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Claims Investigator resume examples

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Skills

  • Underwriting knowledge
  • Familiar with fraud statutes
  • Hail and wind damage specialist
  • Claims intake and documentation tools (Power BI)
  • Fair Isaac Claims Advisor
  • Interior water damage background
  • Claims investigation and fraud detection
  • Collaborating with legal and regulatory agencies
  • Insurance policy coverage knowledge
  • Microsoft Publisher

Work Experiences

  • Bolstered the credibility of the firm's investigations.
  • Calculated the quantifiable features of framework products.
  • Was in charge of maintaining information files and processing paperwork on a daily basis.
  • Looked into legal issues surrounding system claims.
  • Assessed data collection accuracy.
  • Attended national conferences to stay updated on evolving fraud tactics, bringing back 9 new tools for the team.
  • Collaborated across departments.
  • Built risk prediction models.
  • Analyzed claims documentation.
  • Conducted in-depth interviews with witnesses and claimants to gather facts and information.

Summaries

  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Collaborated with claimants and attorneys.
  • Achieved improvements through cross-department collaboration.
  • Expert at creating profitable and high-quality processes.
  • Achieved a metric% improvement in data accuracy.
  • Adept at collaborating with cross-functional teams, delivering a 31% increase in claims processing efficiency by automating system workflows.
  • Solid skills in formulating goals and strategies for resolving metric claims.
  • Adept at producing actionable investigative reports.
  • Strong understanding of claimant intake processes, record documentation, and fraud investigation protocols.
  • Detailed Adjuster with 6 years of corporate insurance claims experience.

Accomplishments

  • Collaborated with data analytics teams to build risk prediction models, improving decision-making accuracy by 40% %.
  • Collaborated with legal teams to provide litigation support on claim disputes, contributing to a settlement savings of $7.
  • Contributed to a decrease in claim processing times by 11%, enhancing customer satisfaction across multiple departments.
  • Achieved OSHA certification to enhance investigation techniques and meet industry standards in claim handling protocols.
  • Investigated high-profile category insurance claims, successfully resolving 80% of cases with a favorable outcome for the company.
  • Worked with interdepartmental teams to ensure consistency in upholding legal and regulatory frameworks in high-value claim investigations.
  • Collaborated across departments to resolve complex method claims, improving processing time by 45% in 2023.
  • Reviewed and audited 12-claim files per month and identified 39% in cost-saving opportunities.
  • Led a taskforce responsible for reinvestigating delayed claims, reducing overall claim delays by 44%.
  • Used advanced data analytics to identify risky claims, reducing the number of fraudulent payouts by 52%.

Affiliations

  • International Association of Auto Theft Investigators (IAATI)
  • Workers’ Compensation Claim Management Coalition
  • International Council of Nurses
  • Project Management Institute
  • Insurance Fraud Association Conference Attendee (2016)
  • American Marketing Association
  • American Bar Association – Insurance and Claims Division
  • American Society of Safety Professionals
  • Society of Certified Insurance Counselors (SCIC)
  • International Association of Special Investigation Units (IASIU)

Certifications

  • Certified Insurance Claims Specialist (CICS) - American Education Institute (AEI)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Associate in Claims (AIC) - The Institutes
  • Certified Fraud Examiner (CFE) – Association of Certified Fraud Examiners (ACFE)
  • Certified Information Systems Auditor (CISA) - process
  • Certified Internal Auditor (CIA) – Institute of Internal Auditors (IIA)
  • Certified Ethical Hacker (CEH) - EC-Council for Cyber/Insurance Fraud Investigations
  • Cisco Certified Network Associate (CCNA)
  • Advanced Interview Techniques Investigator (AITI) - Wicklander-Zulawski (WZ) Academy
  • CompTIA Security+

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