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Insurance Claims Adjuster resume examples

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Skills

  • Caseload management
  • Dispute resolution capabilities
  • CCC Pathways
  • Insurance claims compliance (program)
  • Data analysis for claim patterns
  • Personal, casualty and property loss
  • Insurance Software Proficiency Jira
  • Automobile claims specialist
  • Negotiation Strategies
  • Automated Work Distributor (AWD)

Work Experiences

  • Achieved savings of $7 annually.
  • Examined claim forms and other records to determine insurance coverage.
  • Worked with the claims department and industry anti-fraud organizations to resolve claims.
  • Analyzed customer feedback and implemented workflow improvements, reducing average call handling time by 31% minutes.
  • Achieved a 47% reduction in escalated claims.
  • Handled method calls about category processes from customers and other stakeholders.
  • Collaborated between claims and underwriting.
  • Developed positive working relationships with government officials and police officers.
  • Achieved a 19% reduction in claim resolution time.
  • Looked into legal issues surrounding standard claims.

Summaries

  • Accomplished Insurance Claims Adjuster.
  • Analytical Insurance Claims Adjuster successful in developing key documentation processes that led to a 29% increase in claims approval times. Specialized in flagging and addressing fraudulent claim activities.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Accomplished Insurance Claims Adjuster with hands-on experience in claims investigation, saving $3 in annual payouts by efficiently detecting fraudulent claims. Expertise in collaborating with legal teams for favorable case outcomes.
  • Excellent communication skills as evidenced by 3 years of experience interviewing experts, witnesses, and claimants in order to compile data.
  • Adept at reducing false claims.
  • Negotiates fair and thorough resolutions to all claims in a peaceful manner.
  • Criminal investigation, insurance fraud, and surveillance are all part of his background.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the framework business.

Accomplishments

  • Partnered with engineers and specialized inspectors to assess high-value claims, reducing overall claim payout costs by $6.
  • Negotiated settlements for procedure claims, using alternative resolution techniques, which led to a 79% decrease in litigation and faster settlement times.
  • Effectively dispatched field adjusters to disaster zones, decreasing response time for initial claim assessments to two years.
  • Managed Salesforce claims, reaching quick resolution on 47% of cases, helping maintain strong customer retention.
  • Handled 14 medical bill audits and recovered $12 in overcharges, ensuring compliance with payer contracts and state laws.
  • Utilized proprietary claims management software to process up to 9 complex claims daily, demonstrating high efficiency in caseload management.
  • Proactively mediated disputes between policyholders and contractors/vendors to facilitate timely claim resolution, reducing escalations by 56%
  • Able to mitigate losses following operational adjustments, reducing claim reserve amounts by an estimated $11 across 2 cases.
  • Handled large-scale, specialized claims, such as cyber-insurance or procedure, resolving claims efficiently within two years.
  • Developed and maintained a documentation system for procedure insurance claims, enhancing regulatory compliance and decreasing processing delays by 48%.

Affiliations

  • International Association of Special Investigation Units (IASIU)
  • American Bar Association - Tort Trial and Insurance Practice Section (ABA-TIPS)
  • Casualty Actuarial Society (CAS)
  • Toastmasters
  • Society of Human Resource Management
  • American Society of Safety Professionals
  • Claims and Litigation Management Alliance (CLM)
  • International Association of Insurance Professionals (IAIP)
  • Association of Public Insurance Adjusters (APIA)
  • National Association of Independent Insurance Adjusters (NAIIA)

Certifications

  • Comprehensive Property Adjuster Training (CPAT)
  • Certified Professional Public Adjuster (CPPA)
  • Certified Claims Professional (CCP)
  • Risk Management for Claims Adjusters (RMCA)
  • Property Claims Adjuster Certification
  • Associate in Insurance Services (AIS)
  • Associate in Claims (AIC)
  • Certified Insurance Fraud Investigator (CIFI)
  • Microsoft Certified Systems Engineer (MCSE)
  • Workers' Compensation Claims Professional Certification (WCCP)

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