Claims Analyst Resume Examples

claims analyst

  • Handle auto claims involving damage to vehicle, or liability claims involving third party vehicle or third party bodily injury from liability situations, such as motor vehicle accidents.
  • Policy interpretation, investigate a loss, deciding the policy covers the loss.
  • Examine claim and provide decisions accurately.
  • Inspect vehicle damage to determine degree of damages.
  • Examine photographs and statements.
  • Consult with car manufacture, police, and field surveyor for expert evaluation.
  • Verify overall coverage during the point of accident.

claims analyst

  • Analysis of Claim data to find  reason behind deviation from expected result of different claim parameters.
  • Coordinating with fraud and actuary team and creating  Fraud Risk Model for claim department.
  • Making Board meeting ppt for National Manager based on data analysis.
  • Finding Magma Ranking within 30 days settlement quarterly based on NL-24 and 25 data uploaded by companies on IRDAI website.
  • Coordinating with IT department to resolve system issues.

claims analyst

  • Ensures accurate review of claims document like LOA, hospital bills/SOA concurrent review form, physicians report, original OR for use in processing claims.
  • Reviews and match the endorsed document againts the actual encoded data in the system.
  • Evaluates claims and adjudicates claims to ensure claims are according to benefits plan, coverage and policies and standards.
  • Accurately evaluates and process Out-patient and In-patient claim reimbursement and non-reimbursement, received from various providers and meet the required quota.

claims analyst

  • Acting liason for General Motors customers and suppliers in investigating and claim that may result in asset loss
  • Oversaw return and exchange processes from customer to supplier
  • Took corrective action in the case of accidents and delays to minimize extra expenses
  • Gathered, logged and monitored all shipping data
  • Analyzed and reviewed claims for accuracy, completeness, eligibility and detailed research in verifying claims
  • Monitored claims from start to finish making decision to determine reimbursement in a timely manner

claims analyst

  • Process and adjust claims.
  • Transfer to correct department when necessary.
  • Knowledge of ICD-10 codes.
  • Daily use of 10-Key.
  • Knowledge of Dual monitors.
  • Proficient in hotkeys.

claims analyst

  •  Validate information on all veterinary claims from policyholders seeking reimbursement from their insurance company. 
  • Thoroughly review policy details to ensure that there is no missing or incomplete information. 
  • Adhere to claim requirements and made a request and follows up on missing documents. 
  • Approve or deny reimbursement of claims based on the policy terms and conditions as well as on the extensive knowledge of medical process and terminologies. 

claims analyst

  • Analyse the submitted incident to the company and register it in the system
  • Review and authorize the parts to fix and change the incident
  • Follow-up of the incident until delivery of the vehicle
  • Ensure that the advice on the accident statement is given accurately.

senior claims analyst

  • Examine claims forms and other records to determine payout amount.
  • Calculate and establish payment method.
  • Check to ensure that appropriate changes were made to resolve claimants’ problems.
  • Review claims adjustments , examining claims to be disputes, and approving or disapproving increased payout on claims.

claims analyst

  • Review and process claims according to health care law
  • Assist supervisor in conducting training for new hires.
  • Decision making on whether to accept or reject claim.
  • Interview claimant and witnesses to gather relevant information.

claims analyst

  • Inspect claims history to avoid scam.
  • Negotiate on claim amount with workshop.
  • Handle claim dispute together with negotiation with claimant to settle claim.
  • Work with attorneys to defend insurer’s position is claim is contested.

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