Claim Specialist

Writing a great claim specialist resume is important because it is one of the first things a potential employer will see when they are considering you for a position. It is your opportunity to make a good first impression and sell yourself as the best candidate for the job.

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If you're looking for inspiration when it comes to drafting your own claim specialist resume, look no further than the samples below. These resumes will help you highlight your experience and qualifications in the most effective way possible, giving you the best chance of landing the claim specialist job you're after.

Resume samples

Dashayla Dod

dashayla.dod@gmail.com | (516) 207-6328 | Nashville, TN

Summary


Over three years of experience as a Claim Specialist. Experienced in working with all levels of insurance companies, healthcare providers, and patients. Excellent customer service skills with the ability to resolve conflict and negotiate settlements. Strong analytical and problem-solving skills with the ability to make sound decisions under pressure.

Experience


Claim Specialist at Progressive, TNMay 2022 - Present

  • Successfully processed X number of claims per day/week.
  • Achieved a 97% satisfaction rating from customers for processing speed and accuracy of payments.
  • Received recognition from management for being in the top 10% of performers in the department.
  • Regularly achieved quality scores above 95%.
  • Maintained up-to-date knowledge of all claim processes and procedures.

Claim Specialist II at GEICO, TNSep 2019 - Mar 2022

  • Investigated and processed 100+ complex insurance claims per month, with a 98% accuracy rate.
  • Led team of 5 claim specialists in daily operations and provided training as needed.
  • Negotiated settlements with claimants and attorneys, resulting in an average savings of 15% for the company.
  • Reviewed policies to determine coverage and benefits due, then communicated this information to claimants.
  • Investigated fraud cases by reviewing documentation and interviewing parties involved; referred 10+ cases for prosecution.
  • Authored monthly report on trends observed in incoming claims data.

Education


High School Diploma at Nashville School of the Arts, Nashville, TNSep 2014 - May 2019

I've learned how to effectively communicate with others, how to manage my time wisely, and how to work independently and as part of a team.

Skills


  • Claim processing
  • Claim adjudication
  • Claims management system
  • Medical billing
  • Coding (ICD-10, CPT, HCPCS)
  • Provider relations
  • Customer service

Ronald Nunemacher

ronald.nunemacher@gmail.com | (166) 805-4480 | 28 Adams St,

Summary


I have over three years of experience as a Claim Specialist. In that time, I have worked for two different companies and handled thousands of claims. My work has earned me a reputation as an expert in the field, and I am known for my attention to detail and ability to get results. As a Claim Specialist, I have helped clients save millions of dollars by negotiating settlements with insurance companies. My negotiation skills are top-notch, and I always put the client's best interests first. If you're looking for someone who can help you save money on your insurance claim, then look no further than me!

Experience


Claim Specialist at GEICO, MAJun 2022 - Present

  • Investigated and processed 100+ claims per week, ensuring that all deadlines were met.
  • Reviewed claim documentation for accuracy and completeness.
  • Negotiated settlements with insurance companies on behalf of clients.
  • Resolved complex issues escalated by clients or adjusters.
  • Managed a portfolio of 500+ open claims at any given time.
  • Achieved a 97% satisfaction rating from customers.

Claim Specialist II at Nationwide, MAAug 2019 - Apr 2022

  • Investigated and processed an average of 120 new claims per month, with a 98% accuracy rate.
  • Reviewed and decided the outcome of approximately 50 appeals per month.
  • Recovered $2.5 million in overpayments through fraud investigations.
  • Trained 2 new Claim Specialists I on company procedures and systems.
  • Processed 100 claim adjustments per day during system conversion project.
  • Authored 3 SOPs for various aspects of the claims process.

Education


High School Diploma at Boston Latin School, Boston, MAAug 2015 - May 2019

I've learned how to read, write, and do math.

Skills


  • Claim processing
  • Claim adjudication
  • Customer service
  • Medical billing
  • Insurance claims
  • Investigation skills
  • Organizational skills