Claims Representative Resume Sample

A claims representative in an insurance company addresses clients’ claims. A claims representative responsibilities include assessing client’s claims, determining if client’s claim is valid, determining compensation for client’s claim, researching claims, collaborating with third parties to determine validity of claims, and provide answers to client’s questions about claims.

For many, writing a resume can be daunting. If you are working on your own, it is easy to become overwhelmed with the amount of information you need to include and how best to present yourself.

The sample resumes below provide great examples of how to write an effective resume.

The Best Claims Representative Resume Samples

These are some examples of accomplishments we have handpicked from real Claims Representative resumes for your reference.

Claims Representative Resume Sample 1

  • Negotiated and settled delinquent claims; reduced accounts receivables by over $2,500.
  • Outstanding representation of insurance company at hearings as a member of the professional support staff.
  • Provided exceptional service to policy holders by respecting their concerns regarding their policies and adequately handling escalated claims.
  • Awarded “Employee of the Month” for outstanding performance in first six months on job that included resolving 546 calls.
  • Resolved customer issues within 24 hours or fewer with 98% accuracy rate during peak season times.

Claims Representative Resume Sample 2

  • Expedited the processing of claims by attending to details and prioritizing workloads.
  • Resolved complex claims issues in an organized, efficient, and timely manner following company policies and procedures.
  • Assessed penalties against policyholders who willfully concealed material facts from their application to reduce or cancel insurance policies.
  • Trained agency staff on new processes implemented for escalated claim actions resulting from increased fraudulent abuses of medical billing systems.
  • Spearheaded a task force recruiting partnership with physicians’ offices to guarantee prompt payment of benefits without unnecessary litigation or lengthy administrative hearings.

Claims Representative Resume Sample 3

  • Successfully represented the company and the insurance industry as a whole in dealings with various departments of State government.
  • Reorganized claim files to eliminate redundancies and compiling data and reports for timely submission.
  • Canvassed records throughout the state, speaking at civic groups and with other professionals on topics related to insurance claims.
  • Negotiated contracts with doctors, lawyers, medical supply manufacturers, funeral directors, ambulance services, etc., resulting in significant savings for client companies.
  • Handled every task under the supervision of manager with tact and diplomacy; consistently achieved goals as measured by manager’s performance review criteria.

Claims Representative Resume Sample 4

  • Negotiated claim settlements with injury victims and their families.
  • Used independent judgment to determine eligibility for benefits; solicited additional information by telephone or letter when necessary; coordinated information gathering activities.
  • Evaluated claims against special provisions, exclusions, and limitations of insurance policies; assisted in the preparation of annual benefit plans.
  • Determined accurate settlement amounts; identified appropriate payment methodologies; prepared documentation for processing payments.
  • Recognized by supervisor among top three co-workers who consistently meet established claims deadlines while maintaining high quality service standards.

Claims Representative Resume Sample 5

  • Negotiated and resolved complex claims; resolved cases in three months, while recovering costs exceeding $100,000.
  • Captured and processed claims information given verbally and by phone to adjusters when needed for timely claim reporting.
  • Collaborated with other teams when necessary to provide exceptional customer service.
  • Achieved award for providing superior support to managers during the investigation of suspicious claims.
  • Managed recovery process for several large unique non-traditional claims valued at over $500,000 each.

Claims Representative Resume Sample 6

  • Helped to successfully reduce the loss ratio by 20% in 6 months; recognized by the National Claims Director for outstanding performance.
  • Received an award for writing the top 10% of total claims, including both accident and health insurance policies.
  • Developed knowledge about risk management, catastrophe response, and managed crisis situations during Hurricane Katrina.
  • Performed well above average in merchandise processing responsibility center for five years; responsible for reviewing damage reports, adjusting deposits to customer accounts after receiving payment from insurance policy holders.
  • Achieved success in increasing revenue through profession service determination when promoted to Financial Service Representative.

Claims Representative Resume Sample 7

  • Identified errors in claims file data, entered correct information into database, and submitted claims for payment within 24 hours.
  • Prepared management reports to track claim trends; shared report with supervisor to assist in evaluating staffing needs.
  • Implemented process documentation standard operating procedure using checklist; increased productivity of team by 54%.
  • Developed informal complaint resolution system to give customers access to immediate relief or service recovery.
  • Satisfied 73% of customers who have complained about insurance product according to monthly customer survey ratings.

Claims Representative Resume Sample 8

  • Laid groundwork for the success of a regional management team by introducing innovative practices.
  • Provided exemplary service and loyalty to top-producing customers; recognized with an award for customer retention by the Vice President of Sales.
  • Restored trust and rapport among employees after spearheading a company ethics program that eliminated fraud, abuse, and wasted resources.
  • Promoted daily office morale through games and relatable material during monthly Management Meetings; appreciated by all staff members.
  • Handled over 200 claims in less than eight hours after the town was hit with a sudden flash flood; preventing possible negative exposure to insurance companies and minimizing cost impact on customers.

Claims Representative Resume Sample 9

  • Developed strong client relationships as a claims representative; received letters of appreciation from satisfied customers for service and support following automobile accidents.
  • Completed credit bureau searches to verify claimants’ financial responsibility.
  • Identified patterns in fraudulent claims; recommended revised policies to increase costs, prevent future fraudulent claims and improper payments and reduce risk exposure and loss control expenses.
  • Reorganized departmental filing system which reduced operational costs by $5,000 per year through the elimination of duplicate claim forms and improved turnaround time on incoming requests.
  • Accomplished merit raise within one year of hiring based on exceptional job performance during training period. Received exemplary evaluation scores. Gained approval for new employee identification badges.

Claims Representative Resume Sample 10

  • Verified insurance coverage by following up with customers and carriers as needed.
  • Identified, researched, and developed claims utilizing expert knowledge of policy language; prioritized claims based on severity and urgency.
  • Participated in team interview sessions with representatives from legal, medical review, technical support, and risk management to negotiate settlement of customer’s claim.
  • Effectively communicated and collaborated with outside agencies to develop new channels for resolving complex reimbursement cases; earned high performance appraisal ratings; recognized by supervisor as candidate for promotion into supervisory role.
  • Resolved complex issues related to denied claims resulting from lack of awareness surrounding corporate mandated guidelines; identified opportunities for improvement within workflow process.

Claims Representative Resume Sample 11

  • Resolved claims in a accurate and timely manner according to State Insurance Provider guidelines.
  • Claimed an average of $17,000 each month; recognized by the Regional Director for outstanding performance.
  • Highlighted for identifying fraudulent activity in a claim involving crane damage in a parking area, resulting in a compensation increase from $9,000 to $75,000.
  • Own ability to reduce premiums for customers with multiple policies through negotiation was highlighted during six-month training period at home office.
  • Distinguished from other employees through ability to consistently meet or exceed sales goals – sales which were primarily derived from reoccurring monthly payments.

Claims Representative Resume Sample 12

  • Responded to all claims in less than 24 hours; recognized for efficient service.
  • Sorted, assigned, and set payment according to insurance guidelines when processing claims.
  • Achieved award for claiming perfection by minimizing rejects through innovative research process.
  • Collaborated with an international team of representatives on a $1M project to automate claim handling system.
  • Troubleshot insurance claim-related problems for over 100 different companies; problem solved customer complaints within 2 days of receipt.

Claims Representative Resume Sample 13

  • Handled a high volume of cases, resulting in an excellent record for on-time claim closings.
  • Investigated damaged vehicles by interviewing claimants and witnesses, inspecting damage at accident sites, and taking photos.
  • Negotiated new policy limits with agents from $100k to $500k; recognized as top negotiator for three consecutive years.
  • Resolved disputed claims within 30 days by researching documentation related to the claim until a resolution was reached.
  • Recovered stolen jewelry valued at over $15k through investigative work and pinpointed perpetrator who resided in another state; earned respect of peers and supervisors.

Wrap Up

To become a claims representative, a high school diploma is required, in addition to a DHS license. A claims representative must have excellent interpersonal skills, must have excellent communication skills, must have excellent research skills, must have excellent investigation skills, must be detail-oriented, must be able to negotiate, and must be organized.

Resumes are a crucial aspect of any job search. In order to make a good first impression, it is important that your resume be formatted and written professionally. To create the perfect resume, think about what skills and qualities you want your future employer to see.

Hope these samples gave you an idea of what your resume should look like and some tips on how to make sure that your resume stands out from the rest.


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