5 Amazing claims examiner Resume Examples (Updated 2023) + Skills & Job Descriptions

Are you looking for a job and need to write an effective claims examiner resume? Whether you have years of experience or are a newbie, your resume needs to make a good first impression. Hiring managers are looking for specific qualifications, such as COBRA administration, medical terminology knowledge, flexible spending processing, ICD-9, CPT-4/LI-NC1, and bodily injury claims, that show you are a good fit for the position. Employers typically have to sort through many resumes at a time, so they do not spend much time looking at each one. Incorporate relevant key phrases from the job description to demonstrate the abilities that make you a good candidate. If you are looking for guidance when composing your document, refer to a resume example that our resume professionals have put together. We also have a library of job-specific keywords that hiring managers are looking for. Using our tips will help you write a strong resume that gets noticed.

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claims examiner: Resume Samples & Writing Guide

Professional Summary

Highly experienced Claims Examiner with a proven track record of accurately assessing and settling insurance claims. Skilled in analyzing complex claims and working with customers to ensure a positive resolution.

Employment history

Senior Claims Examiner, Allstate Northbrook, Illinois

December 2009 – Present

Negotiate settlements with claimants and attorneys
Ensure compliance with all applicable laws and regulations
Resolve customer complaints in a timely and professional manner

Associate Claims Examiner, Progressive Mayfield Village, Ohio

December 2008 – November 2009

Resolve customer complaints in a timely and professional manner
Review and evaluate claims to determine coverage and liability
Negotiate settlements with claimants and attorneys

Junior Claims Examiner, Liberty Mutual Boston, Massachusetts

June 2008 – November 2008

Review and evaluate claims to determine coverage and liability
Resolve customer complaints in a timely and professional manner
Collaborate with other departments to ensure accurate and timely processing of claims

Education

University of Texas, Austin, Texas

Master of Arts in Insurance and Risk Management, April, 2008

University of Texas, Austin, Texas

Bachelor of Science in Insurance and Financial Services, April, 2004

Skills

Time Management

Database Management

Relationship Management.

Project Management

Claim Reimbursement.

Microsoft Office

Medical Terminology

Risk Analysis

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Employment history

Senior Claims Examiner, USAA San Antonio, Texas

December 2022 – Present

Develop and maintain relationships with clients, attorneys, and other professionals
Maintain knowledge of insurance contracts, laws and regulations
Resolve customer complaints in a timely and professional manner

Claims Examiner, Nationwide Columbus, Ohio

July 2021 – November 2022

Negotiate settlements with claimants and attorneys
Prepare and submit claim reports
Document and maintain claim files

Entry Level Claims Examiner, Progressive Mayfield Village, Ohio

December 2020 – June 2021

Prepare and present claims in court, if necessary
Collaborate with other departments to ensure accurate and timely processing of claims
Prepare and submit claim reports

Education

University of Michigan, Ann Arbor, Michigan

Doctor of Business Administration in Insurance, November, 2020

University of Michigan, Ann Arbor, Michigan

Bachelor of Science in Accounting and Insurance, November, 2016

Skills

Flexibility

Emotional Intelligence

Troubleshooting

Analytical

Legal Compliance

Claim Estimation

Document Review

Claim Auditing

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Professional Summary

Highly experienced Claims Examiner with extensive knowledge of insurance policies and procedures. Proven ability to accurately assess and process claims efficiently and effectively.

Employment history

Chief Claims Examiner, Allstate Northbrook, Illinois

February 2014 – Present

Collaborate with other departments to ensure accurate and timely processing of claims
Document and maintain claim files
Prepare and submit claim reports

Claims Examiner, Progressive Mayfield Village, Ohio

August 2012 – January 2014

Analyze financial data and prepare reports
Communicate with claimants, insureds, and other parties involved in the claims process
Develop and maintain relationships with clients, attorneys, and other professionals

Entry Level Claims Examiner, Farmers Insurance Los Angeles, California

February 2012 – July 2012

Resolve customer complaints in a timely and professional manner
Communicate with claimants, insureds, and other parties involved in the claims process
Monitor and track claims to ensure timely resolution

Education

University of Michigan, Ann Arbor, Michigan

Insurance Business, December, 2011

Skills

Documentation

Interpersonal

Creativity

Financial Management

Insurance Claims Processing

Claim Settlements

Medical Terminology

Claim Form Completion

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Employment history

Lead Claims Examiner, State Farm Bloomington, Illinois

January 2016 – Present

Resolve customer complaints in a timely and professional manner
Communicate with claimants, insureds, and other parties involved in the claims process
Review and evaluate claims to determine coverage and liability

Associate Claims Examiner, Allstate Northbrook, Illinois

July 2014 – December 2015

Monitor and track claims to ensure timely resolution
Communicate with claimants, insureds, and other parties involved in the claims process
Resolve customer complaints in a timely and professional manner

Junior Claims Examiner, MetLife New York, New York

July 2013 – June 2014

Document and maintain claim files
Ensure compliance with all applicable laws and regulations
Analyze financial data and prepare reports

Education

University of Texas, Austin, Texas

Master of Business Administration in Insurance, May, 2013

University of Texas, Austin, Texas

Bachelor of Science in Insurance and Financial Services, May, 2009

Skills

Adaptability

Quality Assurance

Teamwork

Relationship Management.

Microsoft Office

Claim Reimbursement.

Claim Auditing

Insurance Claims Processing

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Employment history

Senior Claims Examiner, Nationwide Columbus, Ohio

June 2019 – Present

Review and evaluate claims to determine coverage and liability
Monitor and audit claims to ensure accuracy and compliance with company policies and procedures
Communicate with claimants, insureds, and other parties involved in the claims process

Claims Examiner, Liberty Mutual Boston, Massachusetts

January 2018 – May 2019

Ensure compliance with all applicable laws and regulations
Resolve customer complaints in a timely and professional manner
Prepare and present claims in court, if necessary

Junior Claims Examiner, Liberty Mutual Boston, Massachusetts

July 2016 – December 2017

Maintain knowledge of insurance contracts, laws and regulations
Monitor and audit claims to ensure accuracy and compliance with company policies and procedures
Monitor and track claims to ensure timely resolution

Education

University of Washington, Seattle, Washington

Doctor of Science in Risk Management, May, 2016

University of Washington, Seattle, Washington

Bachelor of Science in Accounting and Insurance, May, 2012

Skills

Written Communication

Creativity

Supervisory

Adaptability

Claim Adjustment

Data Entry

Claim Estimation

Claim Auditing

Use This claims examiner Resume Template

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claims examiner Job Descriptions; Explained

If you're applying for an claims examiner 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.

claims examiner

Prepare appropriate coverage letters to be submitted to and approved by claims management
Complete a highly detailed investigation on each claim in a timely manner and fully document the file with pertinent information
Uncovered fraudulent claims scheme; provided evidence leading to the recovery of thousands of dollars in insurance overpayments.
Effectively manage multiple, high-priority projects and take pride in providing exemplary customer service.

claims examiner

Maintain good faith in investigation process to resolve claims for the insurer.
Maintain pdpa at all times (personal data protection act).
Notify insurer on the type of claim being submitted against their insurance (own damage & third party).
Keeping records in excel sheets for tracking purposes.
Investigate and process insurance claims filed by policyholders
Handle letter of demands from workshop and law firm.
Claims finalization, provide proper information to workshop.

claims examiner

Accurately and timely review injury settlement demands
Provide excellent customer service to policyholders while explaining the litigation process
Assist defense counsel throughout litigation while continuing to maintain open negotiations with plaintiff counsel
Issue pay-out amounts.

sr. claims examiner

Manage a portfolio of claims for Accident & Health and /or Combined Insurance claims as allocated and assist processing other Retail claims as required.
Assess claims in accordance with Chubb’s service level and quality requirements and the General Insurance Code of Practice. This includes determining coverage, reserving within timeframes, making payments, responding to customer queries, providing updates, and requesting additional information as needed to manage a claim.
Communication by telephone and written correspondence to brokers, claimants and others as required.
Take part in Claim Department and company-wide training as required.
Respond to enquiries and escalations of matters from underwriters, brokers and customers, and work with underwriters, the Compliance Department and other departments of the company as needed.
Proactively apply claims policies and procedures including Chubb’s policy in relation fraud, salvage, cost containment and complaints.
Where applicable, review income replacement claims for payment of periodic benefits at lodgement stage and at key points in the claim cycle and develop strategies for claim management and successful return to work of the claimant where possible.

claims examiner

Allocation of funds/Receipt Reconciliation.
Liaising with the clients for outstanding invoices.
Debt Analysis, for quick collection of funds from clients
Processing of client accounts according to treaty agreement
Generating statement of account and sending it to clients for agreement,
Reinsurance accounting including Financial settlement with clients according to treaty terms and agreements
Credit Control Activity prior to payments to clients, Additional ad hoc requirements

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claims examiner Job Skills

For an claims examiner 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 Claims Processing
Claim Investigations
Medical Terminology
Claim Adjustment
Insurance Regulations
Claim System Software
Claim Procedures
Microsoft Office
Claim File Documentation
Risk Analysis
Claim Negotiation
Data Analysis
Claim Settlements
Claim Auditing
Claim Estimation
Claim Investigation Techniques
Legal Compliance
Document Review
Claim Form Completion
Claim Reimbursement.

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 claims examiner 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

Senior Claims Examiner, Allstate Northbrook, Illinois

December 2018 – May 2022

Develop and maintain relationships with clients, attorneys, and other professionals
Prepare and present claims in court, if necessary
Negotiate settlements with claimants and attorneys

Associate Claims Examiner, MetLife New York, New York

May 2018 – November 2018

Document and maintain claim files
Monitor and audit claims to ensure accuracy and compliance with company policies and procedures
Analyze financial data and prepare reports

Entry Level Claims Examiner, Farmers Insurance Los Angeles, California

November 2017 – April 2018

Education

Ohio State University, Columbus, Ohio

Master of Business Administration in Insurance, September, 2017

Ohio State University, Columbus, Ohio

Bachelor of Arts in Insurance and Accounting, September, 2013

Skills

Critical Thinking

Decision Making

Written Communication

Training

Data Entry

Claim Investigations

Claim File Documentation

Claim Negotiation

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 claims examiner 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 Claims Examiner, MetLife New York, New York

January 2019 – Present

Ensure complience with all applicable laws and regulaitons
Reivew and evaulate claims to determine coverage and liabiltiy
Reslove customer complaints in a timely and profesional manor

Claims Examiner, Nationwide Columbus, Ohio

January 2018 – December 2018

Prepare and presents claims in court, if necessarry
Develops and maintain relationships with clients, attorney's, and other professionals
Collaborates with other departments to ensure accurrate and timely processings of claims.

Junior Claims Examiner, Nationwide Columbus, Ohio

January 2017 – December 2017

Maintains knowledge of insurance contracts, laws and regulations
Monitor and audit claims to ensure accuracie and compliance with company policies and procedures
Reviews and evaluates claims to determine coverage and liabilitie

Education

Georgia State University, Atlanta, Georgia

Doctor of Business Administration in Insurance, November, 2016

Georgia State University, Atlanta, Georgia

Bachelor of Science in Risk Management, November, 2012

Skills

Quality Assurance

Teamwork

Social Media

Flexibility

Claim Form Completion

Claim Procedures

Data Entry

Legal Compliance

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.

claims examiner Cover Letter Example

A cover letter can be a valuable addition to your job application when applying for an claims examiner 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 Claims Examiner
Progressive
Mayfield Village, Ohio

Greetings Progressive Recruitment Team

I am a highly motivated Claims Examiner with 15 years of experience in Insurance. I am excited to submit my application for the Senior Claims Examiner position at Progressive, where I believe my skills and expertise would be an excellent fit.

As someone who has always been committed to making a positive impact on the world, I have pursued opportunities to contribute to my community through my work wherever I may be. My experience in this field has equipped me with the skills and knowledge necessary to succeed throughout my life and I am confident that they will help me to bring my passion and expertise to your organization and help drive your success.

Thank you for considering my application for the Senior Claims Examiner 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.

Thank you for your time,
Evan Young
623-335-4129
[email protected]

Evan Young

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