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Claims Officer resume examples

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Skills

  • Microsoft Office
  • Internal auditing
  • Time management skills
  • Contract auditing
  • Bilingual in Portuguese
  • Business Development
  • Communications
  • Music showcase training
  • Policy interpretation
  • CRM Systems

Work Experiences

  • Anticipated client needs.
  • Category helped me achieve $100,000.
  • Achieved improvement over 2 months.
  • Assessed and approved claims on complex Workday cases, ensuring strict adherence to PMP guidelines.
  • Adopted category.
  • Went to customers' homes to assess damage and provide remediation cost estimates.
  • Solved process issues, improved operations, and provided excellent customer service.
  • Copied, logged, and scanned supporting documents before filing everything in the client's files.
  • Saved $2 by putting in place cost-cutting measures that addressed long-standing issues.
  • Kept track of all pending authorizations to ensure that they were resolved quickly and that revenue was not lost.

Summaries

  • Authorized to review and approve claims payouts.
  • Approved complex Salesforce cases.
  • Achieved improvements through technology and workflow.
  • Professional with 15 years of progressive experience in the field who is highly organized and detail-oriented.
  • Accelerated approval processes by 68%.
  • Trying to get a similar job with a growing insurance company.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Within Miscellaneous, senior Claims Officer and outstanding performer in performance reporting and workflow optimization.
  • Accomplished in negotiating settlements.
  • Program professional with 14 years of experience evaluating coverage and supervising claims review.

Accomplishments

  • Authored and presented risk analysis reports that helped senior management make informed decisions leading to savings of $13 in claims payouts.
  • Won
  • Integrated
  • Resolved product issue through consumer testing.
  • Monitored
  • Protective Services: Applied safety procedures and policies as outlined in Department Safety Manual.
  • Collaborated with team of 18 in the development of metric.
  • Developed
  • Identified
  • Advised senior leadership on claims-related risk exposures, enabling proactive risk management practices for critical accounts.

Affiliations

  • National Association of Insurance Commissioners (NAIC)
  • Lions Club
  • Society of Financial Service Professionals (FSP)
  • Chartered Insurance Institute (CII)
  • National Association of Social Workers
  • National Alliance for Insurance Education & Research
  • American Medical Informatics Association
  • Project Management Institute
  • International Council of Nurses
  • Toastmasters

Certifications

  • Liability Insurance Claims Adjuster License – Washington
  • Advanced Claims Handling Certification – Cedar Works
  • Medical Fraud Prevention and Detection Certificate – Meridian
  • Fundamentals of Claims Analytics – Summit Group
  • Salesforce
  • CompTIA Security+
  • Associate in Risk Management (ARM) - The Institutes
  • Certified Insurance Counselor (CIC) - metric
  • Google Certified Professional Cloud Architect
  • Certified Fraud Examiner (CFE) – Association of Certified Fraud Examiners (ACFE)

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