Claims Examiner Resume

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3. Claims Examiner Resume

Claims Examiners work for insurance companies and medical facilities. They check the correctness of claims made by policy holders. In case the claim is correct, they decide on the amount to be paid for the settlement of the claim. When claims are contested, the claim examiner may hold it, conduct investigation, gather relevant evidence, and testify in a court. Thus, the role they execute is important for customer service as well as protecting the capital of the company. Insurance companies prefer candidate with any bachelor's degree and knowledge / training in economics, law, math, business or medicine.

Sample Claims Examiner Resume

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Seth P. Boone
2410 Horner Street
Youngstown, OH 44512
Phone: 330-910-8868
Email: spboone@freemail.com Career Objective:

Looking for a claims examiner position with a reputed insurance company where I can protect the interest of policy holders and the company and demonstrate extraordinary example in customer service.

Summary of Skills:

• Excellent experience of health and life insurance sectors
• Experienced in investigating and settling claims
• Strong verbal and written communication skills
• Proficient with computer and drafting reports on claim investigation
• Excellent negotiation, time management, and organizational skills
• Deep knowledge of clauses associated with different policies

Work Experience:

Claims Examiner
ABC Company, Youngstown, OH
October 2015 - Present

• Accepting, investigating, and processing insurance claims
• Negotiating and settling health insurance claims with the party
• Conducting investigation in case of doubtful claims and applying proper judgment
• Analyzing and evaluating liability of the claims and drafting reports
• Review investigations and documenting claims activities
• Following clauses used in the policies for settling claims

Claims Examiner
XYZ Company, Youngstown, OH
February 2013 - September 2015

• Examined, processed, and adjudicated claims
• Verified eligibility for claims settlement as per rules and regulations in policies
• Visited hospitals and verified medical bills and patients' records
• Processed accepted and denial letters for claim settlement and mailed to respective parties
• Maintained constant communication with parties involved thorough the settlement process

Education:

• Bachelor's Degree in Arts
  ABC University, Youngstown, OH
  2012

Reference:

On request.