Claims Specialist Resume Samples

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K Halvorson

Kody

Halvorson

222 Myrna Valley

Chicago

+1 (555) 886 9539

222 Myrna Valley

Chicago

Phone

p +1 (555) 886 9539

Experience Experience

New York, NY

Claims Specialist

New York, NY

Pouros, Lubowitz and Gleichner

New York, NY

Claims Specialist

Researching and providing technical assistance to contracted service providers, Division staff and other external entities relating to claims processing
Assemble data, analyze performance, identify problems and develop recommendations to support Project Management planning and operations
Develop a professional working relationship with the Client, on-site field investigators, technicians, management team and other personnel
Support Claims Management in establishing departmental objectives and procedures to provide direction to claims team
Performs liaison services to both internal and external customers providing assistance in claims
Make outbound calls to carrier, injured employee & health care providers to obtain work status and case notes
Performs quality assurance audits APD claims files to measure quality, provide feedback and develop employees

Houston, TX

Unemployment Claims Specialist

Houston, TX

Metz-Prohaska

Houston, TX

Unemployment Claims Specialist

Good problem solving and decision making abilities
Focusing on financial impact of claims and actively pursues opportunities to enhance unemployment results and impact unemployment tax rates
Researches partner separations and builds claim responses; ensures the timely, courteous and professional follow up to incoming phone calls, and emails
Reviews and updates cases for completion, accuracy, routing and resolution
Develops effective working relationships with customers, team members, Starbucks partners, and other Starbucks organizations
Effectively manages multiple cases, following up with customers, vendors, etc. to ensure a timely and satisfactory resolution
Ensures that work is accurate and complete, processed in a timely manner with proper spelling and grammar

present

Boston, MA

Senior Claims Specialist

Boston, MA

Shields LLC

present

Boston, MA

Senior Claims Specialist

present

Provides plan and claim information, assists with submission of claims, and makes outbound calls to gather missing information on incomplete claims
Participate in the development of policies and procedures to improve department workflow and the claims process ensuring proper documentation
Manage return to work with the Return to Work Coordinator
Provides claim information, assists with submission of claims and makes outbound calls to gather missing information on incomplete claims
Collaboratively work with a network of approved in-house professionals and monitoring the progress of a claim
Advise clients of their claim related obligations under the policy and establish client-specific claims management procedures
Monitors and improves the performance of trading partner’s services for your clients

Education Education

Bachelor’s Degree in Integrity

University of California, Berkeley

Bachelor’s Degree in Integrity

Skills Skills

Knowledge of diagnosis and procedure codes, general medical terminology, and disability duration guidelines
Strong communication, negotiation and presentation skills. Ability to effectively interact with all levels of CNA's internal and external business partners
Manage an inventory of claims to evaluate compensability/liability
Detail oriented/ability to follow client specific guidelines
Knowledge of all types of professional claims
Solid knowledge of claims and insurance theory and practices
Strong interpersonal and communication skills. Ability to effectively interact with all levels of CNA’s internal and external business partners
Solid knowledge of claims and insurance industry theory and practices
Solid knowledge of Microsoft Office Suite as well as other business-related software
Knowledgeable in MS Word and MS Excel

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15 Claims Specialist resume templates

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Life & Specialty Claims Specialist Resume Examples & Samples

Minimum 2 years of direct claims experience
Working towards an insurance industry designation (at minimum 1 course completed)
Experience in effectively managing complex claims
Bilingualism in French and English, written and spoken considered an asset

Senior Claims Specialist Resume Examples & Samples

Evaluate claims, provide support information and recommend authorization decisions to the VP Risk Management
Oversee claim data management, principally in a digital environment
Performs other assignments and projects as requested

Title Claims Specialist Resume Examples & Samples

Two to three years of experience in loan processing and closing activities
Two to three years of experience applying general accounting principles
Strong knowledge of loan processing and closing policies and procedures
Well-developed ability to manage multiple tasks/projects and deadlines simultaneously

Senior Claims Specialist Resume Examples & Samples

5+years claims experience
High School diploma required, degree preferred
Ability to create the most complex and successful strategies for risk mitigation
Knowledge of claim handling & claim adjudication processes and procedures
Understand the basic process and value of basic data analytics and benchmarking
Ability to communicate technical information orally and in writing
Travel required

Claims Specialist Resume Examples & Samples

Claims adjudication experience
Ability to multi-task Manages time effectively
Committed to superior customer servicing
Ability to work independently, a self- starter
3 – 5 years claims adjudication experience
College preferred, or equivalent work experience

Claims Specialist Resume Examples & Samples

Review information contained on the initiation system and set up new claims into the claims system according to the terms of the plan purchased
Set adequate reserves to ensure proper reporting
Verifies travel insurance coverage utilizing various methods e.g., computer, fax, manifest, e-mail or telephone
Provide insurance verification of coverage for the assistance companies
Mails out appropriate claim forms, letters and related correspondence
Cultivates relationships with individuals at tour operators and cruise lines in order to obtain the necessary claim information
Assists with incoming electronic correspondence
Assists with opening and prepping the daily mail
Assists as needed with Scanning documentation and pertinent information to AS400 IMS/21 document system individually or batch mode
Liaison with Customer Service and assists with phone calls
Assists Claims Examiners with claims adjudication
Generates letter requests for the Claims Specialist II
Follows up on outstanding medical records requests
2-3 years of work experience in an office environment
General office skills including data entry

Claims Specialist Resume Examples & Samples

3+ years of directly related industry experience
Experience in reading and understanding UB04 and HCFA forms
Experience in Workman’s Compensation and Motor Vehicle Claims processing
Solid negotiation and analytical skills

Claims Specialist Resume Examples & Samples

Manages the appropriate level of resources for your clients
Displays a visible sign of professionalism and direction for the practice
Maintains local relationships with all major trading partners
Participates in meetings and provides ideas and strategies that strengthen the practice
Ensures quality and consistency in executing best practices
Partners with others as necessary to continually improve quality and innovation of group
Monitors the performance of trading partner’s services for your clients
Ensures practice strategy alignment with Willis business plans
Maintains direct relationships with key clients

Supplemental Rent Claims Specialist Resume Examples & Samples

Logs and initiates all customer claims
Reviews customer claim documentation for completeness and works with customers to resolve shortfalls, as necessary
Customer’s first point of contact within GECAS for all claim related queries
Identify and collate relevant contractual obligations to support maintenance event claims
Interpretation of contractual maintenance and AD cost sharing formulae
Administer all lessor contributions, including budgetary approval
Monitor claims process to ensure cycle time targets are achieved
Serves as a focal point for all queries relating to customer claims
Undertake claims assessment and reporting to support GECAS sales activity and serviced entity queries
Provides on-going analysis and reporting to support other functions and project related work
Supports Claim Manager by leading face-to-face customer meetings to plan maintenance, work-scopes and claims
Professional Engineering, Financial or Business degree
Demonstrated experience in the interpretation of contractual language
Experience in and an understanding of work-scope documentation and shop visit reports
Demonstrated capability in developing and maintaining good working relationships, at all functional levels, within customer airlines
Strong system and computer skills
Aviation industry experience
Working knowledge of operating lease structures
Ability to manage multiple tasks and to prioritise
Good communication skills - written and spoken

Claims Specialist Resume Examples & Samples

Commitment to preserving confidentiality
Must be available to work overtime and/or weekends depending on business needs
Proficiency in all Microsoft Office Programs, including Word, PowerPoint, Excel, and Access

Claims Specialist Resume Examples & Samples

Bachelor's Degree in a related field
Knowledge of order to cash
Knowledge of SAP navigation & logic

Senior Claims Specialist Resume Examples & Samples

8-10+ years experience in multi-jurisdictional claims handling or related work with an insurance service provider and/or preferably in a large, multi-location corporation (an insured)
General liability claims experience required, preferably for entertainment, sports, hospitality, retail or similar accounts with customer-intensive claims
Experience with litigated claims having multiple defendants and complex, 3rd-party contract elements required; must be conversant with legal environment and legal system procedures
Analytical skills necessary to obtain and evaluate complex information, analyze problems, develop alternative solutions, and project long-term effects of decisions
Ability to effectively prioritize, organize, and perform multiple tasks with strict deadlines
Ability to develop relationships and work collaboratively with project teams
Strong Microsoft Office skills required; demonstrated competency in Excel
Proficiency in commonly used claims information data base systems
College degree and/or equivalent experience required
Applicable insurance/claims certifications and licenses a plus

Unemployment Claims Specialist Resume Examples & Samples

Provides coaching and guidance to regional partner resource generalists, district managers, and store managers on the interpretation of Starbucks unemployment, policies and procedures
Analyzes and investigates partner separations in consultation with others in Partner Resources, external contacts or other departments outside PRO Solutions & Services
Provides strong customer service by effectively managing customer expectations while meeting customer needs
Researches partner separations and builds claim responses; ensures the timely, courteous and professional follow up to incoming phone calls, and emails
Reviews and updates cases for completion, accuracy, routing and resolution
Develops effective working relationships with customers, team members, Starbucks partners, and other Starbucks organizations
Effectively manages multiple cases, following up with customers, vendors, etc. to ensure a timely and satisfactory resolution
Maintains current knowledge on state to state unemployment processes, Partner Resources policies, procedures and best practices
Participates in cross-functional teams to successfully execute programs and projects
Performs research and analysis to maintain expertise in specialized state unemployment policies, laws and regulations
Customer service (2 years)
General human resources (2 years)
Case management (2 years)
Ability to conduct independent research and analysis
Proficient in Microsoft Office Suite (Word, Excel, PowerPoint, Visio, Microsoft Project)
Ability to work in a fast-paced and changing environment
Ability to work both independently and as a member of a team
Knowledge of SAP (production environment) or similar software

Contestation / Claims Specialist Resume Examples & Samples

Experience with claims adjudication processes and identifying claim overpayment errors for inpatient and outpatient providers
Prior experience with claims adjudication processes for a healthcare organization or managed care provider
Ability to analyze paid claims and review reports to identify discrepancies for contesting/appealing according to established procedures
Ensure correctness of delivery systems, participating providers, and contractual arrangements per market
Effective communication verbally and written
Experience in analyzing and reporting large volumes of data
Microsoft Office using Access, Excel, Word, and Power Point
Understanding of Current Procedural Terminology (CPT) codes, ICD- 9CM, ICD-10CM, Ambulatory Surgical Center (ASC) groupers, and Diagnosis Related Groups (DRG) and managed care
Knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines
Self-motivated creative and analytical background
Understanding of multiple health plans claims data files, i.e. Humana service fund reports
5 +plus years of understanding health care claims processes and systems
Experience with understanding Medicare and Medicaid Risk models

Senior Claims Specialist Resume Examples & Samples

Extensive experience of handling claims of a complex nature
Helps develop and execute the strategies of the practice - leading full team (including Risk Control Consultant and Data Analyst) on creating strategy for larger accounts
Handles complaints, arbitrates disputes and negotiates alternative solutions
Consults with clients to help mitigate their risk
Support new business with sales presentations and RFP
Monitor the performance of trading partner’s services for your clients
Ensure appropriate program design and documentation - service scope aligns

Claims Specialist Resume Examples & Samples

Ensure support for business lines (lab and business) by evaluating and validating communications for products
Evaluate regulatory and media risks of claims along with different products communication aids
Help identify and report product communication issues
Education : Minimum BA or BS
Years of working experience : 0 to 3 years
Experience : Lab or regulatory experiences
Language : English
Other skills : Interpersonal skills

Claims Specialist Resume Examples & Samples

Reconcile claims filed to payments received on Investor and Mortgage insurance claims
Prepare claim payment reconciliation to ensure full payment is received
Create and update charge removal payments balancing to claims payments received
Determine root cause of curtailed items and determine whether supplemental claim, client expense, or loss has been incurred
Follow up on claim payment status for unpaid, filed claims
Update the system with pending, submitted, withdrawn, and paid claim information
Recommend improvements to established procedures and processes
Analytical Thinking: The ability to tackle a problem by using a logical, systematic, sequential approach
Diagnostic Information Gathering: The ability to identify the information needed to clarify a situation, seek that information from appropriate sources, and use skillful questioning to draw out the information when others are reluctant to disclose it
Personal Credibility: Demonstrated concern that one be perceived as responsible, reliable, and trustworthy
Stress Management: The ability to keep functioning effectively when under pressure and maintain self control in the face of hostility or provocation

Senior Claims Specialist Resume Examples & Samples

Coordinate and oversee claims management strategies on reserving, settlement and closure to bring claims to resolution
Communicate and go on-site as necessary to all NJ warehouses to assist with all internal claims management activities
Participate and manage quarterly claims reviews with the TPA for managed claims
Develop and Monitor goals for claim mitigation within stores
Manage return to work with the Return to Work Coordinator
Act as an internal resource for Workers’ Compensation questions
Utilizes TPA RMIS system for claims management

Senior Claims Specialist Resume Examples & Samples

Help develop and execute the strategies of the practice - leading full team (including Risk Control
Consultant and Data Analyst) on creating strategy for larger account
Handles complaints, arbitrates disputes, and negotiates alternative solutions
Consults with client to help mitigate their WC risk
Ensure TPA/Carrier performance through claim reviews, audits, etc
3+years claims experience
Degree required
Knowledge of workers compensation claim handling & claim adjudication processes and procedures
Knowledge of New York State laws, legal codes, procedures and processes involving WC insurance
Knowledge of Construction Industry WC claims

Claims Specialist Resume Examples & Samples

Adjusts property and general liability claims in the snow sports industry
Determines coverage; sets and adjusts reserves
Oversees all phases of incident investigation; conducts interviews/site inspections; hires outside experts and adjusters
Negotiates settlements within authority
Hires and directs defense counsel; manages defense budgets; plans and oversees discovery process; attends depositions, hearings, mediations and trials, as necessary
Provides risk management services to assigned snow sports accounts
Advises insureds on all aspects of ski area operations, claims, settlement negotiations and other risk management and insurance issues
Responds immediately to notice of catastrophic losses by traveling to and overseeing the on-scene accident investigation, as necessary
Acts as Risk Management resource for insured and snow sports industry
Disseminates information through daily contact and periodic visits with insureds
Conducts Risk Management seminars; participates in industry related meetings and seminars; conducts periodic on-hill inspections and operational inspections, as assigned
Bachelor’s degree and 5-7 years of property and casualty claims adjusting experience, or equivalent combination of education and experience
P&C Adjuster's license is required
Must be an advanced level skier/snowboarder with own equipment and a passion for the snow sports industry
Independent, entrepreneurial spirit
Must be committed to client relationship management and service
Proficient with computer programs, including Word, Excel, and Outlook
Travel, up to 25% of the time, is required. Most travel is planned in advance but some travel is required on an "on call" basis
Prior ski resort risk and operations experience a plus

Claims Specialist Resume Examples & Samples

Execute policies and procedures governing the establishment and management of 3rd Party Liability, Bodily Injury case reserves
Proactively monitor legislative and jurisprudence changes and competitor policies and practices
Participates in authority committee meetings
Alert their manager to any required policies, procedures and product changes based on exposure or risk due to judgements, wording, etc
Contribute to a culture that promotes ethical practices and a high degree of integrity
Financial Management
Acts as a role model in openly endorsing the organization goals and strategies
Proactively monitor market changes and competitor offerings, assess current and future client needs and evaluate unit effectiveness in responding to changing conditions

Claims Specialist, Complex Casualty Resume Examples & Samples

Handles litigated claims as per TDI legal protocol
Make recommendations to their manager on trends with respect to legislative and jurisprudence, supplier relationships and the overall book of business
Collaborate to ensure sound business relationship for 3rd Party Liability, Bodily Injury with legal services suppliers and meet regularly to optimize knowledge transfer
Responsible for identifying and preventing indemnity leakage on files
Work closely with other Complex and Specialist Claims Analysts and the actuarial department to examine trends and predictors that may have a financial impact on Bodily Injury case reserves
Collaborate with internal and external stakeholders and contribute to the Bodily Injury claims team to accomplish goals and objectives
Provide ongoing support and coaching to support the development of Bodily Injury analysts
Continuous Improvement
Develop and encourage change and innovation at all levels of the unit and foster continuous improvement and new ideas adopting best practices

Senior Claims Specialist Resume Examples & Samples

Helps develop and execute the strategies of the practice on creating for larger accounts
Support s new business with sales presentations and RFP
Regularly meets with office leadership and team leaders to ensure delivery alignment
5+ years claims experience
High School diploma required; degree preferred
Knowledge of laws, legal codes procedures and processes involving insurance
Understand the basic process and value basic data analytics and benchmarking
Handle multiple tasks simultaneously and effectively prioritize to meet deadlines
Be self-motivated, able to work both independently and within a matrix team structure

Life Claims Specialist / Assistant Resume Examples & Samples

File and request files during the claim process (this would include ordering files from record retention and from AWD)
Registration (computer in-put information regarding the claim)
Mail claim forms, checks and correspondence
Gather and organize files for internal and state audits

Claims Specialist Resume Examples & Samples

Strong, relevant legal qualifications (Solicitor or Legal Executive essential)
Strong claimant litigation experience; with the ability to draft, issue and progress proceedings to conclusion with minimal guidance
Proven experience providing sound commercial advice within a business setting
Clear knowledge of CPR and relevant legislation (NRSWA etc)
Knowledge of wider law (i.e. tort, land) and experience of self-managing full case load
Ability to listen to and understand stakeholder requirements
Excellent negotiating skills

Claims Specialist Resume Examples & Samples

Conduct outbound calls to all policyholders being assigned claims to the team
Assist claims supervisor if needed, in training temporary staff during a catastrophe event
Answer a high volume of telephone calls and respond to questions by policyholders and other third party stakeholders associated with the claim to provide case management
Schedule follow up contact with the policyholder and other third party stakeholders in order to maintain open lines of communication
Communicate with adjusting firms to obtain any outstanding documentation in order to process claim
Apply National Flood Insurance Program rules and regulations with each claim worked
Insure claims are processed within established company and client guidelines through working with other team members and the Claims Supervisor
Coordinate and track losses using various in-house and potentially external systems
Work with incoming and outgoing communications to ensure timely processing of Claims Department information when received
Complete company training program. Program includes inter-departmental training within the Operations department as well as classroom training
Ensure all correspondence directed from the Claims Department is professional and complete
Work independently as well as within a team environment
Maintain an established level of productivity using time management techniques
Able to shift between priorities as needed throughout the workday
2+ Years of Office and/or Administrative background
2+ years of insurance claims processing experience preferably in insurance, claims and/or flood insurance
The ideal candidate will have experience with phone related customer service and direct customer contact
Communication skills including both verbal and written, with specific attention to detail
Ability to maintain a high degree of confidentiality and ethical behavior
Ability to maintain and display a positive attitude at all times; supporting business needs and changes; supporting continuous improvement; and supporting the National Flood Insurance Program
Reliability and dedication to the position is imperative. Position will frequently require overtime hours
Proficiency at keying alpha and numeric information with accuracy and speed
Knowledge of basic equipment functions, such as how to create and maintain files, printing, copying, faxing, phone messaging and voice mail
Ability to work with frequent and multiple policy, procedure, and regulatory changes
Ability to manage time through establishment of priorities and proper planning

Claims Specialist Resume Examples & Samples

Effective communication skills are a must
Experience using Microsoft Office applications (i.e. Outlook, Excel, etc.)
Must have experience working with data
Experience in a medical office setting
Medical claims processing experience preferred, but not required

Ucs-unemployment Claims Specialist Resume Examples & Samples

Respond to a state agency with all pertinent details within the time frame allowed by the state or departmental procedures
Initiate timely telephone calls, faxes or emails to customers, completed by co-workers, to obtain, document or pass along needed information
Overtime may be required in order to meet state deadlines
Previous office experience with an emphasis on organization of work duties and performing job functions independently
High ethical standards
Ability to handle a high volume of work and work under deadlines
Ability to follow policies and procedures; complete administrative tasks correctly and on time
High level of professionalism
Computer Skills Required
Previous experience with Unemployment Insurance and the Unemployment Claims process is helpful

Junior Claims Specialist Resume Examples & Samples

Determine the amount of benefit payable as a result of the death of a retiree and process payments,
Process payments under the fast track payment program,
Handles Tier 1 creditor claims,
Determine the liability as a result of the Extended Disability Benefit under a PSS Group Contract and sets up the claim
Provide guidance to the client (e.g. the group policyholder or beneficiary on requirements needed to settle the claim and disburse the benefit to the legal beneficiary); works with Senior Specialist regarding gaps uncovered
Communicate by telephone, correspondence and occasionally in person
Serve as a back up to the Support function when needed
Handle return of annual tax slips

Claims Specialist Resume Examples & Samples

Processes claims that pend for various hold reasons to assist in the final determination on claim disposition
Processes adjustments related to projects or provider disputes
Researches post payment claims issues and takes necessary action for correction
Research claims issues and works with other departments to resolve claim issues
Preferred 1+ year of experience in Previous claims or health insurance
Beginner Ability to multi-task
Beginner Ability to work independently
Beginner Ability to communicate and make recommendations to upper management
Beginner Demonstrated written communication skills
Beginner Demonstrated analytical skills
Beginner Demonstrated problem solving skills
Beginner Demonstrated time management and priority setting skills
Beginner Demonstrated organizational skills
Beginner Knowledge of healthcare delivery
Required Beginner Microsoft Outlook
Required Beginner Microsoft Word
Required Beginner Microsoft Excel

Claims Specialist Resume Examples & Samples

Processes adjustments related to projects or provider disputes providing timely follow-up provider call backs
Researches complex claims issues and works with all external departments, markets, and providers on claims related content
Completes new hire audits
Runs and analyzes ad-hoc reports
Identify root-cause issues to ensure enterprise solutions and communicate findings as needed
Participates in all formal and informal training opportunities
Preferred 2+ years of experience in Previous claims or health insurance
Required 6 months of experience in Processing of institutional and / or professional claims
Intermediate Ability to communicate and make recommendations to upper management
Intermediate Ability to work independently
Intermediate Demonstrated analytical skills
Intermediate Demonstrated written communication skills
Required Intermediate Microsoft Word
Required Intermediate Microsoft Excel

Claims Specialist Resume Examples & Samples

Ability to work independently and escalate for assistance as needed
Strong communication ability to work with various internal and external parties to resolve member issues
Ability to proactively identify payer and provider trends, and to communicate this to management
Excellent customers service skills
Excellent listening skills and ability to emphasize with members
Excellent computer skills and experience in Microsoft Office Suite

Claims Specialist Resume Examples & Samples

Daily opening and sorting of all claims related correspondence
Enters mail received dates into the claims computer system
Assists with the scanning process by imaging documents and pertinent information to AS400 IMS/21 system (either individually or by batch mode)
Mailing out checks
Maintaining a neat and orderly file room
Batch processing of claim forms and letters
Assisting with special projects and other duties as assigned
One year prior office work experience preferred, but will consider recent grads
Experience with Microsoft Office suite products
Detail oriented and strong time management and communication skills
Data entry and scanning experience helpful

Claims Specialist Resume Examples & Samples

The Claims Specialist sets adequate reserves to ensure proper reporting
Compares data on claim form with insurance plan to ascertain completeness and validity of the claim
Examines claim form and other records to determine insurance coverage
Proactively works to resolve claim as expeditiously as possible
Reviews and analyze detailed medical records
Calculates reimbursement of benefits according to the schedule of coverage. Runs various claim reports as directed by the account
Liaison with Marketing/Customer Service departments
Cultivates relationships
Incrementally increase productivity without jeopardizing quality
Approves claims at the appropriately demonstrated assigned authority level
Functions as a resource for examiners and assist with training new examiners and customer service representative
Handles difficult phone calls and composes special correspondence
1 – 3 years claims adjudication experience. Will also considerrecent college graduate with a 4 year degree. Majors in Business Admin, English, Finance or Science preferred
Ability to multi-task – manages time effectively

Claims Specialist Resume Examples & Samples

Recognize repetitive problems or issues and escalate as needed
Identify exception handling and process per client requirements. When appropriate, assign a script number or NDC number if not provided
Input claim requests into adjudication platform maintaining production and accuracy standards. Evaluate system rejections to ensure accuracy and appropriateness
Evaluate claim submission, ensure all required information is present and determine what action should be taken. Confirm patient eligibility and verify patient information matches system. Update member’s address to match claim form if necessary
Create correspondence to members, internal departments, and external agencies regarding outstanding claims issues. Compose letters to members or pharmacies for those claims with insufficient information or eligibility or benefit issues
Handle claims requiring additional research, navigate through appropriate system platforms to perform research and resolve issues. Work with other operational departments to research and resolve claims issues within performance agreement guidelines
GED: General Studies (Required) HS: General Studies (Required)
Years of Relevant Work Experience 2 - 3 Years
Proficient written and oral communication skills; strong customer focus
Must be aself-starter and team player
Ability to adapt in a dynamic work environment, learn quickly, solve problems and make decisions with minimal supervision

Claims Specialist Resume Examples & Samples

Relevant professional qualification e.g. (ACII/FCII/CILA)
Bachelor’s degree preferred, advanced degree preferred plus 8 years’ experience
CPCU, or AIC, or ARM within 3 years of obtaining this position or 20 years or more insurance industry experience exempt
Query Management
Compliance Management
Organization and Prioritizations
Market relationship management
London Market Negotiation
Technical knowledge

Senior Claims Specialist Resume Examples & Samples

10+ years claims experience in general liability and construction claims
College degree required, law degree a plus
Travel required, primarily within California

Claims Specialist Resume Examples & Samples

Knowledgeable in Excel, Word and PowerPoint
Strong Default Mortgage background
Accounting and Reconciliation skills
Minimum 2 years Investor Claims Experience
5 years Investor Claims Experience
5 years Mortgage Servicing or Default Experience

Senior Claims Specialist Resume Examples & Samples

Reviews and interprets rebate contract terms and conditions and establishes parameters in the contracting system (CARS) to produce accurate rebate calculations
Conducts initial quality check, including formulary compliance, on all claim submissions to ensure rebate eligibility. Resolves issues with account and prepares validation system (ECP) to receive detail claim data
Reviews suspect claim records and determines if record should be disputed for payment. Communicates disputed records to account
Prepares contracting system to receive validated claim data and calculate rebates. Ensures accurate system results by manually checking calculations
Acts as the primary contact point for rebate questions from account, account managers, Contract Administration and Forecast Administration
Supports the collection and recording of data critical to contract preformance assessment and rebate forecasting
Pharmaceuticals industry
Manipulation of large data sets
Negotiation/conflict resolution
Able to understand and troubleshoot electronic data processing systems
Able to construct system workarounds in special circumstances

GAT Claims Specialist Resume Examples & Samples

English and Japanese (required - for Japanese must be at least able to read, listen and write/type). Proficiency in any of the following languages would be an added advantage - Chinese, Malay, Vietnamese, Thai, Korea
Ability to manage time and resources to meet commitments in a dynamic environment and following through on details
Strong interpersonal skills and communications skills
Able to build professional relationship with business partners internally and externally. Actively responds to business partners' requirement and business priorities
Great team player, works well and collaborates with others to achieve quality results

Claims Specialist Resume Examples & Samples

Acts as Claims Department subject matter expert on departmental and corporate projects. Supports business definition and testing efforts, attends project meetings, maintains project plans and provides internal and external status reports
Works with management and associates to document current business and workflow processes and collaborates in identifying, defining and documenting process improvement options and alternatives
Researches complex claims issues and works with other departments to resolve. Serves as primary liaison to all external departments, markets, and providers on claims related content
Analyzes and trends claims issues, performs true root cause analysis and determines next steps for resolution and process improvement
Researches issues, compiles feedback and drafts corresponding business requirements documents and business decision documents as needed
Communicates changes in processes, project status and issue resolutions through email, memos, group presentations, and/or individual one-off meetings
Performs new hire audits
Preferred 3+ years of experience in Previous claims or health insurance
Required 2+ years of experience in Claims processing with a solid understanding of internal claims functions, and have performed at least 5 of the duties found in the Claims II role (found in job description)
Advanced Ability to communicate and make recommendations to upper management
Advanced Ability to effectively present information and respond to questions from peers and management
Advanced Ability to multi-task
Advanced Ability to work in a fast paced environment with changing priorities
Advanced Ability to work independently
Advanced Demonstrated analytical skills
Advanced Demonstrated ability to deal with confidential information
Advanced Demonstrated customer service skills
Advanced Demonstrated interpersonal/verbal communication skills
Advanced Demonstrated organizational skills
Advanced Demonstrated problem solving skills
Advanced Demonstrated time management and priority setting skills
Advanced Demonstrated written communication skills
Advanced Knowledge of healthcare delivery

Senior Claims Specialist Resume Examples & Samples

Communicate with store personnel and injured customers
Proactive communication in resolution of in-house customer claims
Act as an internal resource for General Liability questions
Provide reports via excel as required

Claims Specialist Resume Examples & Samples

Researches, analyze and resolves customer deductions
Establish relationships with the appropriate business unit and corporate personnel
Advise the business of deduction problems and to the supervisor
Other duties as assigned by the FSCM Supervisor
1 to 3 years experience in a business related field
Previous experience desired in deduction management

Claims Specialist Resume Examples & Samples

Proficient in Microsoft Word, Excel, Access, PowerPoint, and Outlook
Committed to superior customer service with a quality focus
Listens well and communicates effectively both verbally and written
Excellent self-management skills & ability to work independently
Understand multiple client programs, follow process guidelines
Demonstrate strong ability to identify, analyze and solve problem for customer resolution
Claims adjudication experience or relevant experience

Senior Claims Specialist Resume Examples & Samples

Bachelor’s degree preferred, advanced degree preferred plus 10 years’ experience managing Financial & Executive Lines claims (D&O, E&O (including Cyber), EPLI, Fiduciary Liability, Fidelity/Crime)
Knowledge of claims handling, processes and best practices procedures
Ability to conduct claim best practice audits, including outlining findings and recommendations with goal of improving claim program
Strong communication skills both verbal and written with senior management, clients, and vendors
Proven success for working with different personalities
Ability to work effectively in team environment
Must be able to handle multiple tasks simultaneously and manage deadlines
Ability to analyze and report financial data
Obtains relevant technical information to support decision making
Strong presentation skills to be effective in sales meetings with prospects
Proven ability to work independently
Understands company products, services, global network, and industry practices
Data analysis and benchmarking skills including ability to analyze claim data and develop solutions to potential adverse trends

Claims Specialist, Complex Casualty Ontario Resume Examples & Samples

Strategy Execution
Resolve complex claims adhering to established claims settlement policies and processes
Execute policies and procedures governing the establishment and management of 3rdParty Liability, Bodily Injury case reserves
Ensure consistency in behaviour and actions in line with company core values and exercise sound judgment in non-routine and complex situations
Support the development of analysts through empowerment and coaching
Organizational Effectiveness
Apply established decision criteria triggering the management and resolution of complex claims
Execute authority to fairly settle complex claims up to authority limit
Accountable for adequacy of Bodily Injury case reserves on their files

Workers Comp Claims Specialist Resume Examples & Samples

Evaluate claims to determine potential exposure; make recommendations concerning the value of the claim; oversee litigation and assist in the negotiation of settlements
Proactively oversee the Worker’s Compensation claims management activities in assigned territories with a special focus on cost containment strategies
Manage and target aggressive resolution of case inventory, and resolve problems of varying scope and complexity in accordance with state statutes
Evaluate claims for settlement and appropriateness of established reserves
Attend claim reviews; complete follow up action to ensure expedited resolution
Provide daily support / guidance to teammates, claims adjusters, insurers, and defense counsel by answering claims-related questions or concerns in the administration and management of claims, return-to-work issues, and other claim matters
Analyze claims data to identify needed loss control interventions and assist with the development of appropriate loss prevention programs as requested
Provide training and education to facilities on claim processes and procedures
Coordinate handling of claim subpoenas in an expeditious manner
Generate reporting and analysis on assigned case inventory
Escalate exceptions, outliers, or circumstances that are out-of-norm, as they occur, and seek guidance in case resolution
Participate in meetings, presentations, and special projects, as necessary
Commitment to Company’s values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment and Fun with ability to demonstrate those positively and proactively to patients, teammates, management, physicians, and/or vendors in every day performance and interactions
Demonstrated sound judgment and initiative in working within departmental and corporate guidelines, including the ability to maintain confidentiality of information
Strong written, verbal, and interpersonal communications skills including ability to listen attentively and to communicate information clearly and effectively throughout all levels of the organization with audiences of varying degrees of familiarity with material

Complaints / Claims Specialist Resume Examples & Samples

Providing expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of claims and complaints / grievances
Coordinating efforts with other areas as necessary
Communicating issues, implications and decisions with appropriate parties
Analyzing and identifying trends for complaints / grievances
Ensuring optimal performance re: timely, accurate, effective and complete responses
Verifying that all documentation, letters and attachments meet customer, regulatory and internal requirements
Preparing for and participating in audits
Organizing, checking, pulling, reviewing and saving files
Maintaining positive working relationships with internal and external customers including regulators
Word & Excel proficiency
Must be proficient in developing accurate, easy to understand and thorough correspondence
Previous Behavioral Health experience
Must live within a commutable distance of San Francisco, CA
Previous Appeals and/or Complaints/Grievances experience
Previous Claims experience
Bachelor's Degree in Healthcare, Behavioral Health, Business, Psychology or English

Claims Specialist Resume Examples & Samples

Communicate and go on-site as necessary to locations to assist with all internal claims management activities
Maintain an internal active diary system of claims that are being managed
Coordinate for team internal claims update to Risk Management as requested / required, such as an internal claims review
Monitor claims reporting to third party administrator and report claims as required
Work with stores safety to help identify and reduce claim trends
Monitors and reports the effectiveness of third party claims administrators with regard to this position’s assigned case load
Responsible for legally mandated mailings

Junior Warranty Claims Specialist With English & German Resume Examples & Samples

Communicative English and German (mainly written and reading skills on level B2, communication can be passive)
Data processing accuracy, detail oriented and ability to evaluate/research a warranty claim
Experience in Warranty is preferred but not required

Claims Specialist, Senior Resume Examples & Samples

Processes all types of medical claims and adjusts medical disputed claims (Professional and Facility) according to department, contract, and regulatory requirements
Performs prepayment audit on all types of medical claims (Professional and Facility) according to department, contract, and regulatory requirements
Updates authorization information based on information obtained from provider
Troubleshoots problem claims to resolve provider issues or systematic issues
Verifies and interprets information in all vendor contracts to resolve issues
Trains analysts and monitors general office support functions as needed
Analyzes work processes, identifies areas needing improvements and initiates necessary steps to make changes
Participates in the continuous quality improvement of IMCS core business system
Computer literate
Individual must be reliable, dependable, and punctual
Ability to make decisions regarding escalation of referrals to Care Management
Knowledge of all types of professional claims
Knowledge of compliance related to the processing of claims
Knowledge of different sources of authorization documentation
Ability to update authorization information based on information obtained from facilities
Ability to read and interpret all vendor contracts
Knowledge of DRG pricing

Claims Specialist Resume Examples & Samples

Processes all types of professional claims and adjusts professional disputed claims according to department, contract, and regulatory requirements
Performs prepayment audit on all types of professional claims according to department, contract, and regulatory requirements
Processes simple facility claims as needed according to department, contract, and regulatory requirements
Answers telephone inquiries through the “Automated Call Distributor (ACD) Telephone System” as needed
Identifies individual provider needs and take appropriate steps to satisfy those needs
Updates authorization information based on information obtained from facilities
Analyzes work processes and identifies areas needing improvements
Follows unit procedures for performing call processing, claim adjustments and denials and references Policies and Procedures, job aides, provider contracts, and other reference materials to assure complete and accurate decisions
Excellent customer service and telephone skills
Ability to work in an environment with fluctuating workloads
Ability to solve problems systematically, using sound business judgment
Ability to make decisions with every call and handle escalated issues
Familiarity with ICD-9 and CPT codes
Ability to research and verify claims payment issues
Knowledge of medical terminology and pricing options

Claims Specialist Senior Resume Examples & Samples

Handles the most complex/challenging claims issues
Ensures the accuracy and completeness of claims forms
Investigates coverage questions and problems
Works closely with clients, producers, client service staff, insurance carriers
Identifies and resolves complex problems in a timely fashion following established guidelines
May provide guidance and coaching to lower level staff
Operates independently and can service the largest clients and/or resolve the most complex problems
Has a solid understanding of claims processing and the insurance brokerage business
Works with Director of Claims in support of quality claims control
Travel as needed. (Minimal)
Ability and willingness to take initiative
Bachelor’s degree or equivalent combination of education and experience required
Experience in claims management processes and system requirements preferred
5 or more years related professional experience
Good understanding of claims processing and the insurance brokerage business
Licensing required

General Liability Claims Specialist Resume Examples & Samples

Juris Doctor and 1 or more years of experience in the Claims Handling or Insurance area
3 or more years of commercial general liability claims handling experience
AIC, SCLA and/or CPCU designation

Wc-claims Specialist Resume Examples & Samples

Federal
USL& H
Jones Act; DBA (Defense Based Act)
7 or more years of claims handling experience with 2 or more years in USL& H ; Jones Act; DBA (Defense Based Act)

Claims Specialist Resume Examples & Samples

Bachelors Degree and 2 or more years of claims handling experience
At least 1 year in the Claims Foundational Training Program
2 or more years of Auto Liability claims handling
Strong communications, analytical, negotiation and customer service skills
Advanced data gathering and problem solving skills

Professional Liability Claims Specialist Resume Examples & Samples

7 or more years of claims handling experience with 2 or more years in professional liability, EPLI and/or general liability claims
Ability to obtain and maintain required adjuster license
AIC, SCLA and/or CPCU

General Liability Claims Specialist Resume Examples & Samples

At least 2 years of Commercial Liability Claims handling experience
Associate or Bachelors Degree
Experience handling Commercial General Liability Claims
Willingness to embrace the Zurich Basics of Integrity, Sustainability, Customer centricity, excellence and Teamwork

Claims Specialist, General Liability Resume Examples & Samples

Bachelor’s Degree and 3 or more years of directly related experience managing a claims caseload for a P&C line of business
Experience that includes adjudication of GL claims
Strong communication, analytical, negotiation and customer service skills

Claims Specialist Resume Examples & Samples

Bachelors Degree and/or related Claims or Veterinary industries experience. Related experience may include previous experience in an office environment that required computer work, organization, strong communications, customer service and negotiation
Experience gathering data, designing and testing solutions to problems, and formulating plans as well as managing multiple projects simultaneously in a fast paced environment
3 or more years of related Claims or Veterinary industries with Bachelors Degree OR
4 or more years of related Claims or Veterinary industries without Bachelors Degree OR
2 or more years of related litigation experience with a Juris Doctorate
Fundamental knowledge of the Claims or Veterinary industries industry, claims and the insurance legal and regulatory environment
A functional and developing knowledge of the legal statutes and procedures
A thorough functional knowledge and skill of claims handling
Negotiation Experience
Travel required (0-25%)
3 or more years of claims handling experience or veterinary industry experience
Experience in a work environment that required collaboration across work groups
Ability to effectively present information to LOB manager, claimants and customers

Claims Specialist Resume Examples & Samples

Bachelors Degree and/or related industry experience. Related experience may include previous experience in an office environment that required computer work, organization, strong communications, customer service and negotiation
3 or more years of related experience with Bachelors Degree OR
4 or more years of related experience without Bachelors Degree OR
Fundamental knowledge of the insurance industry, claims and the
Insurance legal and regulatory environment
Travel required (0-5%)
3 or more years of claims handling experience in line of business

Liability Claims Specialist Resume Examples & Samples

NY Labor Law claims experience
Strong Organization and time management skills
AIC, SCLA and/or CPCU designations

Claims Specialist Resume Examples & Samples

6 Or More Years Of Related Auto Liability Experience
Bachelors Degree Or Equivalent
Experience in line of business
Willingness to embrace the Zurich Basics of integrity,
Sustainability, customer-centricity, excellence and teamwork
Bachelors Degree and/or related industry experience. Related experience may include previous experience in an office environment that required computer work, organization skills, strong communications, customer service and negotiation skills, experience gathering data, designing and testing solutions to problems, and formulating plans as well as experience managing multiple projects simultaneously in a fast paced environment
6 or more years of related experience with Bachelors Degree OR
7 or more years of related experience without Bachelor’s Degree
2 or more years of demonstrated management experience including
Coaching and mentoring
4 or more years of claims, insurance or litigation experience
Must have experience collaborating across work groups
A functional knowledge of legal statutes and procedures
Thorough knowledge of the insurance industry, claims and the
Travel required 0-20%

Subrogation Claims Specialist Resume Examples & Samples

Assess liability and analyze exposure on assigned matters
Hire appropriate and effective counsel and expert resources
Analyze financial dynamics and directly handle negotiations
Responsible for achievement of individual subrogation goal established annually, typically $7-$9M, while possessing $1,000,000 in indemnity settlement authority and $300,000 in expense authority on each matter
Achieve optimum subrogation results on assigned matters through direct handling, as well as effective management and direction to Property Large Loss adjusters, cause and origin investigators, and subrogation counsel on the investigation, evaluation and strategic planning related to these cases
Mitigate all subrogation expenses in order to contribute to corporate recovery objectives
Attend mediations, settlement conferences and trials as required
Effective and timely reporting on subrogation matters, sharing any trends or legal decisions that affect subrogation recovery with business leaders
Provide oversight, direction and training of internal partners in the Central Recovery Office, as well as the Property Large Loss and Field Operations
Participate as a subject matter expert in ancillary projects that impact subrogation
Embrace enterprise values of customer focus, diversity and inclusion, financial discipline, integrity, team work and a winning spirit by meeting the leadership imperatives of delivering results, inspiring excellence, being a team player, forward thinking, championing talent and becoming a trusted decision-maker
Juris Doctorate strongly preferred with 4+ years of legal experience; alternatively, 8-10 plus years of carrier subrogation experience in first party property matters
Strong knowledge of theories of liability, and understanding of legal procedures and strategies
Excellent analytical, critical thinking and problem solving skills
Strong negotiation and communication skills, both written and verbal
Ability to work independently and embrace positive accountability
Inquisitive, ambitious, and a bias for improvement
Working knowledge of property coverage and the insurance industry

Claims Specialist Resume Examples & Samples

Manages moderate to high complexity commercial subrogation/recovery claim investigation involving the property line of business. Determines if a claim should be negotiated, arbitrated or litigated through conclusion based on a thorough investigation and resolution strategy. Effectively manages loss costs and recovery claim expenses
Manages all types of investigative activity or litigation on claims, including the posting of appropriate reserves in a timely manner. Coordinates discovery and litigation strategy with staff counsel or panel attorneys
Negotiates moderate to high complexity settlement packages within scope of authority, settling recovery claims in the most cost effective manner
Makes recommendations on subrogation/recovery claims processes and resolution strategies to management
Analyzes recovery claims activities; prepares and presents reports to management and other internal business partners and clients
Works with attorneys, account representatives, agents and insureds regarding the handling and/or disposition of moderate to high complexity subrogation/recovery claims
Keeps current on state/territory regulations and issues, industry activity and trends. May participate in industry trade groups
Provides guidance and assistance to less experienced claims staff and other functional areas where appropriate
Responsible for input of data that accurately reflects claim circumstances and other information important to our business outcomes
Advanced technical and product specific expertise, subrogation/recovery claims resolution skill and knowledge of insurance and underlying claim principles, practices and procedures
Strong communication, negotiation and presentation skills. Ability to effectively interact with all levels of CNA's internal and external business partners
Creativity in resolving unique and challenging business problems
Knowledge of Microsoft Office Suite and other business-related software
Ability to manage and prioritize multiple projects
Ability to evaluate claims based on a cost benefit analysis
Ability to fully comprehend moderate to complex claim facts and issues; and to further articulate analyses of claims in presentations to business partners and management as well as in internal reports
Ability to implement strategies with a proactive long-term view of business goals and objectives
Bachelor's degree or equivalent experience. Professional designation preferred
Typically a minimum three to five years commercial property subrogation/underlying property claims experience

Claims Specialist Resume Examples & Samples

Manages moderate to high complexity commercial recovery claim investigation involving ocean marine subrogation/recovery claims. Determines if a major claim should be negotiated, arbitrated or litigated through conclusion based on a thorough investigation and resolution strategy. Effectively manages loss costs and recovery claim expenses
Manages all types of investigative activity or litigation on major ocean marine claims, including the posting of appropriate reserves in a timely manner. Coordinates discovery and litigation strategy with staff counsel or panel attorneys
Makes recommendations on recovery claims processes and resolution strategies to management
Works with attorneys, account representatives, agents and insureds regarding the handling and/or disposition of moderate to high complexity recovery claims
Keeps current on state/territory regulations and issues, industry activity and trends related to ocean marine. May participate in industry trade groups. Understands and can apply admiralty law/statutes including, but not limited to COGSA, Montreal Convention and Hague Convention, as part of strategy to maximize recovery
Provides guidance and assistance to less experienced claims staff and other functional areas when/where appropriate
Effectively manages vendor relationships to include the expansion contraction vendor model with key vendor partners
Solid knowledge of claims and insurance theory and practices
Demonstrated technical expertise, product specific knowledge, and negotiation skills
Strong interpersonal and communication skills. Ability to effectively interact with all levels of CNA’s internal and external business partners
The ability to exercise independent judgment and make critical business decisions effectively
Typically a minimum three to five years ocean marine and/or property claims experience

Claims Specialist Resume Examples & Samples

Interprets more complex or unusual policy coverages and determines if coverages apply to claims submitted, escalating issues as needed
Prepares timely and thorough coverage analysis and may occasionally assign counsel on an insured’s behalf
Recommends appropriate reserves and attempts to effectively settle claims in most cost effective manner and ensuring timely issuance of disbursements
Coordinates and performs investigations and evaluates claims and exposure through contact with insureds, brokers, other insurance carriers and defense counsel
Utilizes negotiation skills to develop complex settlement packages or suggest resolution strategies
Works with defense counsel, underwriters, brokers, and insureds regarding the handling and/or disposition of complex claims
Analyzes claims activities and prepares reports for management. May be responsible for special projects and presentations
Solid knowledge of claims and insurance industry theory and practices
Demonstrated technical expertise and product specific knowledge
Strong interpersonal, communication and negotiation skills. Must have the ability to effectively interact with all levels of CNA's internal and external business partners
Ability to exercise independent judgment and make critical business decisions effectively
Solid knowledge of Microsoft Office Suite as well as other business-related software
Juris Doctorate strongly preferred. Professional designations preferred
Typically a minimum two to five years claims experience in professional liability or 2 plus years in a law firm handling professional liability claims. D&O experience preferred

Claims Specialist Resume Examples & Samples

Demonstrated claims management experience in workers comp, auto and general liability issues
Strong analytical, critical thinking, problem solving, judgment, negotiating, influencing, and decision making skills. Ability to maintain confidentiality, tact, and diplomacy
Working knowledge of federal and state disability laws; specifically FMLA, CFRA, ADA, HIPAA, etc
Familiarity with job restrictions, accommodations and functional capacity exams
Strong working knowledge of workers' compensation claims and process
Strong organizational skills: comfortable managing many multiple and varied complex individual situations
Experience counseling and working with employees regarding disability benefits, vendor claims personnel, internal and external legal departments
Excellent facilitation and oral and written communication skills; ability to prepare clear and concise reports and deliver formal presentations or training to senior management and other audiences
Demonstrated proficiency with business applications, such as Microsoft Office suite and human resource information systems
Proficient in managing multiple sources of data and integrity; ability to identify trends, design reports, conduct audit and analysis of data
Clear thinker who understands the development of and has ability to correctly interpret policy
Flexibility and adaptability in dealing with rapidly changing priorities and demands necessary
Ability to make sound judgments requiring confidentiality, tact, and diplomacy in dealing with a variety of personalities and situations
Bachelor's degree (preferred) and five – seven years of relevant experience, or combination of education and relevant experience
California State disability expertise required

Subrogation Claims Specialist Resume Examples & Samples

Investigate, negotiate, subrogate and settle first and third party losses
Maintain recovery targets set forth each month
Ensure cases are called as scheduled and aging is maintained
Demonstrate professionalism when dealing with contacts
Maximize Collection efforts and customer satisfaction
Practice collection and research techniques to ensure timely resolution
Maintain accurate and complete documentation of all activity
Submit claims for referral and write-off
Develop a systematic approach for case reviews and calls
Include Customer Relations when addressing sensitive case issues
Include Hertz Sales when addressing sensitive case issues
Respond to inquiries within 24 hours to maintain customer service
Other duties as assigned by supervisor/manager
One year Insurance Claims experience and/or collections experience
Basic working knowledge with Microsoft Word and Excel (pre – employment assessment required)
Excellent customer service and telephone skills/experience
Excellent organizational skills and ability to handle multiple tasks
Must be able to work well with others
Must be attentive to detail
Must be an independent worker and able to work with minimal supervision
Criminal background check due to access to Personal identifiable Data (PID)

Senior Claims Specialist Resume Examples & Samples

Good interpersonal and customer services skills
Good data management and analytical skills
Attentive to details and patient
PC literate in Word, Excel and Chinese word processing
Good command of spoken and written English and Chinese
Candidates with less experience will be considered as Claims Analyst or Claims Assistant

Consumer Claims Specialist Resume Examples & Samples

Responsible for receiving, organizing, reviewing, and resolving product complaints related to product safety and quality for Philips North America products
Requests complaint failure investigations; and, ensures returned products associated with product complaints are forwarded to the appropriate facility for investigation
Prepare and distribute written correspondence to the consumer regarding product complaint that resolve the consumer’s issue
Responsible for one time consumer resolution for all products
Responsible for check requests to settle consumer claims along with “closure”/disclaimer letter
Applies acquired job skills, company policies, and procedures to complete assigned tasks but recognizes the need for deviation occasionally
Requires 1-2 years of minimum experience to manage consumer relationship
Minimum 1-2 years of experience using Microsoft Office
Can coordinate multiple tasks simultaneously
Knowledge of working with Consumer Relationship Management (CRM) system like Salesforce
Knowledge of complaint handling

Senior Claims Specialist Resume Examples & Samples

Utilize 3rd party software to price claims for various markets
Monitor and release of all claims in the adjudication queue folder
Quality check claim batches adhering to weekly claim run deadline
Responsible for handling emails including but not limited to reprocessing requests and inquiries from internal and external sources
Attend internal and external operational and/or provider related meetings as assigned

Excellent Recent Grad Claims Specialist Position Resume Examples & Samples

Desire to learn
Desire to grow within a company
Manage claims through the life cycle
Information gathering and research
Issue resolution with clients and carriers
Status reporting
Ad hoc reporting
Strong MS Excel skills including functions and pivot tables
Ability to work in a team and support the team

Claims Specialist Resume Examples & Samples

Processing member claims
Making outbound phone calls to members or providers to get required information for processing
Investigating claims for required processing information
Knowledge in Medical Terminology, CPT-4 , ICD-9, ICD-10 and revenue code
Team player, ability to work with tight schedules, overtime and multiple priorities
Able to meet deadlines and work under pressure
Excellent communication skills, both oral and written, English and Spanish
Experience as Claims Specialist (2 years minimum)

Leave of Absence Claims Specialist Resume Examples & Samples

Communicates decisions and on-going expectations with Employees, Manager and Human Resources. Communicate as necessary with employees, supervisors, and departments to keep employees informed and up to date through FMLA leave application process, period of FMLA leave, and return to work
Counsel employees and supervisors about FMLA rights and responsibilities while maintaining appropriate confidentiality of employee medical information
Interface with Worker's Compensation to ensure that Worker's Compensation claimants are apprised of FMLA and ADA rights and obligations per law and company policy
Performs complex research using PeopleSoft, knowledge base, event management system, Total Benefits Administrator Pension System, Kronos Automated Time Collection system, Authoria, and Microsoft based PC application (Excel, Access, Works) to perform job functions. Create and utilize queries in both PeopleSoft and vendor maintained applications. Communicates outcome in a timely fashion. Responds to inquiries from disability carriers regarding any information needed for claim processing
Review and assess current FMLA/STD leave practices and propose revisions to improve overall accuracy, consistency, efficiency, and communication

Senior Claims Specialist Resume Examples & Samples

Maintain control of outside vendors/attorney and their expenses by directing assignments to them, and limiting the scope of assignments so as to maximize cost efficiency while minimizing delays in claim handling. Such vendors/attorneys must not be used unless pre-approved by the manager. Adhere to provisions of Litigation Management Program and cost containment principles
Maintain compliance with Fair Claim Practices Act or rules and internal instructions
Knowledge of Auto and General Liability policy coverage
Knowledge of tort law, motor vehicle law, basic reinsurance, property damage, bodily injury knowledge required and coding related to claims technical matters

Senior Claims Specialist Resume Examples & Samples

Establish proper loss reserve and negotiate loss settlements
Maintain control of outside vendors/attorneys and their expenses by directing assignments to them and limiting their scope to maximize cost effectiveness while minimizing delays in claims handling. Such vendors/attorneys must not be used unless pre-approved by the department manager
Maintain compliance with Workers' Compensation procedure and requirements established by regulatory authorities
Pursue Workers' Compensation liens and subrogation when appropriate
Maintain compliance with claims practice rules and internal instructions
Keep supervisor advised of significant developments in claims
Answer correspondence and inquiries promptly from brokers/agents, insureds, claimants, doctors, attorneys, outside vendors, TMM employees, etc
Minimum five (5) years of experience investigating and handling lost time Workers' Compensation
Experience in handling claims and detailed knowledge of applicable state jurisdictional Workers' Compensation rules and regulations for GA, TN, MS, AL – required; additional states – FL, NC, SC
Knowledge and understanding of medical and legal terminology which may come within the purview of Workers' Compensation claims
Computer literate (MS Windows preferred)
Valid Georgia Insurance Adjuster License or CWCP

Home Claims Specialist Resume Examples & Samples

Previous experience in a customer-facing role, including demonstrable evidence of providing high standards of customer care are essential
Numeracy and literacy (equivalent to GCSE level Maths and English - Grade C and above)
Problem Solver
Proactive and pragmatic approach

IDI Claims Specialist Resume Examples & Samples

Manages assigned caseload with limited supervision
Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment
Compiles file documentation and correspondence requiring extensive policy and factual detail. Identifies information and resources needed to adjudicate claim
Conducts lengthy detailed information-gathering phone calls that obtain medical condition details, financial details, occupational details and other information
Proficiently calculates benefits due after elimination period, COLA, Social Security Offsets, and residual and non-routine payments
Drafts responses to Department of Insurance and Presidential complaints
Identifies and refers appropriate matters to legal counsel
Represents MetLife at depositions and trials
High School Diploma or Equivalency required; Bachelor’s Degree strongly preferred
1+ year related business experience
In order to post for this position, you need the proper work authorization to work in the country where the position is located and not require relocation assistance

LTD Claims Specialist Trainee Resume Examples & Samples

Provide timely and accurate communication, information gathering, and rendering decisions on Long-term Disability (LTD) claims according to provisions of LTD certificates
Communicate with a variety of constituents (claimants, doctors, nurses, employers, and attorneys) to gather information relevant to rendering decisions based on the provisions of the policy
Learn to use appropriate systems, tools and resources to research and document claims
Learn to develop an action plan and identify the Likely Claim Progression including identifying the return to work potential
Complete regular updates on financial offsets such as SSDI

STD / Fmla Claims Specialist Resume Examples & Samples

2-4 years Customer Service background
High School Diploma/ GED
Bachelor’s Degree Preferred and 2-4 years’ customer service experience

A&H Claims Specialist Resume Examples & Samples

Compiles file documentation and correspondence requiring extensive policy and factual detail
Communicates decisions to policyholders in verbal and written form
Refers to external and internal resources, such as physicians, attorneys and CPAs to gather data such as medical/occupational information in order to ensure well-reasoned decisions
Clarifies and reconciles inconsistencies
3+ years of experience in insurance claims

Meditech Claims Specialist Resume Examples & Samples

MEDITECH 6.1 Billing/Accounts Receivable building required
Testing and training of claims forms to include all facets of electronic and paper based claims including 5010, 835 and 837s required
Identify improvement opportunities or best practices and make recommendations for optimizing workflow
Provide consulting services in all areas of healthcare revenue cycle including: Patient Access, Registration/Admission, Patient Financial Services, and Decision Support/Analytics
Maintain regular communication with client, vendor, team members and team leaders regarding project issues, risks, and needs
On occasion, may be required to lift and/or carry up to 25 lbs
Required to use computer for long periods of time
Candidates may live anywhere in the contiguous US and travel 75-100%, as needed by project
Maintains at least 85% billable utilization rate

Subrogation Claims Specialist Resume Examples & Samples

1+ years of experience in insurance, claims or collection and recovery fields is a plus
Prior knowledge of insurance claims or debt recovery is preferred
Adjusters license preferred, but not required

Claims Specialist Resume Examples & Samples

Provider billing files: Statewide responsibility for processing service provider claims for Title XIX members
Monitoring approved and denied claim files in accordance with Division and AHCCCS regulations to ensure proper adjudication and audit compliance
Reporting member insurance benefits not identified at time of claim submission to AHCCCS, with high volume of customer interaction
ReversalNoided claims: Statewide responsibility for research of service provider payments. Processes provider initiated and management approved claim line Reversals and claim line Voids
Researching and providing technical assistance to contracted service providers, Division staff and other external entities relating to claims processing
Assists with special projects and perform other related work as required
Knowledge of principles and practices of accounting
Knowledge of AHCCCS rules and regulations as applied to processing medical claims, diagnostic and procedural coding used on medical claims
Excellent Customer Services skills a must
Comprehensive oral and written communication skills
Problem solving, analytical, and research skills
Ability to analyze billing problems and recommend usable solutions, the ability to diffuse and resolve complicated issues while maintaining professional relationships, provide training to mixed groups of diverse backgrounds
Ability to cross-train to other duties within the unit
The ideal/preferred candidate will be familiar with medical claims processing, third party liability and/or Coordination of Benefits

LTD Claims Specialist Resume Examples & Samples

Independently assess, analyze and render appropriate claim decisions pursuant to certificates
Adhere to federal and state law to maintain appropriate and timely claim outcomes
Articulate and document their rationale for claim direction, possess the autonomy to take steps outside of CMG guidelines to the extent supported by documented rationale and the facts of the claim file
Utilize tools independently and accurately to identify work to be completed across the entire claim block, prioritize work, determine if/when to involve specialty resources such as clinical staff to obtain additional information on a claim
3-5 years’ long term disability claims experience
Strong communication skills, both written and oral
Comfortable working with multiple priorities in a changing environment

Claims Specialist Resume Examples & Samples

Researching and identifying suspicious activity through comparative analysis
Handling escalated calls and complaints
Assisting in the development of more junior level Claims Specialists
Preparing case documents for security and law enforcement agencies

Senior Claims Specialist Resume Examples & Samples

Analyzes, investigates, and evaluates the loss to determine coverage and claim disposition. Utilizes CMS to document claims and to diary future events or follow-up
Within prescribed settlement authority for the line of business, establishes appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Makes recommendations to set reserves at appropriate level for claims outside of authority level
Monitors the case resolution process. Actively participates in mediations and arbitrations, within limit of settlement authority
Participates in Claims audit process
May provide claims marketing services by participating in meetings with brokers, risk managers and reinsurers
As required, maintains insurance adjuster licenses
Bachelors' and/or advanced degree required. J.D. preferred
5+ years claims/legal experience, with Management Liability experience preferred
Functional knowledge of claims handling concepts, practices and techniques, to include, but not limited to coverage issues and product line knowledge
Functional knowledge of law and insurance regulations in various jurisdictions
Demonstrated strong negotiation skills

Unemployment Claims Specialist Resume Examples & Samples

Receive and prioritize claims, questionnaires and other unemployment related data
Analyze individual case information by reviewing data accessed through the PC, from documented telephone calls or document images, to determine if the facts warrant a response
Using the details regarding an employee’s separation provided by the client, interpret and apply state laws and regulations in response to unemployment documents
Works as a team with our Unemployment Insurance Consultants to ensure accurate and necessary information retrieved from customers is documented clearly and thoroughly into our database
Ensures that work is accurate and complete, processed in a timely manner with proper spelling and grammar
Investigates and resolves state agency concerns with supervisor, other departments and/or State Relationship Managers in a timely manner
Associate’s degree (A.A.) or equivalent from two-year college or technical school; or two years customer service related experience and/or training; or equivalent combination of education and experience
2-3 weeks of immediate, mandatory and uninterrupted training are required upon hire
Ability to work well within a team
Excellent interpersonal, oral and written communication skills
Self-motivated with high level of initiative

Claims Specialist Resume Examples & Samples

Worker characteristics are normally acquired through completion of an undergraduate 4-year degreed program, completion of an in-house casualty training program, and at least 6 months related experience; or equivalent combination of education and experience
Requires knowledge of established Company policies and procedures, with emphasis in claims operations
Written and verbal communication skill to effectively and professionally negotiate with claimants, insureds, attorneys, etc
Work is of a technical nature and requires the analytical ability necessary to analyze, interpret and evaluate relevant information essential in resolving low to moderate value, liability and bodily injury claims
Requires critical attention to detail and good organizational skills to manage a high volume of claims

PIP Claims Specialist Resume Examples & Samples

Worker characteristics are normally acquired through completion of an undergraduate 4-year degree program, completion of an in-house training program, and at least 6 months of related experience; or equivalent combination of education and experience
Requires ability to acquire basic knowledge of established Company policies and procedures, with emphasis on claims operations
Professional written and verbal communication skills, including presentation skills, to effectively and professionally communicate with claimants, insureds, attorneys, medical professionals, etc
Requires team building and customer relationship skills
Work is of a technical nature and requires the analytical ability to analyze, interpret, and evaluate relevant information essential in identifying an appropriate treatment plan and resolving payment for such a plan and/or for lost wages
Requires some exercise of independent judgment which may have significant impact on the Company in areas such as costs, consumer loyalty, and legal complications
Requires critical attention to detail, ability to prioritize, and good organizational skills to manage a high volume of claims
Requires basic skills in MS Word and Excel
Experience in a medical bill processing environment, including use of related software is preferred, but not required
General knowledge of Workers' Compensation claims is preferred, but not required

Complex Claims Specialist Resume Examples & Samples

Effectively evaluate and resolve coverage issues for all lines of business and all liability claim types
Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, insureds, witnesses and others having pertinent information
Effectively and efficiently manage vendors and expenses
Timely analyze information in order to evaluate assigned claims to determine the extent of loss, taking into consideration contributory or comparative negligence. Assign medical or other experts to case and arrange for medical examinations when necessary
Effectively evaluate, negotiate and resolve claims within delegated authority utilizing the appropriate denials or releases
Provide required reports to claims, underwriting, reinsurance and actuarial on significant exposure cases
Report on all cases going to trial on a timely basis and attend portions of trials when warranted or where requested by management
Ensure proper referrals and timely updates to appropriate Reinsurer(s)
Ability to handle or oversee Extra-Contractual, EPLI, Social Services and E&O claims against the Company
Multi-State licensing with strong understanding of Medicare reporting & compliance preferred
Experience in complex coverage analysis and significant large loss evaluations
Superior communication and strategic negotiation and claim disposition skills along with proven problem-solving skills
Moderate proficiency with standard business-related software (including Microsoft Outlook, Work Excel, and PowerPoint
Sufficient keyboarding proficiency to enter data accurately and efficiently
8+ Casualty claims handling experience (of those, a minimum of 5 years handling cases of a complex nature with a primary P&C carrier)

Claims Specialist Senior Resume Examples & Samples

Must have demonstrated core competence as a Claims Specialist Int or Claims Generalist Int negotiating injury claims
Ability to quickly build rapport and successfully effect settlements
Bachelor's degree or a minimum of 6-10 years of relevant work experience and/or postsecondary education
Company-provided Cell Phone - during work hours

Senior Claims Specialist Resume Examples & Samples

Provide first-line assistance for member's questions relating to post-service coverage of medical treatment or services which includes researching and resolving benefit claims issues, billing discrepancies, coding errors, insurance claims processing issues, and educating members on the components of their benefit plan coverage which ensuring adherence to corporate and department policies and procedures
Research plan information and identify where there may be conflicting information which may include escalating to supervisor or other levels of management for clarification and assistance
Assist members with setting up payment arrangements and discounts which may include reaching out to healthcare providers to determine payment options
Handle cases that require complex coordination of benefits issues among several carriers (e.g., motor vehicle, Medicaid, Medicare due to disability, disability administrator, etc.)
Participate in the development of policies and procedures to improve department workflow and the claims process ensuring proper documentation
Minimum of five years customer service, healthcare, or claims experience required
COBRA
Medicare A, B, MediGap, Supplement plans, Medicare Advantage, Medicare Part D plans
High deductible health plans including Health Reimbursement Accounts (HRAs) and Health Saving Accounts (HSAs)
Flex Spending Accounts (FSA) , including limited FSAs
Coordination of benefits and which plan is primary - simple and complex cases (commercial plans, Medicare plans)
Summary Plan Documents (SPDs) and Certificates of Coverage (COCs)
Government programs, resources and legislation and mandates including but not limited to Affordable Care Act, FMLA, Medicaid, CHIP
Group Health Plans (fully insured and self-insured)
Pharmacy benefits including injectable medications
Individual Health Plans and Exchanges plans

Claims Specialist Resume Examples & Samples

Optimizes Work Processes
Instills trust
Cultivates innovation
Decision quality
Collaborates
Minimum 1-2 years post-secondary education or equivalent experience [Minimum 1-3 years disability, workers comp, or waiver of premium claims experience]
Knowledge of diagnosis and procedure codes, general medical terminology, and disability duration guidelines
Excellent verbal and written communication skills including professional telephone skills
Microsoft Office Suite
Ability to multi-task and prioritize workload in a workflow environment
Business Acumen: Appreciation and understanding of the financial services industry in order to make sound business decisions

Life Claims Specialist Resume Examples & Samples

1+ years claims experience (life insurance claims is preferred)
Proven analytical and problem solving skills and attention to detail
High level of compassion and commitment to customer service
Learning Agility: Openness to new ways of thinking and acquiring new skills to retain a competitive advantage

Senior Claims Specialist Resume Examples & Samples

Identifying, monitoring and reporting on emerging liability and coverage trends
Broad surplus claims experience: minimum of 5 years of experience managing claims. Experience in the handling and management of general liability, contracting, premises liability, products liability, and excess liability claims preferred
Collaborative approach: Develop productive working relationships with insured, brokers, claim handlers, Underwriters and legal counsel. Seek input from others as needed to achieve the best result possible. Capable of working and collaborating with a virtual team
Possession of state adjuster licenses is preferred. Insurance designation(s) (CPCU, AIC, ARM) preferred

Claims Specialist Resume Examples & Samples

Minimum of 3 (or more) years of solid experience handling Professional Liability claims to include Lawyers and Accountants E&O, Insurance Agent E&O, Miscellaneous E&O, and other specialty areas preferred
Strong knowledge of the insurance industry, claims, and the insurance environment
Possesses a functional and developing knowledge of multi-state legal statutes and procedures
Law degree preferred
Professional Designations preferred

Senior Claims Specialist Resume Examples & Samples

Helps develop and execute the strategies for large accounts to help identify coverage based on applicable policies, manage claims and overall programs in conjunction with WTW safety and service teams
Directly handles clients as primary consultant including complex consulting and strategy
Maintain direct relationships with key clients
Manage the appropriate level of resources for your clients
Participate in strategic large client meetings as required
Extensive experience of handling multi-line claims with focus on general liability claims of a complex nature. Experience with additional lines including property, construction defect, and/or workers’ compensation claims would be a benefit
High School diploma and college degree required
Travel required, primarily within Denver, Phoenix, and California

100

Priority Claims Specialist Resume Examples & Samples

Attention to detail with the ability to quickly identify trends
Working knowledge of the Medicare audit, appeals, reimbursement, Local Coverage Determinations (LCDs), and policy articles
Working knowledge of medical terminology
Self-starter / take initiative to proactively resolve problems
Strong sense of personal accountability to meet deadlines
Working knowledge of MS Office suite programs
Working knowledge of Electronic Health Records (EHR); such as, OPS and NextGen
Demonstrated ability to pull data and migrate into online records management systems such as OnBase
Demonstrate high ethical standards regarding confidential patient and billing information

101

Claims Specialist Resume Examples & Samples

Process detail billing from provider for complete required data elements and assure all data is captured correctly in the payment system before releasing payment
Accurately assign pay/deny codes and verify the associated charges for services provided
Understand contractual expectations with network providers to assure compliance with terms and expectations
Maintain confidentiality at all times whether in reference to confidential information or as it relates to medical information for specific patients
Create reports and meet deadlines for reimbursements
Identify any inconsistent billing practice or methodology for further review. Forward identified transports to audit area for further investigation
Meet daily productivity quotas on a consistent basis
Demonstrated familiarity with Medicaid terminology and services
Previous experience in claims processing preferred
Must be proficient with Microsoft Office software
Must type 30 wpm
Must operate 10-key calculator by touch
Must have effective oral, written and interpersonal communication skills

102

Claims Specialist Resume Examples & Samples

Daily claims processing
Understanding of Section 125 administrative processes and procedures
Understanding of HIPAA and Privacy Regulations
1Cloud, Excel and OnBase experience preferred
Meets daily deadlines consistently
Must take initiative in jobs performed
Flexibility/ adaptability

103

Claims Specialist Resume Examples & Samples

Sets activities, reserves and authorizes payments within scope of authority. Ensures issuance of disbursements while managing loss costs and expenses
Coordinates and performs investigations and evaluates claims and suits through contact with insureds, claimants, business partners, witnesses and experts. Seeks early resolution opportunities. Identifies files that have potential fraud and refers to SIU
Utilizes negotiation skills to develop complex settlement packages
Identifies claims with third party recovery potential and coordinates with subrogation/salvage unit
Partners with attorneys, account representatives, agents, underwriters, doctors, nurse case managers and insureds to develop a focused strategy for timely and cost effective resolution of more complex claims
Strong interpersonal, communication and negotiation skills. Ability to effectively interact with all levels of CNA's internal and external business partners
Ability to exercise independent judgement and make critical business decisions effectively assessing the merits of claims as well as evaluating claims based on a cost benefit analysis
Typically a minimum three to five years claims experience

104

Senior LTD Claims Specialist Resume Examples & Samples

Independently assess, analyze and render appropriate claim decisions pursuant to certificates on most complex claims
Clarify functional capacity through independent problem solving measures and discretion (gathering medical, vocational, and other information, efficient use of resources, and action planning) sufficient to determine initial and ongoing liability
Communicate clearly and concisely to influence return to work, discuss terms of the certificate, and the basis for payment/non-payment
Communicate with a variety of constituents (for example, claimants, doctors, nurses, employers, and attorneys) to gather information relevant to assessing, analyzing and rendering decisions based on the provisions of the policy and their own discretion, with limited guidance by supervisory personnel
Provide mentoring and/or coaching to less experienced team members, and handle more complex claims
As the sole owner of the LTD claim, determine return to work potential and strategy, identify a likely claim progression based on the facts of the claim and take action on their own assessment of the claim
5+ years’ long term disability claims experience
Ability to prioritize and maintain quality

105

Claims Specialist Senior Resume Examples & Samples

Confirm coverage and policy information
Initially establish and maintain proper loss reserve, and negotiate loss settlements
Conduct in-house investigation by taking recorded statements, ordering police reports, reviewing repair estimates, securing medical reports, etc. Attend necessary meetings or appearances on assigned claims as directed or approved by Supervisor
Keep Supervisor advised of significant developments in claims. Prepare required reports and other notices in a timely manner
Be familiar with and comply with all applicable provisions of Tokio Marine's Employee Handbook
Answer correspondence and inquiries promptly from brokers/agents, insureds, claimants, attorneys, outside vendors, TMM-employees, etc
Perform special projects and other duties as may be assigned
Four to five years of experience
Knowledge of tort law, motor vehicle law, basic reinsurance, and coding related to claims technical matters
Ability to negotiate settlement of claims in a timely and reasonable fashion

106

Claims Specialist Resume Examples & Samples

Reconcile claims filed to payments received on Investor and Mortgage insurance claims. Prepare claim payment reconciliation to ensure full payment is received
Determine root cause of curtailed items and determine whether supplemental claim, client expense or loss has been incurred
Update the system with pending, submitted, withdrawn and paid claim information
Stress Management: The ability to keep functioning effectively when under pressure and maintain self-control in the face of hostility or provocation

107

Claims Specialist Resume Examples & Samples

Helping to implement the general corporate strategy and adapt it to his/her specific work domain
Keeping professional knowledge permanently up to date in order to anticipate what is coming and to
Follow-up on trends in the health care market
Active language knowledge of at least English and French
An extra language may be required, depending on the contracts assigned
At least 5 years of relevant work experience
Solid knowledge of administrative processes and customer services
Advanced knowledge of Microsoft office - and own IT- applications
Sociable: correct, professional and at ease in contact with different stake holders (clients, colleagues,
Team members, superiors, …)
Organisational skills: is able to plan, prioritise and coordinate tasks in an efficient way
Accurate: accurately controls own work and work of team members in order to achieve faultless administration
Analytical: is able to invent, set up and evaluate procedures to achieve the fixed targets
Decisive: is able to set clear targets for him/herself and appropriate targets for his/her team members and takes decisions autonomously
Empathic: is able to imagine oneself in the situation of or see the point of view of others
Managerial skills: knows how to motivate and evaluate a team, how to delegate tasks in an efficient way and how to stimulate cooperation in his/her own team and also with other units and departments
Independent: is able to work independently
Pro-active and problem-solving: anticipates in a creative way expectations of clients and expectations of the company and formulates proposals for appropriate improvement
Writing skills: conveying clear and to-the-point messages in the appropriate style
Responsible: takes care that the assigned tasks are followed up in a dutiful, timely and correct way
Discipline: pays attention to procedures, agreements and document flows
Efficient: finds a good balance between quality and quantity
Discreet: works discreetly with confidential (medical) information

108

Claims Specialist Resume Examples & Samples

Manage claims to appropriate closure while providing excellent customer service
Provide timely and accurate claims administration in keeping with client contracts and within applicable state laws
Respond to requests by mail or telephone from clients, internal staff, claimants, medical providers and adjusters
Adhere to high standards of professional conduct while providing superior claims service
Responsible for conducting employee, client and internal contact on all assigned claims
Work closely with business units to gather claim related information
Review new claim reports and determine the most effective handling procedure for each individual claim
Assist with preparation of files for suit, trial, or subrogation
Respond to all voicemail, e-mail, and faxes associated with assigned claims
Maintain an effective diary on all assigned claims, to include departmental and personal calendars
Maintain current knowledge of assigned insurance lines and court decisions which may impact the claims function
Submit First Report of Injury to the carrier and/or TPA with appropriate tracking designations and in keeping with deadlines
Identify potential fraud through validation of claims information
Make outbound calls to carrier, injured employee & health care providers to obtain work status and case notes
Receive and respond to inbound calls from clients, claimants, adjusters and System One staff

109

Claims Specialist Resume Examples & Samples

Process, review, and adjudicate claims in an accurate and timely manner
Review files for accuracy, file completeness, and eligibility for coverage
Objectively assess claim and create an evidence-based case management plan with ongoing monitoring of progress to ensure quality and appropriate handling
Implement case management plan through communication with internal and external customers, medical providers, and third party vendors
Maintain excellent working relationship with internal and external customers
Problem solving in a team environment
1-3 years Disability, workers comp, or waiver of premium claims experience preferred
Knowledge of diagnosis and procedure codes, general medical terminology, and disability duration guidelines preferred

110

Senior STD Claims Specialist Resume Examples & Samples

Manages assigned caseload of STD claims
Decides payment period, follows up and monitors payment accuracy and timeliness
Follows established claim policies and practices to resolve claims and issues
Strong Letter writing/Microsoft Word
2-4 years Customer Service Background

111

Claims Specialist Resume Examples & Samples

Analyze and determine claims payment in an accurate and timely manner
Maintain excellent working relationships with internal and external customers
Participate in problem solving activities in a team environment

112

STD / Fmla Claims Specialist Resume Examples & Samples

Ensuring the claims contain recent clinical analysis and occupational information at that point
Deliver Customer Centric Service that is consistent with or exceeds our customer commitments and superior reputation
Proactively communicates with the claimant to set expectations, assess medical and non-medical barriers to return to work, and keep him or her fully aware of the status of the claim, including setting expectations with the claimant if other resources will be contacting him/her
Engage the Employer, Attending Physician, and other appropriate resources to efficiently and effectively gather information with the least amount of impact to the claimant
Provide a high-level of service to the claimant, including delivering on commitments, timely return of phone calls, and clear communication
Consistently assess claimant information and medical data to minimize disruption to benefits and ensure ongoing engagement with the customer
Prioritize and organize work with a focus on Claim Management Accuracy. Proactive action to obtain any information, including medical, and extend benefits to medically supported date
3 plus years claims experience or relevant business experience preferred
Bachelor’s Degree or Associate’s degree preferred

113

Claims Specialist Senior Resume Examples & Samples

Contact and establish a rapport with customer, injured party or property owner to obtain information. Comply with 24-hour contact requirements
Obtain all relevant facts to determine coverage, liability or compensability on claims files
Determine and analyze damages through appraisal, inspection and investigation
Utilize and manage experts to determine facts, damages and exposure, ensuring that the value of the service is greater than the cost
Evaluate information to assess proper resolution of claims to determine appropriate and fair payout
Negotiate settlement based upon strategies and plans that ensure appropriate fair settlement of the claims
Provide customer satisfaction by establishing a rapport with customers and by resolving issues
Comply with Quality Validation, TAACC instructions, Customer Service Manual, Information Security procedures and the Tokio Marine SIU program
Determine subrogation and salvage potential of claims
Handle No-Fault/PIP claims
Utilize inter-company arbitration to resolve claims, as well as, use of mediation, settlement conferences and alternate dispute resolution (ADR)
Communicate and work with both internal and external customers
Handle automobile bodily injury, property damage, product liability and general liability claims
Establish and monitor indemnity and expense reserves on claim files
Keep updated on important developments in tort and insurance law
Four-year college degree preferred
Five years or greater Property/Casualty claims experience required
Knowledge of specific line of business required – automobile, liability
Japanese Language a plus
Ability to negotiate first and third party claims required
Computer knowledge, especially Microsoft Word and Excel, desired

114

Senior General Liability Claims Specialist Resume Examples & Samples

New York Labor Law Construction claims handling experience
7 or more years of claims handling experience
Negotiation skills

115

Claims Specialist Resume Examples & Samples

Maintain production and quality standards
Investigate claims for required processing information
Must have previous experience processing medical claims, not just knowledge of
Medical terminology & Medicare experience desired

116

STD / Fmla Claims Specialist Resume Examples & Samples

Manages assigned caseload of short-term disability (STD) and/or Family & Medical Leave Act (FMLA) claims
Determines whether to return, pend, deny or pay claims. Inputs data
Evaluates claimant eligibility via information received from claimant, attending physician, and employer
2-4 years of experience in claims or customer service
Strong customer satisfaction focus

117

Claims Specialist Resume Examples & Samples

Coordinate with team members and escalate as appropriate to ensure timely and quality execution of activities in one or more pre/post foreclosure area(s), in compliance with applicable guidelines, to minimize reputational impact to Fannie Mae and ensure optimal resolution for business unit and vendor
Partner with internal and external parties via in-person meetings, phone calls and emails to resolve escalated or time sensitive collection issues and ensure an ongoing understanding of changes to processes/guidelines and related impacts. Maintain partnerships and facilitate open dialogue
Study, review and measure processes and guidelines of assigned business unit(s)/vendor(s); examine documentation and flow of work through systems and address any perceived gaps
Receive collection issues from assigned business unit(s), input into appropriate systems and monitor and track through to full resolution. Update systems regularly to insure most recent collection activity is tracked
Participate in process improvement activities by suggesting ways to realize process efficiencies based upon feedback and observations. May assist in the implementation of new or revised processes and procedures
Develop both regular and ad hoc reports to monitor business unit/vendor production trends. Distribute reports to appropriate audiences or summarize findings for inclusion in other reports/presentations
May provide training to internal and external groups
Ability to navigate through multiple systems
Reverse Mortgage Claims experience a plus
Strong collaboration and communication skills to partner with internal and external customers

118

Claims Specialist Resume Examples & Samples

Worker characteristics are normally acquired through completion of an undergraduate 4-year program. At least 2-years related experience might substitute for educational requirement
Good written and verbal communication skills to effectively and professionally negotiate with claimants, insureds, attorneys, etc. Solid comprehension of basic principles and practices of Company policies and procedures upon completion of formal training period
Work is of a technical nature and requires the analytical ability necessary to analyze, interpret and evaluate relevant information essential in resolving claims
Requires critical attention to detail and good organizational skills

119

Senior Complex Claims Specialist Resume Examples & Samples

Works on highly complex investigations of claims, analyzes coverage, liability, compensability and damages. Determines if a major claim should be settled or litigated
Manages all types of investigative activity on major claims. Coordinates discovery and litigation strategy with staff counsel or panel attorneys
Negotiates highly complex settlement packages, sets reserves and authorizes payment within scope of authority, settling claims in most cost effective manner and ensuring timely issuance of disbursements
Coordinates third party recovery with subrogation/salvage unit
Makes recommendations on claim management policies and processes to management
Analyzes claims activities; prepares and presents reports to management
Works with attorneys, co-carriers, brokers and insureds regarding the handling and/or disposition of highly complex claims
Keeps current on state/territory regulations, case law and issues, as well as industry activity and trends. May participate in industry trade groups
May provide guidance and assistance to less experienced claims staff and other functional areas, including ceded reinsurance
May be responsible for special claims projects and presentations
Bachelors and Juris Doctorate (JD) Degrees and preferably bar admission in at least one jurisdiction
Ten years of general liability claim adjudication/management experience with an emphasis on the adjudication of asbestos, environmental liability and other types of toxic torts claims
Advanced technical expertise related to CGL policies, claims resolution skills and knowledge of insurance and claims settlement principles, practices and procedures
Strong communication, negotiation and presentation skills. Ability to effectively interact with all levels of the company’s internal and external business partners
Advanced analytical and problem solving skills, with the ability to manage and prioritize multiple projects
Ability to deal with ambiguous situations and issues

120

Senior Claims Specialist Resume Examples & Samples

Provides plan and claim information, assists with submission of claims, and makes outbound calls to gather missing information on incomplete claims
Conducts research when needed to resolve customer questions or complaints
Able to appropriately explain varying plan provisions to customers accurately and in a professional manner
Responds to telephone inquiries from insured’s regarding specific claim details
Understands processes within entire department to assist callers with questions
Outbound calls and letters to customers and providers to research incomplete claims
Escalates complaints and potential complaints appropriately
Documents calls in computer system
Complete form letters, tasks and problem solve for resolution of customer issues
Contribute ideas that enhance service quality
Performs project work and other related duties as assigned or required
2+ years direct customer service experience

121

Unemployment Claims Specialist Resume Examples & Samples

Provide state unemployment claims support to ADP TotalSource clients, regions, state agencies and third party administrator
Serve as the unemployment claims subject matter consultant and third party liaison
Council clients on state unemployment claims matters including the use of state work share and back to work programs
Interprets state unemployment claims laws and enforce employee separation documentation requirements
Identify areas of improvement and noncompliance that impact claim cost control efforts
Provide recommendations and collaborate with HR Business Partners to implement solutions that improve client claims management and compliance with UI integrity regulations
Respond to state agency and third party administrator claims, appeals, and benefit inquires as required by state unemployment law and TotalSource processing procedures
Interpret state unemployment claim laws and council clients on contestable unemployment claims and appeals daily. Provide support and assistance on unemployment claims matters
Partners with clients and HRBPs to identify and address areas of improvement and noncompliance that impact cost control efforts
Audit employee termination documents and provide accurate and timely responds to state agencies and third party administrator inquires related to unemployment claims, appeals and hearings
Obtain missing separation documents for contestable terminations in compliance with state UI Integrity regulations
1-3 years of directly related experience
Experience with HR or unemployment adjudication, hearings, claims, terminations, or disciplinary actions
Ability to work under pressure to meet time constraints and deadlines
Ability to deal with escalated issues
Ability to work and research independently
PHR/SPHR/SHRM-CP

122

Claims Specialist Resume Examples & Samples

Keeping professional knowledge permanently up to date in order to anticipate what is coming and to evolve in line with company growth and expectations of clients
You are mobile when required (rare but important)
Discrete: works discreetly with confidential (medical) information

123

Senior Claims Specialist Provider Verification Resume Examples & Samples

Provider Verification Expiration Report- update providers license/credentials that we are currently paying claims
Provides claim information, assists with submission of claims and makes outbound calls to gather missing information on incomplete claims
Works closely with the claim analysts and care managers to provide a seamless customer experience
Outbound calls and letters to customers and providers to research incomplete claims. Escalates complaints and potential complaints appropriately
Completes form letters, tasks and problem solve for resolution of customer issues. Contributes ideas that enhance service quality

124

Claims Specialist Resume Examples & Samples

Answers telephone inquiries through the “Automated Call Distributor (ACD) Telephone System”
Verifies and interprets information in all vendor contracts to resolve caller issues
Ensures the average call monitoring score over the previous six months meets or exceeds quality standards
Troubleshoots claims that require an authorization
Updates authorization information based on information obtained from caller
Processes simple HCFA claims and performs simple claim adjustments as needed
Tracks progress of resolution of claims issues and routes resolved claims back to the appropriate person in Claims
Ability to make decisions with every call and resolve issue on first call
Familiarity with managed care industry, standard claims forms, ICD-9 and CPT codes
Ability to process simple professional claims as needed

125

Claims Specialist Resume Examples & Samples

Provide high quality cost effective adjudication services which meet or exceed expectations provided to customers and are in accordance with the terms outlined in the certificate of insurance
Manage a block of Life and Disability mortgage creditor claims in accordance with consistent claim guidelines, in conjunction with the appropriate medical and claim consultants, within your authority levels and in accordance with the terms of the certificate of insurance. Be alert for fraud or misrepresentation and take necessary steps to verify and resolve where detected. Refer all claim decisions which can affect our liability, approvals, closures, denials, etc. to the Claim Consultant for sign off and approval before proceeding
Adjudicate claims for misrepresentation, fraud and certificate exclusions
Evaluate medical, employment and mortgage lender documents to determine whether the life or disability claim is eligible. Administer and document claims for assessment of continued eligibility for disability benefits, return to work, bridge payments to the lender while the life claim is being assessed and all requests for additional information
Prepare all written correspondence, including, requests for additional information, communication of decisions, etc
Maintain a sound knowledge of products, procedures, systems, contract wording and claims management
Meet objectives and service standards by working with the Manager to ensure that team goals are met
Process applicable accounting and financial transactions associated with payments and the setting of reserves
Previous experience in adjudicating Life and/or Disability claims
Excellent interpersonal skills with exceptional oral & written communication skills
Demonstrated experience interpreting contractual, medical, financial and legal provisions, by utilizing the appropriate Consultants and fair claim practices and principles
Sound judgment and dispute resolution skills
Must have a good working knowledge of medical conditions and terminology
Must have a good working knowledge of financial documents
Ability to respond constructively and decisively in high pressure or emotional situations and to respond quickly and positively to change
Excellent analytical skills in order to evaluate conflicting information from various key sources in order to assess risk in making timely and effective decisions with appropriate interpretation of policies and procedures
Strong organizational, conceptual, investigative and analytical skills; ability to gather information from key sources to assist in claims decisions and problem solving
Personal style should reflect the high level of professionalism which Manulife projects to our customers
Ability to work independently and as part of a high functioning team
Ability to deal with sensitive and confidential information

126

Claims Specialist Resume Examples & Samples

Administer the self-insured, self-administered general liability, automobile and facility property damage, to both company and other facility owners in the claim process, including collection for damage done by others to Company vehicles and equipment and company facilities
Collect for damage to Company owned facilities by others as invoiced by the Company
Prepare interrogatory answers and produce documents for lawsuits involving the Company
Investigate incidents, claims, and lawsuits on site
Type/write reports and gather records
Appear in Small Claims Court on behalf of the Company, if appropriate in the jurisdiction
Facilitate awareness programs for other departments
Prepare company witnesses for deposition and/or trial
Investigations within the Company territory could involve some travel
Gather the appropriate company and public records, i.e., police, fire reports, etc., as needed
Enter appropriate claim data into the NavRisk system
Maintain a high level of professional ethics and compliance
Strong interpersonal skills with the proven ability to build and establish rapport with a diverse array of people
Ability to work as part of a team and display a positive attitude for this dynamic environment
Two years of experience with customer contact, both by telephone and in person preferred
Two years of experience responding to incidents and/or performing on scene investigations preferred
Two years of experience with/field knowledge of a gas distribution system preferred
Certified Fire Investigator preferred but may be obtained
Strong ethics and integrity, dedication to a safe work environment and commitment to a diverse workforce that recognizes and respects every individual’s unique skills and perspectives
Knowledge of basic PC skills, with an understanding of Microsoft Excel, Word & Outlook and PowerPoint
Good telephone skills - Ability to communicate effectively orally and in writing
Must possess the attitude and abilities to develop new skills and areas of expertise
Must be willing to undertake a program of continuing education regarding matters unique to legal/claims
Ability to perform work for more than one person simultaneously
Effective planning, organizational , administrative and prioritization skills in managing the work load
Strong interpersonal skills with an emphasis on initiative, knowledge sharing, teambuilding and independent decision-making
Ability to work effectively with all levels throughout the organization and across functional lines

127

Senior Claims Specialist Resume Examples & Samples

Analyzes and processes complex or technically difficult medical malpractice claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution
Conducts or assigns full investigation and provides report of investigation pertaining to new events, claims and legal actions
Negotiates claim settlement up to designated authority level
Calculates and assigns timely and appropriate reserves to claims; monitors reserve adequacy throughout claim life
Recommends settlement strategies; brings structured settlement proposals as necessary to maximize settlement
Coordinates legal defense by assigning attorney, coordinating support for investigation, and reviewing attorney invoices; monitors counsel for compliance with client guidelines
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall claim cost for our clients
Identifies and investigates for possible fraud, subrogation, contribution, recovery, and case management opportunities to reduce total claim cost
Represents Company in depositions, mediations, and trial monitoring as needed
Communicates claim activity and processing with the client; maintains professional client relationships
Delegates work and mentors assigned staff
In-depth knowledge of appropriate medical malpractice insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business

128

Claims Specialist Resume Examples & Samples

Responds to customer inquiries, according to productivity and quality standards. Strives to return all voice mail, email and chat messages within contact center expectations
Support the potential claimants through the registration process and the assessment/background/medical questionnaires in the new consumer market product
Support claimants through the use of Allsup Place and empower questionnaires throughout entire process
Understand and support sales process
Accesses claimant’s record on the system (past notes, completed fields, actions); interprets, gathers, and conveys information to the caller (claimant, Social Security Administration, Disability Determination Service, Office of Disability Adjudication & Review)
Reviews claimant completed questionnaires and follows up with claimant for additional information, if needed, prior to submitting forms to Social Security and/or Disability Determination Services
Interviews claimants by telephone to complete application, appeal, questionnaire and ancillary forms, ensuring appeal deadlines are met
Place outgoing calls to gather information from claimants
Accurately and fully records the claimant’s description of the disability onset, medical condition, medical sources, functioning, and vocational history. Resolves discrepancies as necessary
Strives to produce quality work that contains correct grammar, spelling, punctuation, and follows guidelines in “Allsup Style Guide”
Diligently pursues contact with the claimant and initiate emails and/or letters to the claimant to ensure every opportunity was taken to reach the claimant
Demonstrates technical knowledge and application with respect to the first two levels of Social Security disability process. Must have thorough knowledge of functions of all Allsup departments. Provides claimant insight to the process and program requirements
Establishes, cultivates, and maintains a positive and professional relationship with the claimant, while utilizing call management skills
Responds to claimant questions with courtesy, empathy, and professionalism. Demonstrates tact and diplomacy in handling problem solving situations with claimants, Social Security Administration, Disability determination Services and employees
Performs vital data entry in case management system. Accurately and thoroughly document talk notes of all conversations and actions
Processes work in a timely and accurate manner
Participates in the training and development of other specialists; shares information
Maintains strict confidentiality of claimant information, procedural manuals, client/prospect lists, information on new business ventures, and other confidential Allsup information
Obtains information regarding other services/programs that might be helpful to the claimant such as health insurance assistance, Medicare, state funded programs (welfare) and other local resources

129

Claims Specialist Resume Examples & Samples

Ensures timely, accurate and efficient processing of claims edits via EPIC work queues
Meets daily claims edit resolutions goals by reviewing, analyzing, and obtaining appropriate documentation based on payer requirements and regulations
Prepares electronic and paper claims and sends with appropriate attachments
Conducts research and provides updates and current status of claims edit work queues using the appropriate data management system (EPIC)
Resolves issues that are adversely impacting claims submission in a timely and accurate manner
Completes or requests adjustments to accounts based on dollar threshold
Communicates information and ideas to make system-wide process improvements
Updates patient accounts regarding changes and modifications in plan benefits and other contract information relevant to the claims follow up and collection process
Documents claim processing activity on patient accounts
Serves as a communication link to various departments and external payers by developing positive relationships with managed care organizations and outside agencies, and clinical areas within the
Performs liaison services to both internal and external customers providing assistance in claims
Assists with education of internal staff and external customers to bring about the timely, accurate, and cost effective adjudication of all claims
Works collaboratively with other departments to facilitate the insurance collections process and to improve overall cash collection
Monitors the status of claims in work queues and conducts routine, periodic follow up on previously researched claims items
Monitors, reviews, and suggests revisions or updates to existing forms, documents, and processes required to submit a clean claim
Assists other departments/functional areas as needed with billing, claims, or claims follow up related tasks
Ensures completeness of claims by following national, local, and internal billing requirements promoting prompt and accurate submission and payment
Maintains awareness of current regulations
Initiates practices that support current regulations
Shares knowledge of current regulations with staff. Analyzes current practices and makes recommendations for process improvements

130

Claims Specialist Resume Examples & Samples

Using strong technical skills, handle the complex and challenging claims within authority level and specialization. The Claims Specialist main specialization would be Equipment Breakdown, with Energy & Construction losses included to balance the workload
Partner with internal and external counsel in setting and pursuing effective and cost-efficient litigation strategies for claims in litigation
Work with management and Claims Legal to identify and select appropriate counsel
Proactively manage expenses through thoughtful expense management and claims best practice
Active participant in Quality review process
Seek to identify new and improved processes. Embrace short and long-term improvement initiatives, and actively participate to understand and embed any new initiatives
Coordinate and manage communication with internal and external stakeholders (e.g., underwriting, brokers, reinsurers, external vendors, etc.) to ensure the highest level of customer service
Produce internal reporting in support of best practice and reserving guidelines
Identify, monitor and report on emerging liability and coverage trends
Keep current on state/territory regulations and issues as well as industry activity and trends

131

Lost Time Claims Specialist Resume Examples & Samples

Actively participate in claim reviews with clients
Appropriate state licensing to be obtained for assigned jurisdictions
Assign medical or other experts to case and arrange for medical examinations when necessary
Communicate claim status with the injured worker, clients, and broker as needed
Develop lost time claim disposition skills under limited direction of supervisor
Effectively evaluate and resolve coverage issues for all Workers' Compensation claim types
Establish appropriate reserves and review on a regular basis to ensure adequacy. Make recommendations to set reserves at appropriate level for claims outside of authority level
Investigate the claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, clients, witnesses and others having pertinent information
Manage the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment under limited direction of supervisor
Pro-actively manages the case resolution process. May participate in mediations within limit of settlement authority
Provide required reports to AVP, Claims, Underwriting, Reinsurance and Actuarial on significant exposure cases
Timely analyze information in order to evaluate assigned claims to determine the extent of loss
Bachelors and/or advanced degree. (Minimum of 3-5 years of lost time claims experience will be considered in lieu of degree)
Minimum of 2 years of workers compensation lost time claims handling experience
Intermediate knowledge of law and insurance regulations in various jurisdictions
Demonstrated strong analytical and decision making skills
Intermediate knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, litigation management, and product line knowledge
Previous experience with the reserving and adjudication of the following: Workers compensation lost time claims Workers compensation claim investigations (including subrogation) and compensability decisions

132

Claims Specialist Resume Examples & Samples

Understanding of local, state and industry standards (NCIS)
Working knowledge of Microsoft Office suite, general computer software and database systems
Evaluate project outcomes through analyzing current state and desired future state
Handle complex claims using a logical approach
Provide adjusters detailed instructions for claim procedures and company policy
Solve day-to-day problems, using critical thinking

133

Claims Specialist Resume Examples & Samples

Must be flexible and able to prioritize tasks. Ability to meet deadlines
SAP experience is an asset
Must have excellent interpersonal skills with the ability to interact with high credibility at all levels of the organization
Must have strong negotiation and decision making skills

134

Claims Specialist Resume Examples & Samples

Review and approve or deny claims for payment
Determine which reinsurer holds the liability for a claim, and the amount ceded to that reinsurer by referring to the reinsurance treaties, and the group contract
Review and verify all policy provisions, to determine if payment can be made. Approve claim for payment, and forward, if needed, to the appropriate officer or manager for second approval according to our approval guidelines
Review and process all continuance requests for disability claims
Arrange payment plans with claimants that are overpaid on their benefits
Check monthly figures on all claim accounts with appropriate company records and accounts
Research all complaints from State Insurance Departments regarding claims
Work with all levels of the AICK staff in making changes in our existing contracts and assist in developing new products
The work requires a great amount of concentration and the ability to use a PC 80-85% of the day. Mental fatigue is associated with a position of this nature. Primary contact for all life and disability claims. This position experiences constant interruptions
Minimum of LPN, Certified Nurses Aid or Certified Medical Aid with two or more years clinical experience; or 60 hours course work towards a degree in a medical field to include courses such as Human Anatomy, Biology and/or Medical Terminology required
Ability to analyze detailed contract provisions and make decisions based on a set of facts or criteria
Excellent written and verbal communication skills. Must be able to communicate tactfully and accurately with physicians, attorneys, judges and other professionals
Experience with Word, Excel, Lotus and Access is required
Extensive knowledge of Kansas Insurance Department regulations for life and disability products preferred
Extensive knowledge of ERISA/FICA regulations preferred
High aptitude for math

135

Complex Claims Specialist Resume Examples & Samples

Within prescribed settlement authority for line of business, establishes appropriate reserves for both indemnity and expense and reviews on a regular basis to ensure adequacy. Makes recommendations to set reserves at appropriate level for claims outside of authority level
Prepares comprehensive reports as required. Identifies and communicates specific claim trends and account and/or policy issues to management and underwriting
Manages the litigation process through the retention of counsel. Adheres to the line of business litigation guidelines to include budget, bill review and payment
Pro-actively manages the case resolution process. Actively participates in mediations and arbitrations, within limit of settlement authority
Participates in the claims audit process
Provides claims marketing services by meeting with brokers, risk managers and reinsurers, as necessary
Bachelors' and/or advanced degree. 7 + years claims/legal experience, with at least 2 years within a technical specialty preferred
Advanced knowledge of claims handling concepts, practices and techniques, to include but not limited to coverage issues, and product line knowledge
Demonstrated advanced verbal and written communications skills
Demonstrated advanced analytical, decision making and negotiation skills

136

Claims Specialist / Assistant Resume Examples & Samples

Research to find all policies held by the insured. Communicate with other Transamerica offices that might also have coverage
Request files during the claim process (this would include ordering files from record retention and from AWD)
Knowledge of claims process would be a benefit
Skills Advantage Work Ready Certificate, Optional
Above average customer service skills
Knowledge of the claims department and other departments within the company and the other offices that form Transamerica is helpful, but not required

137

Senior Claims Specialist Resume Examples & Samples

Proactively manage assigned claims across the United States, while setting and implementing the case strategy for these claims under the direction of the Practice Leaders and Claims management. Ensure all documentation is present in the file, and Claim Handler Guidelines and protocols are followed
Using strong technical skills, handle the complex and challenging claims within authority level and specialization
As claim file owner, collaborate with Claims Manager and Practice Leaders on large and complex losses to achieve optimum file outcome for the client and XL Catlin, determine if / which external vendors to engage, and establish strategic plan with vendor, identify Large Losses and ensure all steps are taken to achieve the best outcome for the client and XL Catlin (including those claims within authority level)
Partner with internal and external counsel in setting and pursuing effective and cost-efficient litigation strategies for complex claims in litigation
Work with management and Claims Legal to identify and select appropriate counsel. Pro-actively manage litigation strategy on claims
Assist Underwriters with policy review and drafting initiatives, participate in external marketing and business development activities. Share lessons learned and other identified trends to improve risk assessment and underwriting process
Produce internal reporting in support of best practice and reserving guidelines. Follow the XL Catlin Claim Alert process
Coach less experienced colleagues and be a role model in best practices
Education: Bachelor's degree required, JD preferred
Experience: Minimum 8-10 years of Construction Defect claim handling experience; working knowledge of applicable regulations; extensive experience managing, negotiating and resolving high exposure and complex claims. State Licensing in required states desired
Analytic Skills: Possesses strong analytical skills and sound judgment
Leadership: Role model by setting a high bar for performance, engagement and commitment. Ability to coach, develop, set expectations, evaluate and hold people accountable for delivering. Takes initiative and has the ability to lead independently
Strong communication: Excellent verbal and written communication, collaboration, presentation and influencing skills. Able to communicate effectively with internal and external stakeholders at all levels of sophistication. Ability to work in a fast-paced environment and efficiently juggle numerous concurrent responsibilities
Continuous Improvement Focused: Willing to ask questions and explore new ideas. Eager to learn and focused on continuously improving technical skills and XL Catlin claims capabilities
Client-service Oriented: Focused on value at all points in the claims experience delivering on our promise to clients

138

Claims Specialist Resume Examples & Samples

Validates member eligibility, appropriateness of claim data that is billed
Resolve complex claims issues from providers
Other miscellaneous duties as assigned by manager
Knowledge of Medicare, Medicaid, and commercial claims state and federal regulation
Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up

139

Senior Claims Specialist Resume Examples & Samples

Managing assigned Professional claims across multiple jurisdictions, setting the case strategy for these claims in partnership with Regional Practice Leaders and Claims Management to take all available steps to achieve the best outcome
Partnering with internal and external counsel in-setting and pursuing effective and cost-efficient litigation strategies for claims in litigation
Producing internal reporting and ensuring that reserves are set according to best practice guidelines
Coordinating and managing communication with internal colleagues and key external stakeholders (e.g., clients, brokers, reinsurers, vendors, etc.) ensuring we are providing the highest level of customer service
5 to 10 years of Professional claims experience managing third party and liability loss exposures
Law degree preferred; will consider commensurate experience
Proven experience managing all facets of claim files including analysis, investigation, evaluation, presentation and negotiation skills
Building and refining effective working relationships with insured, brokers, claim-handlers, underwriters, co-insurers, excess and reinsurers as well as external vendors including investigators and legal counsel
Passion for results: Approaching tasks proactively and anticipating needs. Thinking quickly and prioritizing multiple work streams without sacrificing quality. Acting with a sense of urgency
Intellectual curiosity: A willingness to ask questions and explore new ideas. Eager to learn and focus on continuously improving technical skills
Excellent verbal and written communication, negotiation and presentation skills with the ability to communicate and interact internally and externally with senior management, business leadership and business partners
Seeking input from others as needed to achieve the best result possible with effective skills working with and collaborating with virtual teams
Handling claims responsibilities with integrity and the highest standards of professionalism
Travel is anticipated at up to 10% of the time

140

Claims Specialist Resume Examples & Samples

Support Claims Management team for claims reporting and claims data analysis
Support Claims Management in establishing departmental objectives and procedures to provide direction to claims team
Troubleshoot and conduct root cause analysis of claims issues, recommend solutions and resolve issues
Oversee all First Tier Downstream and Related Entities(FDR) issues and fallout processing
Maintain current knowledge base of all CMS guidelines and train support staff to ensure compliance
Identify trends and issues across the environment to ensure compliance and delivery of seamless service to members and implement solutions
Assist with Claims System(QCARE) maintenance such as Opt-Out and Sanction list upload, generating and distributing of ClaimStat reports, Monthly Medicare Refund Reports and any additional reporting required
Participate in and actively support all CMS claims activities, including Enterprise compliance meetings, requests, and monitoring activities
Assist Claims management with various reports and Claims projects as needed such as Orphan Claims reports, Recovery, Invoice reconciliation, Adjustments and any other Claims projects as needed
High School Diploma or equivalent required. Bachelors degree is preferred
At least 2 years of knowledge of Medicare Advantage claims, systems, processes and CMS guidelines with regards to claim processes required
At least 3-5 years of relevant work experience in a claim organization, a focus on Medicare Advantage products preferred
Must have Microsoft Office product knowledge - including at least intermediate to advanced working knowledge of Microsoft Excel
The ability to maintain high attention to detail
Ability to work with all levels of matrix partners and outside vendors

141

General Liability Claims Specialist Resume Examples & Samples

Juris Doctor and 1 or more years of experience in the Claims Handling area
Commercial general liability claims handling experience
Experience reviewing and analyzing coverage

142

Furniture / Bedding Claims Specialist Resume Examples & Samples

Customer-oriented focus
Excellent problem solving skills with the ability to multi-task
Ability to work well with others and be a team player
Flexible availability that includes one to two evenings a week and a Saturday rotation

143

Senior Claims Specialist Resume Examples & Samples

Provider Verification: Research providers to see if they meet requirements rules vary depending on state and policy provisions
Research what providers are available to our insured’s based on their area of residence
Update our administrative system
Understands processes in entire department to assist callers with questions

144

Unemployment Claims Specialist Resume Examples & Samples

Analyze individual case information by reviewing data accessed through internal systems/platforms, from documented telephone calls or document images, to determine if the facts warrant a response
Work as a team with our Unemployment Insurance Consultants (UIC’s) to ensure accurate and necessary information retrieved from customers is documented clearly and thoroughly into our database
Investigate and resolve state agency concerns with supervisor, other departments and/or State Relationship Managers in a timely manner
Perform any additional functions needed to meet the goals of the department
Overtime may be required in order to meet state deadlines or volume demand
Attention to detail and processing efficiency
Good problem solving and decision making abilities
Previous and successful experience or familiarity with the unemployment insurance process is preferred
Proficiency with Microsoft Office applications including Word, Excel, and Outlook
Ability to learn and utilize associated technologies/systems

145

Unemployment Claims Specialist Lead Resume Examples & Samples

Assists team where needed due to vacations, absences and fluctuations in work load
Assists with coordinating the work load, ensuring adequate distribution of the work among available staff. Works with the supervisor to use all resources to accomplish the daily work load, by assuring each desk if fully covered
Acts as a source for answers/guidance for employee questions and investigates through research any concerns that arise
Assists with cross-training of employees
Assists with checking completed and ongoing work of newly trained employees, ensuring a high level of performance
Assists with client and/or account manager concerns, questions, and follow-up
Assists supervisor with report generation, special projects, and teamwork initiatives
Maintain confidentiality with manager concerning members of the team
Successful experience and performance as an Unemployment Claims Specialist
Proven knowledge of unemployment compensation and company procedures
Proven experience prioritizing, organizing, and working with deadlines
Good state-communication and problem-solving skills
Must possess diplomatic people skills and maintain a professional mannerism while performing in a fast-paced environment
Proven ability to multi-task and work under strict deadlines
Ability to function independently from supervision to meet workload demand/deadlines on a daily basis
Proficiency in Microsoft Office Applications
Ability to type 35 WPM

146

Claims Specialist Resume Examples & Samples

Review, analyze, and ensure timely settlement of investor and mortgage insurance claims and manage aging claims to determine status and bring to closure
Document and maintain all systems necessary for proper claim handling and follow-up
Research issues and obtain proper supporting documentation in a timely manner as requested by investor or mortgage insurance company
Manage application of all claim funds received and provide additional information as necessary in order to validate all available funds received prior to claim being closed
Monitor claim process reports to ensure all required responses are timely filed
Complete timely audits of all assigned claims to ensure all requirements have been met, and claim process can be validated
Knowledge of Microsoft Office – Excel, Word – computer skills should be above basic level
Previous work with mortgage claim filing a plus

147

Claims Specialist Resume Examples & Samples

Review, analyze, and ensure timely filing of investor and mortgage insurance claims while managing outstanding receivables of claims filed to determine status and bring claim process to closure
Research and analyze trending, accounting data, figures and transactions with large number sets throughout the system of record and acquisitions data
Research issues and obtain proper supporting documentation by contacting previous servicers, attorneys, taxing authorities, HOA’s and other vendors in a timely manner as requested by the investor or mortgage insurance company
Review and analyze outstanding receivables by fulfilling outstanding document requests that is preventing payment from the investor or mortgage insurance company
Monitor claim applications and complete timely audits of all assigned claims to ensure all requirements have been met and claim process can be validated
General knowledge of the default process completed by foreclosure, loss mitigation and escrow
Proficient in Microsoft Office – Excel, Word
Proficient in 10 key skills
1-2 years of recent, residential, mortgage servicing experience as a team manager/supervisor

148

Claims Specialist Resume Examples & Samples

Claims/debt cancellation experience
Ability to meet production goals and contractual quality standards
*Shift hours: Monday - Friday 9:00 AM - 6:00 PM

149

Claims Specialist Resume Examples & Samples

Investigating and settling one or more of these complex claims types: liability, property and/or material damage
Determining applicable policy coverage, evaluating damages, assessing liability, and creating applicable negotiation strategies
Obtains and analyzing a wide variety of applicable documentation related to assigned claims, some of which may include, i.e., ISO reports, fire reports, police reports, cause & origin reports, medical reports, engineer reports, written estimates, witness accounts, etc
Completing physical inspections of the more extensive losses (when necessary), evaluating damages, and preparing written estimates according to policy provisions and published company guidelines
Initiating first contact with insureds, claimants, and all relevant parties to gather basic information, obtain recorded statements (when necessary), and explain the overall claims process
Maintaining continuous communication with all affected parties regarding each step of the claims process
Communicating and negotiating with a variety of individuals regarding investigation and settlement of applicable claims, i.e., insureds, claimants, attorneys, medical providers, insurance carriers, and other involved parties
Acting as resident expert while providing direction, support, and training of lesser-experienced Claims Representatives
Participating in round tabling on applicable claim files and has significant responsibility for coaching and developing employees
Education equivalent to graduation from college (or the equivalent in related work experience)
Maintains the appropriate adjuster's licensing as required by the states in which we do business
Five or more years of claims adjusting experience (or the equivalent)
Demonstrated ability to evaluate, investigate, and settle the more complex claims within higher settlement authority limits than those handled by Sr. Claims Representative
Knowledge of insurance contracts and claims law
Requires highly-developed oral and written communication and negotiation skills to communicate with a wide variety of internal and external contacts
Must possess the ability to handle potential conflict effectively and constructively
Excellent decision-making, analytical skills, and attention to detail
Proven time management, prioritization, and organizational skills are required to handle a high volume of assigned claims within expected timeframes
Must be comfortable with ambiguity where claims facts and circumstances may be unknown or vague
Proven ability to multi-task while interacting effectively with financial representatives, claimants, insured’s, internal staff members, and external contacts
Education equivalent to graduation from college with a degree in business, insurance or agribusiness (or the equivalent in related work experience)
Previous experience handling specific claims applicable to area of specialist assignment
Experience with the claims investigation and settlement process of one or more claims types
Experience handling property claims, bodily injury, and/or material damage claims (including total losses)
Good working knowledge of the policy provisions and coverage’s associated with these claims

150

OS&D / Claims Specialist Resume Examples & Samples

20% Gather documentation from carriers/customers/Business units to support claims against carriers. Sort and maintain data base tracking from initial receipt of claim to filing claim with the carrier
15% Collect and prepare departmental reports including claims tracking, departmental scorecard and other ad hoc reports requested by internal clients /reporting/A/R review
10% Initial review and analysis of claims for determination of carrier liability
5% Other duties as required

151

Senior Claims Specialist Resume Examples & Samples

Analyzes and processes complex or technically difficult Errors & Omissions claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution
Represents Company in mediations, and trial monitoring as needed
In-depth knowledge of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security application procedures as applicable to line-of-business

152

Trade Claims Specialist Resume Examples & Samples

Process all trade related customer claims; obtain and verify supporting documentation and proof of performance, identify and select appropriate rebate or fund, conduct research and provide notification and full back-up for unauthorized deductions, and verify collection attempts prior to any write off per department SOPs and step guides
Communicate and work closely with the third party processor, broker, sales team and other WWFC departments to resolve all deductions in a timely and accurate fashion as measured by team KPIs
Hold periodic calls with each sales team that handles assigned accounts per management determined frequency. Ensure effectiveness through proper scheduling, management and reporting of call
Track data, communicate issues and provide reports to management
Identify areas for improvement in deduction processing and develop and present written recommendations for changes in policy and procedure
Maintain and create internal reports
Bachelor’s Degree in Accounting or related field with 0 years of transactional accounting experience OR High School Diploma or equivalent with at least 3 years of progressive transactional accounting experience (Accounts Payable, Accounts Receivable, Accounting Clerk) required
Must demonstrate initiative to solve issues independently, consistently, and professionally
Must have working knowledge of general accounting procedures and process including GAAP
Must be detail oriented and possess strong organizational skills
Strong computer skills, particularly with Excel, Microsoft Word and an e-mail system
Ability to prioritize work, manage multiple tasks and effectively meet deadlines
Ability to produce timely, accurate, reliable and relevant information
1 year CPG/food manufacturing industry experience preferred
Bachelor’s degree in accounting or related field preferred

153

Senior Claims Specialist Resume Examples & Samples

Responsible for investigating and resolving claim related tickets and other types of requests including but not limited to claim reprocessings and inquiries from internal and external sources
Provides accurate and timely maintenance of the most complex provider and reimbursement information
Analysis of provider’s trends and issues with reported findings
Monitor, review and release of all claims batches in the Claims Management module in FlexCare. Includes: New, Queue, Pending and plan specific claims folders
Ensures all applicable batches are released in time for weekly check runs
Maintains thorough knowledge of the processing requirements for each Plan
Review and process member reimbursements
Quality check claim batches adhering to weekly check run deadline
Check refund processing
Liaison with Mail Room team with claims related items
Review and process specialty batches
Enter claims as needed
Assist in post implementation process for new business
Liaison for Member Services related to escalated claim calls
Assist in training of new staff
Working knowledge of vendor relationships (3M and other vendors as contracted)
Working knowledge of specialized pricing methodologies, I.E. 3M groupers – MS-DRG, APC, APGs, APR-DRGs
Create and maintain a manual documenting departmental tasks
SOC remediation point person
SOC remediation- ensures monthly SOC scores are tracked by plan, findings are resolved through to completion
SOC remediation- responsible to research claims outside of SOC purview however related to findings from SOC review. I.e. provider retro rate load/reprocess, ITR completion/follow through with identifying affected claims
Review, analyze post adjudication review findings and completes through resolution
Serve as a back up to the Manager for specific functions
Represent the Claims department on calls as needed
Bachelor’s Degree in Business, Healthcare Administration or related fields; or an equivalent combination of education, training and experience is required
Minimum of five years’ of related work experience
Ability to handle demanding caseload, make independent decisions and multi-task

154

Warranty Claims Specialist With English Resume Examples & Samples

Validate warranty claims according to regional policies
Manage unclear – on hold – repair claims
Provide support to service centers/client’s local care team
Communicate results of validation
Create pro-forma invoices/payment proposals based on country specific rules
Co-operation with other sub-teams
Processing team tickets and ensuring ticket resolution according to agreed timelines
Organize/participate the conference calls with agreed counter parts according to he agreed frequency, making notes and their follow ups
Process document creation/update
Reference data structure management, preparation for system update

155

Inside Casualty Claims Specialist Resume Examples & Samples

Assists adjusters with more complex claim handling, analyze documentation and settle basic, straight-forward, and routine claims quickly and efficiently
Insurance background especially desirable
Good oral and written communication skills

156

Claims Specialist / Assistant Resume Examples & Samples

Receive calls from insured’s, beneficiaries, agents, attorneys and funeral directors who are calling to report or inquire about the status of a claims (average 150 calls per person per week)
Open, stamp and count incoming mail
Proofread Examiner letters before mailing

157

Claims Specialist Resume Examples & Samples

Proactively manage assigned liability claims across multiple jurisdictions, while setting and implementing the case strategy for these claims under the direction of the Practice Leaders and Claims management. Handle all claims in accordance with XL Catlin’s Claim Handling Principles
Collaborate closely with senior claims handlers and Practice Leaders to achieve optimum file outcome, determine if / which external vendors to engage, and establish strategic plan with vendor, identify and notify management of Large Losses and take all appropriate steps to achieve the best outcome for the client and XL Catlin
Work with management and Claims Legal team to identify and select appropriate counsel or alternative resolution technique. Pro-actively manage and control litigation strategy on assigned claims
Active participant in Quality Review Process
Assist Underwriters with policy review and drafting, participate in external marketing and business development activities Share lessons learned and other identified trends to improve risk assessment and underwriting process
Coordinate and manage communication with internal and external stakeholders to ensure the highest level of customer service and transperency
Monitor and report on emerging liability and coverage trends
Effectively manage, track and report on portfolio performance
Legal qualification desirable
Prior claims experience preferred
Collaborative approach: Develop and maintain productive working relationships with insured, brokers, claim handlers, underwriters and legal counsel. Provide guidance and seek input from others as needed to achieve the best result possible. Capable of working and collaborating with a virtual team
Results Oriented: Approach tasks proactively and anticipate needs. Think quickly and prioritize multiple work streams without sacrificing quality. Act with a sense of urgency
Strong ethics: Handle responsibilities with integrity and the highest standards of professionalism

158

Claims Specialist Resume Examples & Samples

Proactively manage assigned property claims across multiple jurisdictions, while setting and implementing the case strategy for these claims under the direction of the Practice Leaders and Claims management. Handle all claims in accordance with XL Catlin’s Claim Handling Principles
Collaborate closely with senior claims handlers and Practice Leaders to achieve optimum file outcome, determine if / which loss adjusters and experts to engage, and establish strategic plan with vendor, identify and notify management of Large Losses and take all appropriate steps to achieve the best outcome for the client and XL Catlin
Coordinate and manage communication with internal and external stakeholders to ensure the highest level of customer service and transparency

159

Senior Claims Specialist Resume Examples & Samples

Completes 3-point contact on new claims within 24 hours in order to obtain information necessary to make a compensability decision on the claim
Directs Assistant to properly pay indemnity benefits payments and Awards. Issues state-mandated benefit notices within the required timeframes
Annotates, categorizes and addresses incoming mail on a daily basis
Responds to questions and requests from the client
Ability to prioritize multiple tasks and meet deadlines
Must remain flexible as assignments vary
Workers’ Compensation law specific to assigned jurisdiction; policies and procedures
Medical and legal terminology
Integration with Medicare
5 to 8 years' handling California workers' compensations claims
Public Entity and 4850 experience a plus

160

Claims Specialist Resume Examples & Samples

Adjust commercial surety bond claims by receiving claim assignments, communicating with claimants and principals, investigating claims, analyzing documentation, understanding coverage under the bonds, evaluating exposure, setting reserves, making payments, and asserting indemnification rights
Evaluate the appropriate method and extent of investigation for each claim
Review underwriting files and bond and indemnity agreements
Communicate promptly to claimants and bonded principal/indemnitors
Analyze claim, verify applicability of coverage, and evaluate exposure on a variety of bond types in various jurisdictions
Draft appropriate position letters to claimants and/or principal and indemnitors, when necessary
Work with principals and indemnitors to promptly resolve claims under their duty to indemnify the Surety and make formal indemnification demands on principals and indemnitors, when necessary
Manage litigated claims toward a prompt and reasonable resolution
Consult with management at all levels of the claims department to strategize and make recommendations where assistance and consultation is needed on claims exceeding assigned authority
Prepare reports, document claim files, review and manage outstanding files, as assigned, for adequacy and timeliness of investigation, evaluation and reserving, and maintain a timely diary for each assigned claim
Assess recovery potential and collaborate with the subrogation unit to obtain information required to successfully pursue recovery
Provide superior customer service to policyholders and external vendors and agents during entirety of the claims handling process
Complete special projects and tasks, as assigned

161

Outside Claims Specialist Rm-entry Level Resume Examples & Samples

Complies with contractual stipulations and requirements with regards to the payment of all outside claims
Works with contracted providers and health plans to verify proper insurance and validity of transport
Reviews claims from contracted providers to determine level of payment, validity of service and medical necessity of transport
Maintains the outside claims database tracking of claims and payment in compliance with contractual requirements
Works with the Financial Manager to create reports regarding payments of outside claims, provides monthly flash accountability and monthly reports for contracts
Processes and sends denials and claims acknowledgements as appropriate
Maintains positive relationships with contracted providers and health plans
Supervises the Outside Claims Clerk to ensure proper processing of invoices and posting of paid invoices
NO experience required
Strong Microsoft Office experience with emphasis on Excel
Exhibit high degree of social, ethical, and organizational norms
Maintain a stable disposition despite external pressure and opposition
Excellent Customer Service (for internal and external customers)

162

STD Claims Specialist Resume Examples & Samples

Determines whether to pend, deny or pay claims
Inputs data
Evaluates claimant eligibility via information received from claimant, attending physician and employer
Working knowledge of FMLA/Disability/Leave procedures
Familiarity with STD regulatory requirements

163

Claims Specialist Resume Examples & Samples

Obtain all necessary and available information to initiate processing of all liability and physical damage claims. Establish files and distribute the required information to insurance carriers and other internal department personnel to ensure prompt handling with 24 hours
Initiate in-house processing of all claims within established deductibles/SIR including, but not limited to assigning of independent adjusters for scene/liability investigation with the aid of Claims Administrative Assistant II or Liability Claims Administrator
Maintain accurate files, ensuring they are neat, orderly and current
Claims less than carrier deductible/SIR will be assigned to appropriate personnel. Property Damage claims with potential minor injuries will be assigned to Claims Administrative Assistant II and claims with known injury claims will be assigned to Liability Claims Administrator
Perform duties as directed by your manager
Maintain inventory and order departmental supplies
Support and assist associates with special projects in the department and other duties as assigned

164

Claims Specialist Resume Examples & Samples

Recovery of repair costs on third-party network damages across multiple sites and municipalities
Individual will learn, understand and be able to utilize state dig laws and statutes , 811 excavator requirements, NESC standards, CGA guidelines, etc
Develop a professional working relationship with the Client, on-site field investigators, technicians, management team and other personnel
Develop a solid working relationship with the Client’s and other utility locate companies and their claims coordinators and management
Achieve monthly and quarterly recovery targets set by the department
Learn the functionality of the company’s Claims Database Tool and enter all notes and documentation within the tool throughout the recovery process
Resolve and negotiate claims recovery via phone, email, letter and other means of communication
Be able to support claims investigation packages with photographs, narratives, job costs, site sketches, locate tickets and other components provided to you from the field investigator and visualize and understand the damage scene to accurately defend liability
Work directly with liable parties’ insurance provider to defend claims and negotiate settlements
Work directly with claims departments and management of liable parties from small businesses to large corporations and municipalities
Communicate with the field investigator for post-claim submittal needs
Attend weekly department meetings to discuss individual and team recovery numbers and goals
Maintain a working knowledge of the entire claims process
Use analytical and quantitative methods to understand, predict and enhanced project management processes
Assemble data, analyze performance, identify problems and develop recommendations to support Project Management planning and operations

165

Claims Specialist Resume Examples & Samples

BACHELOR’S DEGREE REQUIRED**
HR experience
Employee terminations
Unemployment claims

166

Claims Specialist Resume Examples & Samples

Manages moderate complexity commercial second injury fund recovery claim investigation arising out of the workers’ compensation line of business. Understands the underlying workers’ compensation claim process, as well as SIF process across multiple states. Effectively manages loss costs and recovery claim expenses
Manages and organizes investigation and documents required to establish a SIF case in conjunction with state requirements
Effectively manages vendor relationship within the scope of SIF requirements
Effectively presents supporting documents and arguments to establish a viable SIF recovery in accordance with state requirements
Works with attorneys, account representatives, agents and insureds regarding the handling and/or disposition of SIF recovery claims
Keeps current on state/territory regulations and issues, industry activity and trends
Moderate technical and product specific expertise related to SIF recovery claims. Possesses knowledge of insurance and underlying claim principles, practices and procedures
Good communication, negotiation and presentation skills. Ability to effectively interact with all levels of CNA's internal and external business partners
Good analytical and problem solving skills, with the ability to manage and prioritize multiple projects
Ability to fully comprehend moderate claim facts and issues; and to further articulate analyses of claims in presentations to business partners and management as well as in internal reports
Typically a minimum three to five years workers’ compensation claims experience

167

Senior Operational Claims Specialist Resume Examples & Samples

Works with team and cross-functional partners to ensure plans deployed to the field are operationally sound
Coordinate with Claims Supervisor on a regular basis
Collaborate with cross-functional teams and various 3rd parties as needed
Provide feedback of findings to appropriate parties
2 + years call center/claims handling experience
2+ years of experience supporting a retail organization
3+ years of experience in a role working cross-functionally to gain influence and develop partnerships
2+ years of people management experience
Ability to influence and partner across the enterprise at multiple levels
Team player that can inspire others
Leadership abilities
Effective communicator who can write and speak well
Capacity to problem solve
Planning and forecasting skills
Able to give direction
Strong analytic skills and strategic thinker

168

Claims Specialist Resume Examples & Samples

In lieu of a degree, a minimum of 5 years injury claims handling insurance experience
Ability to build rapport and successfully effect settlements directly with customers or their attorney
Demonstrated proficiency analyzing coverage and liability

169

Claims Specialist Resume Examples & Samples

Provides a consistent, positive, and satisfying claims experience for our clients by delivering superior claims service
Investigates and settles one or more of these complex claims types: bodily injury/liability and/or material damage including auto total losses. Determines applicable policy coverage, evaluates damages, assesses liability, and creates applicable negotiation strategies
Obtains and analyzes a wide variety of applicable documentation related to assigned claims, some of which may include, i.e., ISO reports, fire reports, police reports, cause & origin reports, medical reports, engineer reports, written estimates, witness accounts, etc.. Draws the proper conclusions related to claim investigation
Evaluates damages associated with the more extensive losses according to policy provisions and published company guidelines
Maintains continuous communication with all affected parties regarding each step of the claims process
Communicates and negotiates with a variety of individuals regarding investigation and settlement of applicable claims, i.e., insureds, claimants, attorneys, medical providers, insurance carriers, and other involved parties
Acts as resident expert while providing direction, support, and training of lesser-experienced Claims Representatives. Participates in round tabling on applicable claim files and has significant responsibility for coaching and developing employees
Education equivalent to graduation from college (or the equivalent in related work experience). Maintains the appropriate adjuster's licensing as required by the states in which we do business
Investigates and settles one or more of these complex claims type of bodily injury/liability claims. Determines applicable policy coverage, evaluates damages, assesses liability and creates applicable negotiation strategies
Obtains and analyzes a wide variety of applicable documentation related to assigned claims, some of which may include, i.e., ISO reports, fire reports, police reports, cause & origin reports, medical reports, witness accounts, etc.. Draws the proper conclusions related to claim investigation
Demonstrated ability to evaluate, investigate, and settle the more complex claims within higher settlement authority limits than those handled by Sr. Claims Representative – Inside. Knowledge of insurance contracts and claims law

170

Senior Claims Specialist Resume Examples & Samples

Monitors complex claims situations
Manages and communicates complex claims issues with client, carrier or producer
Attends and facilitates client meetings, claim reviews and vendor visits as requested
Reviews claim status, action plans, and reserves using advanced problem resolution skills
Negotiates for changes in reserves for a positive client outcome
Provides status reports to clients and keeps sales team informed
Advocates, consults and provides coverage advice to clients as appropriate
Researches and obtains claims data from carriers and challenge adjusters as warranted while advocating the best possible outcome for clients in accordance with service standards
Responsible for keeping Broker Management System up to date with correspondence and/or notes on open claims
At least 5 years of insurance brokerage or property/casualty claims experience required
Adjusters License, Agents License or CSR License required
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to communicate effectively with carriers, clients and claimants
Bilingual in English and Spanish a big plus
To perform this job successfully, an individual should be proficient in Microsoft Office including Excel, Word and Power Point; follow guidelines on working in BMS (EPIC) for premium efficiency with your team
LI-AM

171

Limited Warranty Claims Specialist Resume Examples & Samples

Identify non-validated/unaudited policies, develop validation processes, and implement into the field to drive positive customer experience and savings in warranty spend
Manage customer requests on serial loads and start date changes through various Ingersoll Rand manufacturing, ordering, inventory and warranty systems
Assist Falcon/SIL team on all validation requests related to Residential HVAC customers and claims
Communicate policies and procedures to all levels of the value stream, including sales partners at dealer and wholesaler levels
Provide Customer Relations support through all aspects of the Limited Warranty value stream
Data mine, research and analyze Limited Warranty claims data to identify and execute on identified gaps in the process
Review and process domestic and international claims per policies and procedures
Manage Part to Model process
Assist in claim entry, approval, process and policies
Provide training as necessary on the claims management system and processes
Facilitate monthly claims audit process for Residential HVAC claims
Access, extract and link data elements from a variety of disconnected sources for further analysis, including but not limited to Oracle, Falcon, Citrix, Product Registration, SIL, QDW, CRM etc
Support team efforts to manage and reduce warranty spend, accruals, reserves and the warranty segment of COGS
Percentage of Travel: 10%
Min. Yrs. Experience: 2-4
Education Standard: BachelorsWe are committed to helping you reach your professional, personal and financial goals. We offer competitive compensation that aligns with our business strategies and comprehensive benefits to help you live your healthiest. We are committed to building an inclusive and diverse culture that engages as well as values the different backgrounds and experiences of our employee, which, in turn, spurs innovation, generates creative solutions and enhances our customer relations

172

Claims Specialist Resume Examples & Samples

High school diploma or equivalent plus 2 years experience with healthcare customer service and/or claims, accounting
Must have held a Claims Specialist 2 position for a minimum of 12 months
Bachelors degree plus 1 year of experience in healthcare customer service and/or claims, accounting

173

Claims Specialist Resume Examples & Samples

Evaluation/handling of complex insurance claims and litigation management duties within XL Catlin's Professional division including, but not limited to, Cyber/Technology E&O liability claims
Developing and maintaining corporate client relationships, working closely with our insured’s executives and in-house counsel, establishing an effective risk management infrastructure, and achieving resolution of claims disputes
Assisting underwriters with respect to the creation and development of insurance contracts, products, and services
College degree as well as licensed J.D
Four plus years of verifiable legal experience in the industry
Insurance adjuster license preferred, but not necessary for hire
A strong background in Cyber / Technology business

174

Senior Claims Specialist Resume Examples & Samples

Directs the Claims Assistant to properly pay indemnity benefits payments and Awards, Issues state-mandated benefit notices within the required timeframes
Proficient in all aspects of California WC and can easily adapt to change
5 to 8 years of experience handling workers' compensation claims
Prior experience handling LC 4850/public entity preferred

175

Senior Claims Specialist Resume Examples & Samples

Degree holder
4 years’ relevant experience in life insurance industry
Mature and reliable and able to work under pressure
Proficient in MS Office, including Word, Excel, PowerPoint and Chinese word processing

176

LTD Claims Specialist Trainee Resume Examples & Samples

2-4 years of experience in claims or customer service preferred
Working knowledge of FMLA/Disability/Leave procedures preferred
Familiarity with STD regulatory requirements preferred

177

Senior Claims Specialist Resume Examples & Samples

Help develop and execute the strategies of the practice by creating strategy for larger account
Directly handle large clients as WC consultant including complex consulting and strategy
7+ years of complex worker’s compensation claims experience
Extensive experience handling workers compensation construction claims of a complex nature

178

Claims Specialist Resume Examples & Samples

Meet accounts receivable operational standards for productivity, quality, and customer-service standards
Research and analyze denial data submitting appeals and contacting insurance companies as needed to overturn denials
Research, respond, and document insurer correspondence regarding coding, eligibility and benefits, and reimbursement on patient accounts
Identify, analyze, and research frequent root causes of denials to coordinate corrective action plans for resolution of denials and identify opportunities for improvement
Ability to effectively communicate with others within the business office, at the clinics as well as outside contacts (patients, vendors, physicians, etc.)
Protects organization-s value by keeping information confidential. Accomplishes accounting and organization mission by completing related results as needed
Maintain a working knowledge of insurance policies and procedures to ensure the timely resolution of claims issues
Other duties as related and/or assigned

179

Claims Specialist Resume Examples & Samples

Regular communication with internal business units, as well as external contacts, to seek resolution on items that may delay timely claim filing
Remain up to date on HUD and FNMA guidelines and accurarately convey information during claim filing
Demonstrate business professional behavior and teamwork, maintain punctuality, and adherence to department and company policies and procedures
Ability and willingness to effectively communicate with internal and external contacts
Default, foreclosure, and/or previous work with mortgage claim filing a plus

180

Claims Specialist Resume Examples & Samples

Minimum 1-2 years post-secondary educations or equivalent experience (minimum 1-3 years claims of insurance experience for claims examiner)
Effective customer service skills
Medical Terminology for specific roles

181

Claims Specialist Resume Examples & Samples

Sets reserves and authorizes payment within scope of authority, effectively settling claims in most cost effective manner and ensuring timely issuance of disbursements
Coordinates and performs investigations and evaluates claims and suits through contact with insureds, claimants, witnesses and experts. Identifies files that have potential fraud and refers to SIU
Works with attorneys, account representatives, agents, internal large claim unit, managers, underwriters and insureds regarding the handling and/or disposition of more complex claims
May update the claims systems
Bachelor's degree or equivalent experience. Professional designations preferred. Attorney license a plus
Minimum three to five years claims experience preferably in Lawyers Professional Liability

182

Claims Specialist Resume Examples & Samples

Interprets more complex Auto and General Liability (GL) losses including UM/UIM losses, unusual policy coverages and determines if coverages apply to claims submitted, escalating issues as needed. Claim Specialist will draft appropriate coverage letters
Keeps current on state/territory regulations and issues as well as industry activity and trends. Maintains appropriate state adjuster licenses
Has extensive knowledge on reviewing litigation and addressing possible coverage issues related to those lawsuits and handles overall litigated cases. Ability to analyze coverage and draft the appropriate letters (disclaimers, ROR’s)
Typically a minimum three to five years of claims experience

183

Claims Specialist Resume Examples & Samples

Serve as primary point of contact to internal and external parties for escalations related to one or more business functions in pre/post foreclosure areas to minimize reputational impact to Fannie Mae and ensure optimal resolution for business unit and/or vendor
Monitor overall workflow and delegate and prioritize activities across the team to ensure timely and quality execution, in compliance with applicable guidelines
Regularly partner with internal and external parties via in-person meetings, phone calls and emails to resolve escalated or time sensitive collection issues and ensure an ongoing understanding of changes to processes/guidelines and related impacts. Maintain partnerships and facilitate open dialogue
Work with management to develop and implement new or revised processes and guidelines and realize process efficiencies within own department or for assigned business unit(s)/vendor(s)
Manage internal and external procedures and guidelines changes are appropriately communicated. Work with the team to ensure procedures and guidelines are accurate and up-to-date
Responsible for new case assignment, case resolution, and timely reimbursement for services rendered to vendor(s)
Update databases to ensure information is accurate, complete and accessible
Performs analysis on business unit/vendor performance and data quality
Train and develop internal and external staff
Mortgage servicing experience (mortgage insurance, loss mitigation, default servicing, REO, foreclosure, expense reimbursement) and back end servicing experience a plus
Account reconciliation experience required
Previous experience analyzing data
Knowledgeable in MS Word and MS Excel
Experience with Pivot tables a plus

184

Claims Specialist Resume Examples & Samples

Investigating and settling one or more of these complex claims types: liability, property and/or material damage. Determining applicable policy coverage, evaluating damages, assessing liability, and creating applicable negotiation strategies
Demonstrates excellent oral and written communication, including telephone etiquette, possesses good decision-making skills and the ability to persuade and negotiate effectively, possesses the ability to handle potential conflict effectively and constructively, and demonstrates good organizational skills, analytical ability, and detail orientation and knowledge of basic math and geometry
Previous experience handling claims applicable to area of specialist assignment
Possesses the ability to multi-task while interacting effectively with financial representatives, claimants, insureds, internal staff members, and external contacts, and must be able to work independently in the field or as a member of a team
Possesses competent knowledge with residential and commercial construction techniques
Bilingual in English and Spanish is preferred
Working knowledge of Microsoft WORD and Excel (or their equivalents), Xactimate, and/or other claims estimating software (as applicable). Basic computer and data entry skills

185

Claims Specialist Resume Examples & Samples

Prepare and file all claims according to Agency guidelines within appropriate time frames
Understand Loss Mit guidelines in regards to specific claim type
Follow up with attorneys for needed information to include clear title, documents, to ensure information is provided in a timely manner
Prepare files for internal and external audits
Draft written correspondence to agencies, officers, vendors and clients as needed
Minimum of 3 years work experience in the legal field or default mortgage servicing
Working knowledge of accepted business practices in the mortgage industry and a strong understanding of claims process
Working knowledge of foreclosure process and appropriate guidelines
Good analytical, written and verbal communication skills
LPS-MSP (Mortgage Servicing Platform)
Knowledge of Microsoft office- Excel and Word
Two (2) years job-related course work or paralegal studies
Working knowledge of claims processing

186

Catastrophe Claims Specialist Resume Examples & Samples

This position is part of a job family. Placement will be determined by skills and qualifications of the candidate
Responds to deployment directives and travels to catastrophe areas to evaluate, negotiate, and settle personal and commercial lines property claims resulting from natural catastrophes in various geographic locations
Investigates and completes physical inspections of property claims, evaluates damages, and prepares written estimates according to policy provisions
Initiates first contact with insureds and all relevant parties to gather basic information, obtain recorded statements and explain the overall claims process
Bachelor’s degree and at least 5 years of property claims adjusting or construction or equivalent work experience ORat least 7 years of property claims adjusting or construction or equivalent work experience

187

Claims Specialist Resume Examples & Samples

Graduated in the upper third of the graduating class in the college, university, or major subdivision; OR
Graduated with a cumulative 3.0 GPA or higher out of 4.0 based on 4 years of education, or based on courses completed during the final 2 years of the curriculum; OR
Graduated with a 3.5 GPA or higher based on the average of all the required courses completed in the major field or the required courses in the major field completed during the final 2 years of the curriculum; OR
Election to membership in a national scholastic honor society that meets the minimum requirements of the Association of College Honor Societies (except for freshman honor societies)

188

Claims Specialist Resume Examples & Samples

Effectively assist Third Party Administrator with handling claims to conclusion
Provides high quality customer service by determining the best approach for handling issues
Processes documents and inputs information into the database
Gathers claim file material from multiple sources including internal and external parties. Analyzes claim file material for potential impact on claim mitigation
Initiates and conducts follow-ups via proficient use of the claims handling system or other related systems
Utilizes Risk Management best practices
Submits statistical reports as required
Manages vendors, as assigned
Focus on quality work and job performance
Must be able to multi-task, be well organized and detail oriented
Must be proficient working with database and processing software, excel, word and outlook
Must have mathematical, problem solving and analytical skills
Must be able to successfully complete licensing and claims certification schools/classes, where required
Pen and paper
Ability to use a computer and related devices, such as a keyboard or mouse or other related equipment, throughout the day while seated at a workstation
While performing the duties of this job, the employee is regularly required to speak or hear. The employee is also frequently required to stand, walk, use hands and fingers, handle or feel and reach with hands or arms

189

Senior Claims Specialist Casualty Resume Examples & Samples

In a small team of experienced handlers, independently investigate, negotiate and settle all assigned lead
At least five years of experience in the national or international insurance industry
Already seasoned in the handling of Casualty claims with a specific focus on product liability cases
And ideally with a legal background (Master of Law / Attorney at Law), fluent in German and English , any other european language is of advantage
Driven to deliver service excellence; a strong team player with developed analytical, negotiation, communication and problem solving skills
Willingness to work independently with a significant amount of contact with the business and customers in an international, matrix organized, fast-paced and dynamic environment
Up-to-date knowledge of claims handling, administration systems and processes

190

Senior Claims Specialist Resume Examples & Samples

Managing assigned claims across multiple jurisdictions, as well as setting the case strategy for these claims in partnership with Regional Practice Leaders and Claims management
Proactively managing external counsel and setting litigation strategies when counsel is engaged on a claim
Coordinating and managing communication with internal and external stakeholders (e.g., underwriting, brokers, reinsurers, external vendors, etc.) to ensure the highest level of customer service
Consulting with Regional Practice Leaders and Claims management on Large Losses and ensuring all steps are taken to achieve the best outcome for the client and XL
This role will report to the Manager of Construction Professional Liability Claims
Broad Construction Professional Liability claims experience: 5-10 years of experience managing Construction Professional liability claims. Experience managing high exposure and complex claims. Demonstrated experience negotiating and settling complex claim files
Collaborative approach: Develop productive working relationships with insured, brokers, claim handlers, underwriters and legal counsel. Seek input from others as needed to achieve the best result possible. Capable of working and collaborating with a virtual team

191

Claims Specialist Resume Examples & Samples

Advanced level of Third Party claims handling with a handling authority level up to £12,500
Is able to effectively handle claims involving staff, VIP and Product v Product claims in line with the agreed best practice
Handles RTA/Article 75 cases in line with the agreed guidelines
Can handle escalated Customer complaints through to resolution
Actively looking for opportunities to maximise settlement and reduce TP Costs
Maximises recovery, improve process and drive efficiency within the team/department
Ability to audit files/calls and provide relevant feedback to help coach and improve your colleague’s performance on a consistent basis
Review and authorise cheques in accordance with company procedure up to £12,500
Ability to allocate claims/workflow across the team
Ability to monitor workflow and telephony performance within your team
Act as a role model within the team. Mentoring new individuals into the team
Take on additional responsibilities over and above the core role
Will lead meetings / buzz sessions within the team so that the team are kept well informed
Able to deal competently with general HR issues (excluding capability / conduct issues)
Has a thorough knowledge of claims exceptions and the management of these controls
Is aware of the Team Leader duties and able to carry out day to day management of the team

192

Field Claims Specialist Resume Examples & Samples

Distribute and direct losses and claim tracking for defined territory or agency base to support delivery of effective customer service and claim resolution and ensure team alignment with business goals
Accurately document, process and transmit loss information in order to determine potential damages associated with difficult and complex claims
Provide overflow support to Compliance Department of quality control audits for Federal Crop Insurance Corporation (FCIC and Crop Hail)
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 insurance statues and regulations and complying with state and federal regulatory requirements
Provide effective and timely communication with agencies in defined territory on claim status and other inquiries
Build and maintain relationships with customers by providing timely an accurate policy service, answering questions and communicating adjustment determinations
Coach claims adjusting team by supporting and mentoring team members and providing advice and feedback to guide the success of the team and meet service level expectations
Provide information and feedback regarding the quality of agent business and/or policy files of regional claim operations to maximize profit and quality of business
Deliver classroom and field training programs for claims technology applications and crop programs ensuring effective educational resources for clients and alignment of training services with key stakeholders expectations
Participate with internal committee to develop global claims technology solutions that support business need
Attend National Crop Insurance Services (NCIS) regional and state committee meetings to make business aware of any legal issues or changes that will impact the business
5 years experience in MPCI and Crop Hail claims experience
Working knowledge of claims administration best practices and procedures
Understanding of relevant laws and regulations across multiple jurisdictions
Utilize effective communication channels for both external and internal customers
Support implementation of company strategies
Train others on process and procedures

193

Senior Claims Specialist Resume Examples & Samples

Proactively manage assigned claims across Property while setting and implementing the Adjustment plan for these claims. Ensure all documentation is present in the file, and Claim Handler Guidelines and protocols are followed
Minimum of 3 (or more) years of solid experience handling Equipment Breakdown claims to include Energy, Property & Construction, and other specialty areas preferred
Displays a thorough functional knowledge and skill of claims handling specific to assigned area
Strong interpersonal, communication and negotiation skills
Knowledge of Microsoft Office Suite as well as other business related software
Minimum 3 years handling Equipment Breakdown Claims
Requisite State Claims ‘Adjusters licenses preferred or Candidate will commence acquisition of same

194

LTD Claims Specialist Resume Examples & Samples

Claim Specialist Trainees are responsible for timely and accurate communication, information gathering, and rendering decisions on Long-term Disability (LTD) claims to which they have been assigned according to provisions of LTD certificates
The job entails communicating with a variety of constituents (for example, claimants, doctors, nurses, employers, and attorneys) to gather information relevant to rendering decisions based on the provisions of the policy
Claim Specialist Trainees will work more independently, use their own discretion, and increase their caseload as they become proficient in LTD and demonstrate consistency in metrics, philosophy, and process
They will learn to use appropriate systems, tools and resources to research and document claims
They will develop an action plan and identify the Likely Claim Progression including identifying the return to work potential
Claim Specialist Trainees will complete regular updates on financial offsets such as SSDI
They will utilize CMG which provides an overview of high level topics, factors to consider in the administration of claims, and examples of claim situations
CST’s perform their work under direct supervision by peer coaches and Unit Leaders
Render appropriate claim decisions pursuant to certificates
Clarify functional capacity through problem solving measures (gathering medical, vocational, and other information, efficient use of resources, and action planning) sufficient to determine initial and ongoing liability
2+ years of disability claims or customer service experience
Bachelor’s degree preferred
Critical thinking in activities requiring analysis, investigation, and/or planning
Ability to prioritize
Disability claims or 2-4 years strong customer service experience preferred
Demonstrated ability in the following areas

195

Casualty Claims Specialist Resume Examples & Samples

Interviews, telephones, or corresponds with claimant and witnesses; consults police and hospital records; and inspects property damage to determine extent of company's liability, varying method of investigation according to type of insurance
Assists in preparing loss experience report to help determine profitability and calculates adequate future rates
Supports the organizations quality program(s)
Knowledge of professional liability claims
Ability to review information and ensure accuracy and applicable policy placement

196

Claims Specialist Resume Examples & Samples

Drive For Results
Functional/Technical Skills
Learning On The Fly
1-2 years of recent, residential, default mortgage servicing experience

197

Claims Specialist Resume Examples & Samples

Ensures timely, accurate and efficient processing of claims edits via EPIC work queues. Meets daily claims edit resolutions goals by reviewing, analyzing, and obtaining appropriate documentation based on payer requirements and regulations. Prepares electronic and paper claims and sends with appropriate attachments. Conducts research and provides updates and current status of claims edit work queues using the appropriate data management system (EPIC). Resolves issues that are adversely impacting claims submission in a timely and accurate manner. Completes or requests adjustments to accounts based on dollar threshold. Communicates information and ideas to make system-wide process improvements. Updates patient accounts regarding changes and modifications in plan benefits and other contract information relevant to the claims follow up and collection process. Documents claim processing activity on patient accounts
Serves as a communication link to various departments and external payers by developing positive relationships with managed care organizations and outside agencies, and clinical areas within the organization. Performs liaison services to both internal and external customers providing assistance in claims resolution. Assists with education of internal staff and external customers to bring about the timely, accurate, and cost effective adjudication of all claims. Works collaboratively with other departments to facilitate the insurance collections process and to improve overall cash collection
Monitors the status of claims in work queues and conducts routine, periodic follow up on previously researched claims items. Monitors, reviews, and suggests revisions or updates to existing forms, documents, and processes required to submit a clean claim
Ensures completeness of claims by following national, local, and internal billing requirements promoting prompt and accurate submission and payment. Maintains awareness of current regulations. Initiates practices that support current regulations. Shares knowledge of current regulations with staff. Analyzes current practices and makes recommendations for process improvements
Must have knowledge of insurance billing regulations and reimbursement procedures; excellent phone etiquette and customer service skills; and an analytical aptitude and ability to translate functional needs to a computerized environment
Preferred: familiarity with medical terminology, ICD-9 and CPT-4 coding; third party payors in a healthcare billing environment; and Epic billing module
Follows standard and/or other appropriate precautions using personal protective equipment as required
Previous experience with computerized billing and/or healthcare billing preferred

198

Warranty Claims Specialist Resume Examples & Samples

Seek opportunities to control warranty costs through effective auditing, editing, and review of claims and registration requests
Identify and correct internal and external errors
Identify and address issues that conflict with established warranty policies and programs
Assist in the responsibility for the integrity of product registration and warranty claims database
Participate directly in and support all company and department programs, goals, and objectives that support outstanding customer service
Assist dealers/distributors in resolving questions related to electronic filing of warranty claims and registrations
Maintain a positive business relationship with business partners, dealers, distributors, and local personnel
Adjust warranty claims as necessary, and be accountable to the business partner as well as dealer/distributor for the adjustments made
Assist Registration Specialist in the resolving of dealer inquiries on product registration issues as necessary
Must be flexible and willing to perform a variety of other tasks and duties as required by department needs
Strong organizational/analytical skills a must
Knowledge of snowmobiles and ATV's and their related parts, clothing, and accessories would be very beneficial
Friendly, professional email and telephone etiquette
Knowledge of computer programs Microsoft Excel, Word, Outlook
Must demonstrate good judgment and decision making skills
Mechanical knowledge is beneficial, but not required
Post-secondary education preferred and/or job related experience
Office and computer experience necessary

199

Claims Specialist Resume Examples & Samples

Bachelor’s degree in any area of study
Certified Workers' Compensation Professional
Five years of experience applying the Kansas Workers Compensation Act, case law and board decisions; State of Kansas programs; reading/comprehending medical records and reports, mediating/negotiating settlement, facilitating return to work
Knowledge of the principles, methods and priorities of legal research of state laws, rules and regulations applicable to the Kansas Workers Compensation Act, case law and board decisions
Ability to work in a high volume environment
Ability to plan/conduct investigations by phone or personal interview; read, interpret and apply complex laws/policies; document/maintain claim activity; effectively communicate orally and in writing; calculate payments; read/comprehend medical records and reports; mediate/negotiate settlements and exercise sound judgment
Working knowledge of applicable Kansas statutes and regulations
Knowledge of Kansas Workers Compensation Act
Knowledge of Americans with Disabilities Act
Knowledge of the Family and Medical Leave Act

200

Homeowners Field Claims Specialist Resume Examples & Samples

Determines scope of repairs. Prepares a repair bid using Xactimate estimating system
Follows the repair process to conclusion
3-5 years homeowner claims experience

201

Senior Claims Specialist Resume Examples & Samples

Active management of caseload of high value workers compensation claims venued throughout the United States for assigned clients in the Global Risk Management business unit
Conduct claim handling and oversight of TPAs in accordance with XLC best practices in the major phases of claim handling including coverage, investigation, evaluation, reserving, recovery, and resolution
Provide oversight, guidance and direction to Third Party Administrator claim adjusters on all major phases of claim handling including coverage, investigation, evaluation/reserving, recovery, and resolution
Collaborate with client risk management/claim management team on claim management and strategy to help deliver the most optimal outcome and ensure, to the extent possible, that we are in alignment on our evaluation of the exposure and strategy to resolve
Collaborate and consult with internal claim resources such as regional practice leaders and claim legal to ensure the most optimal outcome and mitigate claim expense
Interact regularly with the Claim Account Management team for assigned clients to communicate claim issues and results, participate in the TPA audit process, and collaborate on technical and service issues relating to the TPA performance and the client
Communicate proactively with internal and external stakeholders regarding claim experience, results, and trends (e.g. actuarial, reinsurance, credit risk and underwriting)
Provide input into the development of key metrics to support Claim Audits, and assist in the coordination and retention of external counsel, as needed
Minimum of 10 years of claim handling experience involving high value/complex claim management and litigation management
Multi-jurisdictional (U.S.) experience
Demonstrated expertise in designated line(s) of business: Worker’s Compensation, Auto and General Liability, or Property
Experience managing claims in an unbundled insurance model
Leadership: Demonstrates managerial courage and ability to influence actions of external relationships. Coaches, sets expectations, evaluates and holds people accountable for delivering
Strong communication and negotiation skills: Excellent verbal and written communication, and negotiation skills
Strategic thinking: Exhibit ownership to look for ways to continuously improve internal processes as it relates to improving claim outcomes and managing the performance of external relationships
Strong teamwork/collaboration skills in order to effectively collaborative with Regional Practice Leads, Claim Legal, TPAs and clients to produce desired outcomes, as well as with other internal and external stakeholders, such as Claim Account Managers, brokers, actuarial, reinsurance and business partners to communicate regarding claim results, experience and trends

202

Claims Specialist Resume Examples & Samples

Refers claims exceeding own personal authority level to management for their review, along with recommendations for investigation and settlement
Establishes initial claim file reserves and adjusts accordingly as investigation progresses (if applicable)
May temporarily perform duties in other company locations when catastrophes occur or as other business needs dictate
As applicable, travels to loss locations, determines coverage, evaluates liability and estimates damages
Basic computer and data entry skills with a working knowledge of Microsoft WORD and Excel (or their equivalents), Xactimate, and/or other claims estimating software (as applicable)

203

Extended Warranty Claims Specialist Resume Examples & Samples

Accepts extended warranty claims as allocated by leadership
Adjudicate each claim individually based upon standard work, current extended warranty task times, and program details in a timely manner
Ability to clearly document reasons for claims adjustments and rejection
Accepts direction from team lead on specific claims management processes
Run multiple access queries that are used for claim payment validation and accuracy
Able to use multiple sources of information simultaneously to properly administer claims payment policies

204

MCU Excess Casualty Liability Claims Specialist Resume Examples & Samples

Juris Doctor and 5 or more years of experience managing general liability claims and litigation
Expertise in managing bodily injury and property damage claims and litigation
Strong skills in coverage, claim evaluation and negotiation
Proven organization and time management skills
AIC, SCLA, CPCU or JD

205

Unemployment Claims Specialist Resume Examples & Samples

Ensuring the proper execution of the unemployment claim process within Southwest Airlines, utilizing current unemployment logistics management vendor to ensure timely responses and cost management,
Recognizing and analyzing trends in unemployment terminations and utilizing strong partnerships with Human Resource Business Partners, General Counsel, etc., to communicate insights and potential risk,
Focusing on financial impact of claims and actively pursues opportunities to enhance unemployment results and impact unemployment tax rates
High School Diploma, GED or equivalent education required
Must have authorization to work in the United States as defined by the Immigration Reform Act of 1986
2-3 years working knowledge of the unemployment claims management process required
Experience within an HR Shared Services environment preferred
Experience with HR information systems and HR process preferred
Must have a keen awareness of federal and state law including an understanding of the Federal Unemployment Tax Act (FUTA), State Unemployment Insurance (SUI), and the State Unemployment Tax Act (SUTA)
Must be technically proficient with respect to Microsoft Office products, particularly PowerPoint, Excel, and Word with the ability to analyze data
Strong organizational skills, including the ability to prioritize and multi-task in a fast-paced, deadline driven environment
Ability to communicate confidently, effectively demonstrating the ability to influence without authority to all levels within the organization regarding sensitive matters
Must demonstrate a strong attention to detail
Ability to work under stressful situations
Must maintain a well-groomed appearance per Company appearance standards as described in established guidelines
Recent experience processing 500 or more annual/per year Unemployment Claims (UI Claims)
2-3 years working UI experience with majority of responsibility reviewing and processing UI Claims
Experience with an electronic UI Claims processing system (example; Equifax, ADP, EmployerEdge, etc)
Demonstrable experience in reporting on UI Claims trends/statistics
Experience using MS Office (Word, Outlook, Excel)
Ability to handle heavy workloads under tight time lines
Ability to work with little to no instruction or manager supervision - taking initiative to seek out answers via research/resources)
Ability to demonstrate professional communication via phone, email and in person

206

Liability Claims Specialist Resume Examples & Samples

Investigate coverage and liability of claims through telephone, written correspondence, and/or personal contact with claimants, attorneys, insureds, witnesses and others having pertinent information
Analyze information in order to evaluate assigned claims to determine the extent of loss, taking into consideration contributory or comparative negligence. Assign medical or other experts to case and arrange for medical examinations when necessary
Process incoming calls and correspondence from insureds, claimants and agents regarding questions or problems associated with claims. Interact with underwriters and agents on claim resolution
Evaluate, negotiate and resolve claims within delegated authority. Handle general liability and auto liability files from start to finish
Update claims system on a continual basis to accurately reflect status of each assigned file and to initiate percentage of negligence on the part of the insured to determine "chargeability"
Receive and approve expenses incurred to investigate, process, and handle a claim
Prepare check requisitions for all loss and expense payments
Explore contribution on all claims assigned
Prepare for and participate in claims review and settlement conferences
Close claim by issuing check or denial and securing appropriate releases
Negotiation and claim disposition skills with proven problem-solving ability
Strong judgment and decision making skills
Self-starter with ability to work independently
Moderate proficiency with standard business-related software
Minimum of three years of claim handling experience preferred
Industry training/designations preferred

207

Senior Claims Specialist Resume Examples & Samples

Extensive experience of handling general liability and construction claims of a complex nature
Experience with professional lines claims
Helps develop insurance programs for clients which include the creation of policy and
Must possess a law degree
College degree required, graduate/law degree a plus
Construction industry client experience
Current on case law and appellate decisions to use in the adjudication of claims
Travel required, primarily within New York

208

Large Loss Claims Specialist Resume Examples & Samples

Handling assigned claims across multiple jurisdictions, as well as setting the case strategy for these claims in partnership with Regional Practice Leaders and Claims management
Coordinating and managing communication with internal and external stakeholders (e.g., Underwriting, brokers, reinsurers, external vendors, etc.) to ensure the highest level of customer service. Participation in new account and renewal meetings may be required
Consulting with Regional Practice Leaders and Claims management on Large Losses and ensuring all steps are taken to achieve the best outcome
Producing internal reporting and ensuring that reserves are set according to best practices guidelines
Dentifying, monitoring and reporting on emerging liability and coverage trends
Broad surplus claims experience: minimum of 7 years of experience managing claims. Experience in the handling and management of general liability, contracting, premises liability, products liability, and excess liability claims preferred
Strong communication: Excellent verbal and written communication, presentation and negotiation skills. Able to communicate and negotiate effectively with internal and external stakeholders at various levels of sophistication
Collaborative approach: Develop productive working relationships with insured, brokers, claim handlers,
Passion for results: Approach tasks proactively and anticipate needs. Think quickly and prioritize multiple work streams without sacrificing quality. Act with a sense of urgency
Intellectual curiosity: Willing to ask questions and explore new ideas. Eager to learn and focused on continuously improving technical skills
Education: Bachelor's degree required
Ability to travel approximately 10%, typically for short duration trips

209

Claims Specialist Resume Examples & Samples

Adopt the DPDHL culture of professionalism, integrity, effectiveness and dynamic attitude contributing to an internal environment of collaborative teamwork and promote a positive IRM claims service provision to internal customers
Serve as a key active member of IRM’s mainland claims handling team, interacting and working with team members to ensure business objectives are aligned and IRM claims management is performing to operational objectives
Proactively pursue economic, early resolution for all customer claims, adopting a collaborative approach to addressing a wide variety of claims administration requirements, providing workable solutions to senior management
Manage high volume freight, marine cargo claims and underwriting control standards and protocols
Provide advice on making a claim and the process to customer services, including collection accurate information and documentation to proceed with a claim
Collaboratively work with a network of approved in-house professionals and monitoring the progress of a claim
Manage service quality & KPI monitoring in association with external parties (Insurers & third party claims administrators etc. within agreed authority and in conjunction with IRM London)

210

Senior Claims Specialist Resume Examples & Samples

Ensure claims are handled swiftly and efficiently by reviewing and deciding on the extent and validity of a claim, checking for any potential fraudulent activity
Provide customer claims reporting and data analysis on claims activities and resolutions
Identify reasons why full payment may not be made, and ensure fair settlement of a valid claim
Build relationships with loss adjusters, legal, as well as other legal/claims professionals
Ensure customer claims are treated fairly and receive excellent service in accordance with industry and company guidelines
Handling complaints in a professional manner associated with a claim
Adhere to legal requirements, industry regulations and customer quality standards set by GBS IRM
Navigate, network and establish cross boarder relationships to leverage best practices and execute program-wide claims strategies through internal claims management communities
Build co-operative relationships between GBS IRM team and stakeholders within the claims process
Manage claims information exchange between business units and GBS IRM, including suppliers and other key process stakeholders
Coordinate with GBS IRM central team for significant claims on content of coverage, precedent setting and commercially sensitive issues

211

Warranty Claims Specialist Resume Examples & Samples

Immediate assignment of leak complaints and ensuring that all customer service objectives are met. Prepare and process claim settlements in accordance with the applicable terms and conditions of the correct guarantee type issued for the product and in compliance with company policies, guidelines and best practices. Assignment to GAF Field Services Representatives (“FSRs”) and/or contractors on a timely basis is required
The ability to effectively communicate claim decisions both in writing and verbally with internal and external customers by telephone and written communication, including emails and coverage position letters. Follow up with contractors and FSRs in a timely fashion both in writing and verbally is required
Negotiate guarantee settlements under the direction of the Warranty Claims Supervisor, Director of Claims Management or Legal department
Handle customer issues and disputes in an effective manner with a minimum of supervision
Ensure that the proper requests for information are distributed on a timely basis and that results from the laboratory, inspections or claim committee sessions are quickly and effectively communicated with all applicable parties to the claim
Schedule roofing inspections and leak repairs with contractors or FSRs
Aggressive diary follow up to ensure that action items are completed in accordance with our best practices and procedures to assure maximum customer service experiences and timeliness of handling
Provide department support for absences, assist on special projects and general office duties
Handle incoming calls from property owners, contractors or Sales
Open, maintain and update claim files
Prepare customer letters
Conduct timely follow ups with internal and external customers as necessary
Provide support to Sales and GAF Field Service Representatives
Timely assign leaks to the applicable contractors or Field Service Representatives (“FSRs”) in a timely fashion and pre-authorize repairs within assigned authority limit
Accurately assess proposed settlements through the correct application of the applicable warranty
Process payments within assigned authority through PeopleSoft and GAF’s claim system
Seek timely and accurate authority for payments in excess of assigned limits through the Warranty Claims Supervisor or Technical Specialist team
The ability to effectively communicate claim information and recommendations for resolution to all levels of management
Completion of online courses provided by GAF through National Roofing Contractors Association (“NRCA”) will be required during the initial employment period
Basic knowledge of standard roofing concepts and practices
Proficiency working with Microsoft Excel, Word and Outlook
Advanced telephone skills
Associate or Bachelor’s degree is preferred
Minimum of two years’ experience in a customer service environment is required with a preference for any background in the insurance industry, working with contractors or in a roof related field being a plus

212

Senior Claims Specialist Resume Examples & Samples

Responsible for store claims
Adhering to Service Level Agreements
Deliver premier Boss Centric service by communicating with friendliness and confidence
Empathize with the Boss, diffuse and navigate complex situations
Develop and maintain professional relationship with all parties
Communicate via telephone, email, regular mail with the Boss and various 3rd parties
Obtain relevant facts to claim through interviews, investigations and documentation
Review and evaluate all allegations/situations surrounding the claim
Coordinate necessary appointments with Boss, field personnel and other 3rd parties
Set up rentals, investigations, and repairs as needed
Monitor all open claims and maintain a follow-up calendar system of outstanding issues
Keep all parties apprised of status on a regular basis
Analyze all facts, details, and information obtained for claim
Collaborate with higher technical teammates or cross-functional teams to review more complex situations or when necessary
Make informed decisions after analysis
Manage and negotiate resolution
Communicate resolution to all involved parties
Process paperwork as needed (i.e. release, letters, etc)
Administer requests for payments, refunds and customer satisfaction considerations
Pays invoices associated with claims in a timely manner
Ability to navigate a matrixed environment
Conflict management skills; ability to stay calm and composed under pressure situations
2 + years call center or claims handling experience
3rd Party Labor / Vendor Management Experience
P&L Management Experience
Strong Business Acumen
Strong listening skills – active listening
Proficient with keyboard and various Microsoft programs
Solid analytical and interpretive abilities
Capable of making confident and informed decisions independently

213

Senior Homeowner Claims Specialist Resume Examples & Samples

Investigates, evaluates, negotiates and settles homeowner 1st- and 3rd-party property claims involving fire, black water, mold, earth movement and public adjusters
Serves as a team lead, coach and mentor to staff
May be called upon to provide training to staff
Analyzes claim to determine coverage recommendation
Arranges and handles through conclusion all emergency services required to protect the property from further harm, accommodate the needs of the insured
Recognizes and prepares files for subrogation

214

Claims Specialist Resume Examples & Samples

Appropriately administer insurance coverage to moderately complex claims by conducting loss investigations, analyzing factual information, interpreting insurance policies and applying legal and technical knowledge to independently resolve claims files in a timely manner
Negotiate claims settlements by collaborating with subject matter experts and involved parties, recommending appropriate reserve modifications for assigned claims and communicating solutions to mitigate risks and coverage conflicts and achieve cost effective outcomes
Inform internal and external stakeholders on claims resolution processes by summarizing factual information, reporting out of scope, specialized exposures and accurately managing documentation of assigned claims to ensure effective communication of current state for individual claims portfolio
Build strong working relationships by reporting on approved, cost-effective claims strategies to ensure understanding of Claims operations and encourage a collaborative approach to enhancing the business
Support claims workflow efficiency by accurately documenting portfolio progress, referring high risk exposures outside authority levels and seeking opportunities that enhance operational knowledge to ensure achievement of individual and department objectives
Experience in a claims department or the insurance industry
Management Liability and Professional Lines (MLPL) - Law degree; prior experience working in a law firm or other in-house counsel position; familiarity with interpretation of contracts and negotiation
Experience handling MLPL matters including directors and officers liability, employment practices liability, professional liability, fidelity, pension trustee’s liability, data protection and privacy liability
Experience in agency, retail or wholesale brokerages, third-party administrator, risk management, legal or other roles
Knowledge of claims administration best practices and procedures
Knowledge of insurance products and services
Understanding of market trends and organizational strategies
Knowledge of Microsoft Office Suite, general computer software and database systems
Utilize effective communication to effectively influence and persuade decision makers; understand the needs and goals of customers and actively look for ways to meet them
Mediate and resolve conflict using a logical approach
Identify relevant information and understand it’s impact
Maintain integrity of claims portfolio and evidence
Use multiple resources to gather and analyze significant data
Leverage technical knowledge to make cost-effective decisions
Encourage open communication, cooperation and knowledge sharing
Implement planning to organize, prioritize and measure individual work

215

Claims Specialist Resume Examples & Samples

Interacts with customers/claimants to obtain facts, explain the coverage and claims process, set expectations and provide high quality service to achieve a positive customer experience
Perform coverage analysis to review policy and endorsement language, giving consideration to definitions, exclusions, general conditions, jurisdictional rules/requirements, insurance, and policy period
Plan and conduct investigation to determine liability and damages; use the claim facts to identify when a recorded interview should be obtained, such as when liability or damages are undetermined, subrogation potential exists, or in case of possible fraud or misrepresentation
Assesses actual damages associated with claims and conducts negotiations to settle claims and achieve the best possible outcome
Establish and maintain reserves based on the most probable outcome – i.e., the estimate of the ultimate financial cost to resolve a claim whether through settlement or other adjudication
Use judgment and expertise to evaluate claim for potential fraud and subrogation; makes referrals to the Special Investigations Unit or Loss Recovery as appropriate
Use claims system to properly document files (including initial resolution strategy, evaluation, negotiations, etc.), manage a diary and issue payments
Performs quality assurance audits APD claims files to measure quality, provide feedback and develop employees
Knowledge of PIP and Med Pay claims coverage, clams handling procedures, and applicable laws
Ability to negotiate, analyze/solve problems; plan/organize work; express facts clearly in writing and verbally; and communicate effectively
Other capabilities include interpersonal skills, listening skills, tact, empathy, and drive for results
Knowledge, skills, and capabilities normally acquired through a bachelor’s degree (or equivalent), completion of the formal training program, and at least 2 years of experience
May be required to be licensed in states serviced. Pursuing continuing education courses leading to industry certifications (e.g., AEI, IIA, CPCU)

216

PEO Claims Specialist Resume Examples & Samples

Provides daily case management activities on lost time claims. Proactively initiates recommendations for return to work opportunities and ensures successful implementation
Partner with carrier on workers’ compensation claims issues and recommends best claims management strategies as appropriate
Manages and negotiates carrier reserve reductions on an on-going basis
Reviews client claim and risk information for clients; analyzes loss data and participates in making risk management recommendations for loss control and underwriting
Functions as client/carrier liaison and advocate on claims service issues
Provides internal and external client claims service issues
Monitors workers’ compensation claim reports to control costs and ensure profitability
Provides clients with industry surveys and statistics to educate on benefits of a return to work culture
Analyzes issues and trends for program and policy recommendations
Multi jurisdictional work comp knowledge and previous handling preferred

217

Senior Look No Further Claims Specialist Resume Examples & Samples

Assists Look No Further Claim Specialists with inquiries regarding specific claims submitted
Responds to hotel associates when an approved claim is challenged
Reverses approved claims, as appropriate, ensuring proper communication with Accounting Department is made to reverse penalty fees assessed to hotels when claims are approved
Research and resolve Marriott’s Look No Further claims reported via voice, email, and chat channels
Utilize Engage to manage customer contacts and email communication regarding claims
Properly document claim details, using screen shots and claim recording system, which are used by hotels to eliminate identified claim scenarios
Determine if claim is approved or denied and communicate results to the customer
Respond to all claims submitted within 24 hours of submission and within 4 hours for claims submitted for same-day reservations
Report issues involving hotel information or specific anomalies to Marketing Systems for correction and notify eChannels regarding outside rate sources
Identify trends in claim submission patterns and share those details with department leadership for action
Seek assistance with challenging claim scenarios from manager, when necessary
Utilize proper writing skills (grammar, spelling, formatting) for written communication with guests regarding claims
Communicates directly with Customer Care Leadership to identify opportunities for individual associate instruction and identify service trends impacting department operations
Maintains strong awareness of department procedures and systems, including processes supported by the multiple systems utilized (such as Engage, Outlook, PURE, eFolio, etc.) within the Customer Care Contact Centers
Follows established department policies and procedures
Utilizes sound judgment when encountering unique customer concerns without direct supervision
Maintains a professional demeanor in personal appearance, work area and all interactions with guests, hotel personnel, peers, and management. Follows leadership guidelines for attire (business casual Monday – Thursday, casual attire on Friday) unless otherwise instructed by management
Assist with training for new team members, as appropriate
Maintains privacy and integrity of guest and associate personal information
Performs a variety of other duties as directed by management
Safety and Security
Report work related accidents, or other injuries immediately upon occurrence to manager/supervisor
Follow property specific procedures for handling emergency situations (e.g., evacuations, medical emergencies, natural disasters)
Follow company and department safety and security policies and procedures to ensure a clean, safe, and secure environment
Identify and correct unsafe work procedures or conditions and/or report them to management and security/safety personnel
Six months employment with Marriott Global Reservation Sales and Customer Care
No more than 5 occurrences on file (if applicable)
2 or less active notifications (if applicable)
No active written warnings
No written warnings or counseling on file for non-servicing, negative interaction or professional demeanor within the last 12 months

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