropriate
Perform detailed research and analysis on individual topics, as directed by Senior Claims Management, and produce report/s detailing findings and making recommendations when required and appropriate
Assist in the analysis and reporting of large complex losses and events, including assisting in the co-ordination / production of LLNs, ensuring accuracy of advised figures especially where an accumulation of exposures has been identified
Assist in broad analysis of the claims portfolio, including monitoring of potential exposures (‘watchlist’) and reviewing appropriateness of historical reserves (‘statics’)
Monitoring and quarterly testing of ICS controls
Assist in ensuring that globally aligned processes and procedures are adhered to, identifying opportunities for improvements, thereby enabling a move towards a more aligned and efficient operating environment
Liaise and support the claims departments in other SCOR EMEA hubs/branches as required and appropriate
Keep abreast of claim and industry developments/trends in order to maintain a high level of expertise
Good technical knowledge of legal principles, policy wordings and insurance market practice relevant to the handling and reserving of claims
Excellent IT Skills including Word, Excel and Power Point
Minimum 5 years of combined insurance/reinsurance claims handling experience
Experience of claims within assigned business areas
Good working knowledge and experience of local and exposed territories

153

Casualty Complex Claims Adjuster Resume Examples & Samples

Functional Responsibilities
Strive for continuous improvement on claim file handling with feedback and support through the Quality Assurance Review processes
Contribute to maintenance of best practice procedures for FL Complex claims, consistent with global best practice
Effective communication of key Complex claims and FL portfolio messages to internal stakeholders

154

Claims Adjuster Resume Examples & Samples

Requires good interpersonal skills and strong decision making and organizational skills
Excellent customer service skills, strong analytical, and written and verbal communication skills
Ability to work and prioritize multiple tasks and to use Microsoft Word and Excel

155

Claims Adjuster Resume Examples & Samples

Receive correspondence or phone call alleging some type of loss or claim from insured and/or claimant. Review existing pertinent correspondence or talk to party on the phone. Send letters and necessary forms to the insured and/or claimant requesting pertinent facts or information. Determine if an independent adjuster is required and make proper arrangements by contacting local adjusting bureau in that area by letter or telephone
Gather facts pertinent to the liability of the claim by written correspondence, telephone and services of an independent adjuster, if necessary
Evaluate data supplied by police reports, repair statements, contracts, witness statements, claim settlements, etc. to determine if liability exists
Prepare formal denial letters by dictation or verbally by telephone, with prior supervisor approval, if there is no coverage or liability
Evaluate the amount of the claim according to the facts of the accident and investigation in which there is coverage or liability
Settle at a fair price, after proper investigation, claims within the adjuster’s authority limits without sacrificing quality of work to meet established standards of quantity
Must become licensed in all states handled, within six months of employment, which require an adjuster’s license
Maintain a number of pending claims within acceptable limits and control expenses through proper work organization
Utilize the adjuster’s experience, knowledge and judgement to provide the insured and/or claimant with the best possible service, thereby avoiding complaints
Refer questions on claims exceeding individual authorization to the Supervisor
Keep abreast of industry trends and new practices and methods by formal schooling and reviewing technical publications
Take recorded statements as required
Must read and follow fair claims practices of states for which they are accountable
Must meet or exceed company and department performance goals
1-2 years in claims or related field. This position requires a working knowledge of multiple state insurance rules, regulations and unfair claims practice, medical terminology, legal terminology and processes and negligence laws
Must have excellent communication skills (written and verbal) and inter-personal skills
Must be able to deal with all levels of personnel in government agencies, claimants, insureds, adjusters outside of the company, etc
Must be able to work in a computerized environment with software applications such as Windows 95, email, etc
Must be able to operate standard office equipment such as a fax machine, photocopier, computer terminal or personal computer (PC), calculator (10-key) and single or multi line telephone. Use a PC 60% daily, use a telephone 50% daily

156

Commerical Claims Adjuster Resume Examples & Samples

4+ years experience in commercial claims
Commercial General Liability experience
Litigation Experience
Experience with claims in construction due to accidents

157

Claims Adjuster Resume Examples & Samples

Assure that all Crop Hail, MPCI (Multiple Peril Crop Insurance), Private Product claims investigating and adjusting are in accordance with AmTrust Agriculture Insurance Services & FCIC/RMA goals and objectives.Ensure that claims are investigated and processed in compliance with state and federal regulation by performing continuous research on changing governmental regulations
Ensure uniform and compliant adjusting procedures are used and maintained
Facilitate effective claims investigating and processing
Ensure that AmTrust Agriculture Insurance Services is not paying unnecessary claims by reviewing and approving claim files and resolving disputed claims in an equitable manner
Recommend solutions involving crop claims or other problems and crop accounts
Respond to and resolve customer service requests according to AmTrust Agriculture Insurance Services policies in a prompt, efficient and courteous manner for external customers, departmental staff, and other AmTrust Agriculture Insurance Services personnel at all times
Ensure staff inspects, appraises and adjusts crop claims using RMA and company rules, manuals, and procedures
Conducts crop risk management activities on large crop claims
Provides oversight towards the resolution of claims files
Submit weekly reports on events and issues impacting assigned territory

158

Senior Claims Adjuster Levels Resume Examples & Samples

Review claims regularly using diary system to ensure accurate reserves and timely closure
Comply with all GB and office procedures
Actively participate in GB training programme
Attend Conferences/Consultations when appropriate
Detailed understanding and knowledge of all company specific procedures, including Service Instructions and Adjuster’s Manual

159

Claims Adjuster Level Resume Examples & Samples

Respond to all written and phone enquiries clearly, courteously and promptly
2 - 5 years experience in a similar role
Advanced MS Excel skills

160

Senior Claims Adjuster Resume Examples & Samples

Gathers information and documents claims file to comply with company guidelines and state regulations
Determines value of the claim, negotiates with claimants and/or attorneys moving claim to closure
5+ yrs. related business experience
Candidate is expected to obtain required state licenses after hired
Bachelor's degree or equivalent business experience
Strong investigative, evaluation and negotiation skills

161

Complex Claims Adjuster Resume Examples & Samples

Managing key claims handling enquiry; coverage determination and quantum analysis for high value complex claims
Ensuring effective vendor and litigation management on Complex claims within a personal allocation, including demonstrable savings
Reporting key claims messages to their Team Manager and to internal stakeholders
Broadening internal / external stakeholder communication where required, as Property & Energy technical claims expert and thought leader
Delivering technical training to colleagues and external contacts as appropriate
Assisting in continuous improvement across the region through support for the Quality Assurance / Regional Audit processes (potentially assisting Team Manager to complete monthly quality assurance reviews)
Ensuring adherence to best practice procedures for Property & Energy Complex claims, consistent with global best practice
Handling higher level of complexity claims within authority limits
Timely, accurate and customer focused claim resolution, minimising indemnity exposure and mitigating vendor and legal expense
Consistent proactive claims handling on an ongoing basis (i.e. initial file review, investigations and liability, negotiations and settlement, and litigation management)
Effective communication and management of key advanced Complex claims and Property & Energy portfolio messages to internal stakeholders and customers/clients
Line of business specialist knowledge
Property – Real estate/office, Leisure (hotels, resorts, fitness etc) Transport Infrastructure, Manufacturing & process Industries, Terrorism
Energy – Oil & Petro-chemical knowledge, Oil-rig experience, Power/Utilities knowledge, CAR, Mining loss knowledge, Terrorism
Good presentation skills and file knowledge
Time management – ability to manage & prioritise workload and diary management
Ability to contribute effectively within a team environment and with internal/external stakeholders at all levels
Ability to assist with technical training to team claim handlers as required
Ability to influence claims and non claims stakeholders to effectively direct claims strategy
Well developed/Advanced expertise and knowledge in Property & Energy most technically complex claims topics
An advanced and thorough knowledge of legal / regulatory and litigation / procedural requirements for their line of business
Experience in negotiation, mediation, arbitration and ADR skills on higher value complex claims
Experience in effectively following up on recommendations from technical claims audits and continuous file handling improvement

162

Claims Adjuster Resume Examples & Samples

Authorize a minimum of 20 - 28 claims per day based upon approved dollar limit authority and answer a minimum of
40– 50 calls per day
Perform one (1) inspection per 45 phone authorization or 2 per week
Answer phone inquiries and calmly provided information about claim processing and explain the different levels of contract coverage and terms
Process and complete all paperwork according to established procedures
Other Job Duties as assigned

163

Claims Adjuster Resume Examples & Samples

Investigates and reviews all information related to claims
Processes documentation according to established procedures to review and resolve claims
Maintains account records of claim activities
Advises claimants and DHL personnel on claims procedures and Terms and Conditions
Prepares claims reports
Receives and establishes files for all cargo claims
Escalates unusual or complex claims issues as appropriate
Gathers and prepares data for claim files
Will evaluate Claims procedures manual on an on-going basis for accurate and complete information, and provides recommendations for improvement as needed
Will review cargo claims for settlement recommendations and approve within stated guidelines, regardless of claimants request
One year of claims experience, preferably in logistics industry
Handles outbound and inbound customer calls
Reviews customer claims and communicate outcome approve within stated guidelines
Preferably 3+ years of experience in related area of responsibility
Subject matter expert in service, production, or support area of responsibility
Performs all of the standard, specialized and most complex aspects of the function

164

Crop-senior Claims Adjuster Resume Examples & Samples

Build and maintain relationships with customers by providing timely and accurate policy service, answering questions and communicating adjustment determinations
Accurately document, process and transmit loss information in order to determine potential damages
Support business objectives by participating in quality control tasks, audits, risk assessments and field reviews
Adopt QBE values in personal work behaviors, decision-making, contributions and interpersonal interactions; manage own career development by soliciting feedback and valuing other perspectives
Experience with agriculture and/or farming
Work effectively under pressure; able to comply with tight deadlines
Establish and maintain effective, trusting and respectful relationships with others
Work independently with little to supervision
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165

Claims Adjuster Resume Examples & Samples

Under technical management direction, adjudicate complex Professional Liability claims requiring specialized knowledge and expertise
Bachelors degree, or equivalent relevant experience required
A minimum of three years’ experience adjudicating management and professional liability claims with experience with exposure of $100,000 or more

166

Field Propety Claims Adjuster Resume Examples & Samples

Conducts inspections of loss sites, writes appraisals for dwelling repairs and issues payment to policyholders where possible. May work with a Liberty network contractor in the appraisal process. Ability to independently scope losses
May be called upon for catastrophe duty. For Catastrophe (CAT) roles, investigative fieldwork includes a high amount of travel to claim location
Capable of writing structural damage estimates of moderate to severe losses
The capabilities, skills and knowledge required is normally acquired through Bachelor’s Degree or equivalent experience and at least 2 years of directly related experience

167

Warranty Claims Adjuster Resume Examples & Samples

Solid interpersonal, conflict resolution, negotiation, and decision making skills
One or more years of directly related experience at a professional level
Previous automotive/technical experience at either a manufacturer or dealer level is preferred, especially in the Parts and Service area
High School or equivalency, bachelor s degree in a related discipline is preferred
Working knowledge of a Microsoft Office Suite and other PC applications
Typing skills: 30 WPM
This position provides day to day direction and assistance to dealer and regional personnel with telephone support and telephone training on all facets of the claims life-cycle, including warranty, service contracts, campaign, goodwill inquiries, pre approvals, and post approvals. In this position, the rep will work closely with others in a large team environment

168

Senior Casualty Claims Adjuster Resume Examples & Samples

Evaluate coverage based on an investigation that includes, but is not limited to, the claim report, the insurance policy, memorandum of coverage, and applicable statutes and case law to determine if a claim can be accepted as being within coverage. Determine coverage aspects and prepare coverage letters as necessary
Evaluate compliance with the applicable governmental statutes with in-depth knowledge of multi-jurisdictional claims handling issues including governmental tort claims statues and legal principles associated with insurance coverage
Identify and report to client key coverage, damages, and liability issues; develop plan and conduct investigation utilizing appropriate methods according to type of coverage and nature of the exposure. Investigation shall be in accordance with contractual obligations and prevailing professional standards along with York quality standards
Obtain and evaluate medical records to make a causation and/or damage assessment
Maintain current, all required licenses and certifications; meet all continuing training and certification requirements
Calculate the extent of the client’s financial exposure with respect to claims, including, but not limited to, liability, estimated expenses and potential indemnification; analyze information to set case reserves for use by clients and applicable regulatory authorities
Revise case reserves based on diverse factors, including additional evidence and medical developments discovered in the course of investigating the claim
Have a sense of awareness to fraud factors and implement Special Investigation procedures if insurance fraud factors are detected
Employ cost-benefit analysis to develop and manage litigation strategy and plan same with defense counsel, specifying the nature and extent of discovery, use and selection of experts, filing of motions, etc
Negotiate and settle claims within assigned levels of authority as set forth in individual client account instructions and consistent with company policies and guidelines
Use analysis of situation to recommend appropriate experts for testimony regarding damages and liability or, conversely, advise when not to use said experts
Involve client in decision-making as set forth in client account instructions and consistent with company policies and guidelines. Determine when to involve the client in decision-making by applying client’s instructions and corporate guidelines
Collaborate with co-workers on analysis of situations by being able to apply knowledge appropriately and communicate same effectively
Provides back-up support to the Unit Manager or Assistant Vice President on special projects, as well as leadership and technical expertise for the lower level adjusters, and managing client relationships
Be available for after-hours calls from clients for immediate analysis and response to accident scenes or loss locations to conduct investigation and /or claim management
Evaluate needs and when appropriate hire and oversee outside vendors
Based on experience, analysis and discretion, manage litigation
Excellent oral, interpersonal, written communication/negotiation and presentation skills
Superior analytical and interpretive skills
Advanced organizational/multitask/prioritizing skills
Strong customer service skills and works well under pressure
Coverage analysis
Investigation
Litigation management
5+ years’ experience in Commercial Lines including Commercial GL and Construction Defect claims

169

Senior Claims Adjuster Resume Examples & Samples

You will provide oversight and direction related to coverage analysis, investigation, evaluation, reserving and resolution of a book of product specific claims in accordance with your agreed authority and the Claims Handler Guidelines
Management of Delegated Authority arrangements ensuring they adhere to the service levels in place and provide the expected outcomes to our customers in line with the XL Catlin philosophy including analysis of Management information
You will effectively control a portfolio of claims by ensuring that communications, new claims and notifications are dealt with in a timely manner
Supporting Underwriting teams and key stakeholders in connection with claim trends, marketing and business development
Interaction with and support of management and all other relevant internal stakeholders with a view to effectively support Underwriting Growth and Profitability
Effectively communicate with insureds, brokers, TPAs and Coverholders to understand the customer needs and deliver claims outcomes
Understanding and adherence to Lloyd’s Minimum Standards and Conduct Risk requirements
Leverages technical expertise and capabilities across the Claims business
Acts as a trusted partner and collaborator with colleagues, internal and external stakeholders, and clients proving claim insights to minimize risk exposure
Takes ownership and accountability for the management of assigned claims and successfully oversees the strategy to obtain the best result for both XLC and the insured
Advanced knowledge of insurance line of business

170

Claims Adjuster Resume Examples & Samples

Make liability enquiries, in accordance with Adjuster’s Manual, using most appropriate method (phone, correspondence, field visit)
Develop relationships with clients by providing a friendly, efficient service
Liaise with and control own solicitors to ensure cases not abandoned to them
Promote and enhance GB image
Proficiencies in MS Word, MS Excel (Intermediate Level), and Lotus Notes
Intermediate MS Access skills

171

Claims Adjuster Resume Examples & Samples

Reviews policy provisions and medical facts, along with any other documentation as needed, to make an appropriate claim decision in accordance with statutory and company requirements
Calculates payment of benefits due and processes claims in the appropriate admin system
Communicates with beneficiaries, policyholders and/or agents to request additional documentation, or to advise them of procedures necessary to complete claim adjudication and to communicate claim decisions
Documents claim file of all actions taken
Makes recommendations for process improvements
Consults with other areas of the company as the work demands (i.e. Underwriting, SIU, PHS, Legal, etc.)
Ability to provide prompt and high quality customer service to our policyholders, beneficiaries and agents
Basic knowledge of insurance products
Good critical thinking abilities
Basic ability to prioritize
Basic ability to multi-task and adapt to an ever changing environment
Good knowledge of Microsoft Word, Excel and Outlook
Good ability to effectively communicate, both verbally and through written correspondence to our customer
Basic knowledge of medical terminology
Good decision-making abilities
Good interpersonal and organizational skills

172

Complex Claims Adjuster Casualty Spain Resume Examples & Samples

17 % - Managing key claims handling enquiry; coverage determination, quantum analysis and legal liability assessment, where appropriate within authority limits and providing a high standard of customer service
17 % - Work with Team Manager/Senior Adjuster to ensuring effective vendor and litigation management on Complex claims within a personal allocation. 17 % - internal stakeholder communication where required 17 % - Strive for continuous improvement on claim file handling with feedback and support through the Quality Assurance Review processes
17 % - Contribute to maintenance of best practice procedures for (LoB) Complex claims, consistent with global best practice. 15 % - Demonstrate a basic standard of technical claims competence for handling moderate to lower complexity complex claims. Handle complex claims allocated within agreed level of authority limit

173

Claims Adjuster Resume Examples & Samples

Identify all exposures, establish accurate and timely reserves and monitor those reserves as claim matures
Direct the investigation and settlement of claims in litigation which may involve coverage issues
Will be called upon to conduct training or participate in auditing claims files
Identify vendors with the appropriate skill sets for the situation and effectively manage the vendors to achieve satisfactory results on both expense and indemnity costs
Training and/or mentoring claim handlers and specialists
10 years or more claims handling experience preferred

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