5 Amazing claim specialist Resume Examples (Updated 2023) + Skills & Job Descriptions

claim specialist

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claim specialist: Resume Samples & Writing Guide

Employment history

Senior Claim Specialist, Progressive Mayfield Village, Ohio

September 2015 – Present

Recommend changes to existing claims policies and procedures
Prepare claim reports and review for accuracy
Liaise with external vendors, service providers, and other stakeholders

Associate Claim Specialist, State Farm Bloomington, Illinois

September 2014 – August 2015

Negotiate settlements with claimants
Prepare claim reports and review for accuracy
Provide customer service and maintain customer relationships

Jr. Claim Specialist, Travelers Hartford, Connecticut

September 2013 – August 2014

Liaise with external vendors, service providers, and other stakeholders
Analyze claims data to identify trends and areas of improvement
Monitor claims to ensure timely and accurate resolution

Education

University of Washington, Seattle, Washington

Doctor of Arts in Insurance and Accounting, August, 2013

University of Washington, Seattle, Washington

Bachelor of Arts in Insurance and Accounting, August, 2009

Skills

Social Media

Stress Management

Listening

Planning

Microsoft Office

Claim Reimbursement

Regulatory Compliance

Data Analysis

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Professional Summary

Highly experienced Claim Specialist with an in-depth understanding of insurance policies and procedures. Proven track record of accurately assessing and resolving complex claims in a timely manner.

Employment history

Chief Claim Specialist, Farmers Insurance Los Angeles, California

June 2010 – Present

Ensure compliance with applicable laws and regulations
Recommend changes to existing claims policies and procedures
Review and process claims according to established guidelines

Associate Claim Specialist, Travelers Hartford, Connecticut

December 2009 – May 2010

Assist in the development of new claims procedures and processes
Negotiate settlements with claimants
Investigate and analyze complex claims

Jr. Claim Specialist, Progressive Mayfield Village, Ohio

December 2008 – November 2009

Investigate and analyze complex claims
Prepare claim reports and review for accuracy
Evaluate and process claims for payment

Education

University of Illinois, Urbana, Illinois

Insurance Brokerage, October, 2008

Skills

Relationship Management.

Flexibility

Technical

Negotiation

Medical Billing

Claim Processing

Microsoft Office

Claim Investigation

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Employment history

Chief Claim Specialist, Liberty Mutual Boston, Massachusetts

September 2016 – Present

Analyze claims data to identify trends and areas of improvement
Assist in the development of new claims procedures and processes
Review and process claims according to established guidelines

Associate Claim Specialist, Farmers Insurance Los Angeles, California

March 2016 – August 2016

Resolve customer inquiries and complaints
Negotiate settlements with claimants
Evaluate and process claims for payment

Junior Claim Specialist, State Farm Bloomington, Illinois

March 2015 – February 2016

Investigate and analyze complex claims
Provide customer service and maintain customer relationships
Negotiate settlements with claimants

Education

University of Pennsylvania, Philadelphia, Pennsylvania

Bachelor of Business Administration in Insurance, January, 2015

Skills

Planning

Problem Solving

Risk Management

Documentation

Litigation

Subrogation

Communication

HIPAA Compliance

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Employment history

Senior Claim Specialist, Nationwide Columbus, Ohio

February 2016 – Present

Provide customer service and maintain customer relationships
Liaise with external vendors, service providers, and other stakeholders
Monitor claims to ensure timely and accurate resolution

Associate Claim Specialist, Farmers Insurance Los Angeles, California

March 2015 – February 2016

Ensure compliance with applicable laws and regulations
Review and process claims according to established guidelines
Liaise with external vendors, service providers, and other stakeholders

Jr. Claim Specialist, Allstate Northbrook, Illinois

March 2014 – February 2015

Review and process claims according to established guidelines
Ensure compliance with applicable laws and regulations
Provide customer service and maintain customer relationships

Education

University of Wisconsin, Madison, Wisconsin

Doctor of Science in Risk Management, January, 2014

University of Wisconsin, Madison, Wisconsin

Bachelor of Science in Accounting and Insurance, January, 2010

Skills

Training

Quality Assurance

Teamwork

Time Management

Subrogation

Claim Auditing

Claim Processing

Data Entry

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Employment history

Senior Claim Specialist, MetLife New York, New York

May 2021 – Present

Recommend changes to existing claims policies and procedures
Analyze claims data to identify trends and areas of improvement
Assist in the development of new claims procedures and processes

Claim Specialist, State Farm Bloomington, Illinois

November 2019 – April 2021

Liaise with external vendors, service providers, and other stakeholders
Prepare claim reports and review for accuracy
Ensure compliance with applicable laws and regulations

Junior Claim Specialist, Allstate Northbrook, Illinois

June 2018 – November 2019

Liaise with external vendors, service providers, and other stakeholders
Analyze claims data to identify trends and areas of improvement
Prepare claim reports and review for accuracy

Education

University of Wisconsin, Madison, Wisconsin

Bachelor of Science in Risk Management, April, 2018

Skills

Emotional Intelligence

Risk Management

Strategic Thinking

Financial Management

Insurance Verification

Regulatory Compliance

Microsoft Office

Claim Denial Management

Use This claim specialist Resume Template

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claim specialist Job Descriptions; Explained

If you're applying for an claim specialist position, it's important to tailor your resume to the specific job requirements in order to differentiate yourself from other candidates. Including accurate and relevant information that directly aligns with the job description can greatly increase your chances of securing an interview with potential employers.

When crafting your resume, be sure to use action verbs and a clear, concise format to highlight your relevant skills and experience. Remember, the job description is your first opportunity to make an impression on recruiters, so pay close attention to the details and make sure you're presenting yourself in the best possible light.

claim specialist

Investigates, evaluates, negotiates, and settles auto claims in an assigned area.
Verifies coverage, legal liability and extent of damage to persons and property
Uses various electronic resources for claim handling
Applies knowledge of policies, procedures, laws, statutes and insurance regulations when determining coverage, liability, and property damage
Interview or correspond with claimants, witnesses, police, or other relevant parties to determine claim settlement, denial, or review.Examine claims forms and other records to determine insurance coverage.

claim specialist

Resolved complex, severe exposure claims, using high service oriented file handling.
Maintained claim files such as records of settled claims and an inventory of claims requiring detailed analysis.
Investigated, evaluated and settled claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.
Managed pivot table projects which contain provider claim discrepancies on CMS 1500 and UB-04 forms, in a timely manner resolution complete.
Created Policies and Procedures for Claims review

claim specialist

Responsible for overseeing and tracking customer inquiries at the executive level.
Supported field managers with reviewing and managing independent adjuster handled claim files.
Assigned to Phase I MI IPM teamCreated and wrote requirements to interface software CPS currently uses to work in IPM.
Data mined Excel spreadsheets to find trends and to summarize results.

claim specialist

Guide policyholder on how to proceed with a claim.
Analyse a claim to establish whether it satisfies the conditions or not.
Uphold relationships and communication with insurance companies and clients.
Negotiate and ensure fair settlement of valid claims.

claim specialist Job Skills

For an claim specialist position, your job skills are a key factor in demonstrating your value to the company and showing recruiters that you're the ight fit for the role. It's important to be specific when highlighting your skills and ensure that they are directly aligned with the job requirements, as this can greatly improve your chances of being hired. By showcasing your relevant skills and experience, you can make a compelling case for why you're the best candidate for the job.

How to include technical skills in your resume:

Technical skills are a set of specialized abilities and knowledge required to perform a particular job effectively. Some examples of technical skills are data analysis, project management, software proficiency, and programming languages, to name a few.

Add the technical skills that will get hired in your career field with our simple-to-use resume builder. Select your desired resume template, once you reach the skills section of the builder, manually write in the skill or simply click on "Add more skills". This will automatically generate the best skills for your career field, choose your skill level, and hit "Save & Next."

Data Entry
Insurance Verification
Claim Processing
Claim Investigation
Claim Adjustment
Documentation Review
Regulatory Compliance
Claim Auditing
Claim Reimbursement
Claim Denial Management
Medical Terminology
HIPAA Compliance
Medical Billing
Medical Coding
Subrogation
Auditing
Litigation
Data Analysis
Microsoft Office
Communication

How to include soft skills in your resume:

Soft skills are non-technical skills that relate to how you work and that can be used in any job. Including soft skills such as time management, creative thinking, teamwork, and conflict resolution demonstrate your problem-solving abilities and show that you navigate challenges and changes in the workplace efficiently.

Add competitive soft skills to make your resume stand-out to recruiters! Simply select your preferred resume template in the skills section, enter the skills manually or use the "Add more skills" option. Our resume builder will generate the most relevant soft skills for your career path. Choose your proficiency level for each skill, and then click "Save & Next" to proceed to the next section.

Communication
Interpersonal
Leadership
Time Management
Problem Solving
Decision Making
Critical Thinking
Creativity
Adaptability
Teamwork
Organization
Planning
Public Speaking
Negotiation
Conflict Resolution
Research
Analytical
Attention to Detail
Self-Motivation
Stress Management
Collaboration
Coaching
Mentoring
Listening
Networking
Strategic Thinking
Negotiation
Emotional Intelligence
Adaptability
Flexibility
Reliability
Professionalism
Computer Literacy
Technical
Data Analysis
Project Management
Customer Service
Presentation
Written Communication
Social Media
Troubleshooting
Quality Assurance
Collaboration
Supervisory
Risk Management
Database Management
Training
Innovation
Documentation
Accounting
Financial Management
Visualization
Reporting
Business Acumen
Process Improvement
Documentation
Relationship Management.

How to Improve Your claim specialist Resume

Navigating resume pitfalls can mean the difference between landing an interview or not. Missing job descriptions or unexplained work history gaps can cause recruiters to hesitate. Let's not even talk about the impact of bad grammar, and forgetting your contact info could leave your potential employer hanging. Aim to be comprehensive, concise, and accurate.

Employment history

Jr. Claim Specialist, Farmers Insurance Los Angeles, California

August 2021 – May 2022

Education

University of Texas, Austin, Texas

Bachelor of Arts in Insurance and Financial Services, June, 2021

Skills

Professionalism

Problem Solving

Networking

Leadership

Medical Terminology

Litigation

HIPAA Compliance

Data Entry

Unexplained Year Gaps and Missing Job Experiences are a No-no

Gaps in your resume can prevent recruiters from hiring you if you don't explain them.

Key Insights

It's okay to have gaps in your work experience but always offer a valid explanation instead of just hiding it.
Use the gap to talk about positive attributes or additional skills you've learned.
Be honest and straightforward about the gap and explain it using a professional summary.

How to Optimize Your claim specialist Resume

Keep an eye out for these resume traps. Neglecting to detail your job roles or explain gaps in your career can lead to unnecessary doubts. Grammar blunders can reflect negatively on you, and without contact information, how can employers reach you? Be meticulous and complete.

Employment history

Lead Claim Specialist, Allstate Northbrook, Illinois

April 2016 – Present

Anaylze cliams data to identfy trends and areas of improvent
Communcate with cliamants, adjusters, and other insurance personel
Assit in the devlopment of new claims procedurs and proccesses

Associate Claim Specialist, Nationwide Columbus, Ohio

November 2014 – March 2016

Maintain inaccurate records and documentation of claims
Monitor clames to ensure timely and inaccurate resolution
Ensure complience with applicable laws and regulations

Junior Claim Specialist, USAA San Antonio, Texas

April 2014 – October 2014

Communicate with claimants, adjusters, and other insurance personel
Resolve customer inquirys and complaints
Analize claims data to identify trends and areas of improvment

Education

University of Pennsylvania, Philadelphia, Pennsylvania

Master of Science in Accounting and Insurance, March, 2014

University of Pennsylvania, Philadelphia, Pennsylvania

Bachelor of Arts in Insurance and Risk Management, March, 2010

Skills

Quality Assurance

Supervisory

Negotiation

Strategic Thinking

HIPAA Compliance

Claim Reimbursement

Microsoft Office

Medical Terminology

Avoid Spelling Mistakes and Include your Contact Information

Missing contact information prevents recruiters from understanding you're the best fit for the position.

Key Insights

Make sure you're not missing contact information on your resume. That should include your full name, telephone number and email address.
Make sure to use a professional email address as part of your contact information.
Highlight your contact information and double check that everything is accurate to help recruiters get in touch with you.

claim specialist Cover Letter Example

A cover letter can be a valuable addition to your job application when applying for an claim specialist position. Cover letters provide a concise summary of your qualifications, skills, and experience, also it also gives you an opportunity to explain why you're the best fit for the job. Crafting a cover letter that showcases your relevant experience and enthusiasm for the Accounts Payable role can significantly improve your chances of securing an interview.

Senior Claim Specialist
Allstate
Northbrook, Illinois

Greetings Allstate Recruitment Team

I am a highly motivated Claim Specialist with 10 years of experience in Insurance. I am excited to submit my application for the Senior Claim Specialist position at Allstate, where I believe my skills and expertise would be an excellent fit.

As someone who has always been curious and eager to learn, I have pursued my education and gained experience in areas like Fraud Detection to develop my skills in my work. This experience has given me the opportunity to lead major projects and provide my input in diverse areas, which have helped me gain a deeper understanding of the industry. I am excited to bring my passion and expertise to the role at this company and work towards achieving your organization's goals.

Thank you for considering my application for the Senior Claim Specialist position. I hope you will allow me to show you what I am capable of bringing to your organization and how we can work together to make an impact on the industry.

Kind regards,
Andrew Wilson
727-432-7119
[email protected]

Andrew Wilson

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