Top 12 Claim Examiner Skills to Put on Your Resume

Building a sharp résumé as a Claims Examiner isn’t just listing duties. It’s a deliberate display of judgment, systems know‑how, and calm precision under pressure—so hiring teams can see, quickly, how you sort the messy from the legitimate and move files to clean resolution. Put your technical tools, analytical chops, and human touch up front. Show the story: you reduce leakage, accelerate cycle time, and keep policyholders informed without sugarcoating.

Claim Examiner Skills

1. ClaimVantage
2. Guidewire
3. Duck Creek
4. Xactimate
5. Medical Terminology
6. Risk Analysis
7. Fraud Detection
8. Regulatory Compliance
9. Negotiation
10. Data Analysis
11. Microsoft Excel
12. Customer Service

1. ClaimVantage

ClaimVantage (now part of Majesco) is a cloud-based claims platform used across disability, absence, and life lines to orchestrate intake, adjudication, and payments with rules-driven workflows and audit-ready tracking.

Why It's Important

It matters to a Claims Examiner because it centralizes evidence, automates repetitive steps, enforces policy rules, and cuts decision time—so you focus on judgment instead of chasing documents.

How to Improve ClaimVantage Skills

1. Master core workflows: Intake, eligibility, reserves, benefit calculations, and diary tasks—know the sequence cold.
2. Tune rules and templates: Refine decision trees, letters, and checklists to shrink rework and keep outcomes consistent.
3. Use analytics: Build saved views and dashboards to spot aged items, leakage patterns, and bottlenecks—then act.
4. Shortcuts and search: Learn power search, bulk updates, and keyboard flows to slice minutes off every file.
5. Feedback loop: Report friction points to admins; small configuration tweaks can erase daily pain.
6. Security hygiene: Apply role permissions and redaction wisely to protect PHI while keeping teams productive.

How to Display ClaimVantage Skills on Your Resume

2. Guidewire

Guidewire is an insurance platform (with ClaimCenter at its core) that unifies claims intake, coverage validation, investigations, payments, and communications—tight, trackable, reliable.

Why It's Important

For a Claims Examiner, it streamlines handoffs, automates compliance checks, and surfaces the right data at the right moment, improving accuracy and speed in one go.

How to Improve Guidewire Skills

1. Learn ClaimCenter inside out: FNOL paths, exposure setup, activities, notes, reserves, and financials.
2. Practice end-to-end scenarios: Mirror real claims—coverage quirks, subrogation, litigation—until the clicks are muscle memory.
3. Keep current: Track release features and adopt the ones that shave time or reduce errors.
4. Use saved searches and queues: Prioritize intelligently; starve the backlog.
5. Collaborate with admins: Request screen tweaks, fields, or validations that harden quality.

How to Display Guidewire Skills on Your Resume

3. Duck Creek

Duck Creek is a modular, cloud-based insurance suite that supports policy, billing, and claims with configurable workflows, rules, and reporting—built to scale without chaos.

Why It's Important

It helps Claims Examiners cut cycle times, keep documentation airtight, and improve consistency across high-volume claim types.

How to Improve Duck Creek Skills

1. Automate the mundane: Use rules, tasks, and integrations to reduce manual entry and repeated follow-ups.
2. Customize dashboards: Surface work-in-progress, SLAs at risk, and quality flags for quick triage.
3. Refine correspondence: Standardize letters and reminders to reduce back-and-forth.
4. Mobile fluency: Use mobile access to keep files moving when you’re away from your desk.
5. Data checks: Validate data mappings and required fields to avoid downstream cleanup.

How to Display Duck Creek Skills on Your Resume

4. Xactimate

Xactimate (from Verisk) is the estimating tool property claims rely on for line-item pricing, diagrams, and scoped repair costs.

Why It's Important

It standardizes estimates, speeds negotiations, and anchors settlements to transparent, current pricing data.

How to Improve Xactimate Skills

1. Train formally: Work through beginner to advanced modules; fill gaps you didn’t know you had.
2. Practice varied scenarios: Water, wind, fire, contents—diverse files build faster instincts.
3. Use macros and templates: Prebuild common scopes; stop reinventing line items.
4. Keyboard shortcuts: Small keystrokes, big time savings.
5. Calibrate with the field: Compare estimates with contractor feedback to keep scopes realistic.

How to Display Xactimate Skills on Your Resume

5. Medical Terminology

Medical terminology is the standardized vocabulary for anatomy, diagnoses, procedures, and treatments. Claims work depends on it—no guesswork, just clarity.

Why It's Important

It lets you decipher charts, parse CPT/ICD coding contexts, and adjudicate with accuracy and confidence.

How to Improve Medical Terminology Skills

1. Daily micro-study: Ten new terms a day, reviewed a week later—spaced repetition wins.
2. Root words and suffixes: Learn patterns so unfamiliar terms stop being intimidating.
3. Code-aware reading: Read EOBs, clinical notes, and operative reports with an eye for coding nuance.
4. Build a quick-reference: Your own glossary for frequent claim types saves time.
5. Talk to clinicians: Short syncs with nurse reviewers sharpen judgment fast.

How to Display Medical Terminology Skills on Your Resume

6. Risk Analysis

Risk analysis in claims means evaluating exposure—financial, legal, operational—so decisions align with policy language and appetite.

Why It's Important

It prevents leakage, flags emerging issues early, and channels complex files to the right path before they snowball.

How to Improve Risk Analysis Skills

1. Use data, not hunches: Track severity drivers, provider patterns, and loss trends in your book of business.
2. Scenario thinking: Map best case, expected, and worst case; set reserves that match reality.
3. Signals library: Maintain a checklist of risk cues—late notice, inconsistent statements, prior loss history.
4. Cross-functional consults: Involve SIU, legal, and clinical early on thorny files.
5. Post-mortems: Review closed claims with variance; learn what you missed and why.

How to Display Risk Analysis Skills on Your Resume

7. Fraud Detection

Fraud detection is spotting false, inflated, or staged elements so legitimate claims get paid and bad actors don’t.

Why It's Important

It protects policyholders, stabilizes premiums, and keeps the system fair. Miss it and costs quietly climb.

How to Improve Fraud Detection Skills

1. Pattern recognition: Learn common fraud typologies by line of business and geography.
2. Data triage: Use rules and anomaly scores to surface high-risk files for deeper review.
3. Consistency checks: Verify timelines, documentation, metadata, and provider histories for contradictions.
4. Interview craft: Ask precise, open-ended questions; confirm, then corroborate.
5. Tight partnerships: Work closely with SIU; share intel, refine red flags, and close feedback loops.
6. Document everything: Clear notes, preserved evidence, and defensible decisions.

How to Display Fraud Detection Skills on Your Resume

8. Regulatory Compliance

Regulatory compliance means your claim handling follows laws, regulations, and guidance—think NAIC model regs, state mandates, ERISA, HIPAA, CMS rules—without shortcuts.

Why It's Important

It reduces legal risk, prevents penalties, and builds trust with claimants and regulators alike.

How to Improve Regulatory Compliance Skills

1. Track rule changes: Keep a living register of state and federal updates that affect timeliness, notices, and file documentation.
2. Checklists and timers: Use standardized checklists and SLA timers to hit every required step and deadline.
3. Internal audits: Sample files monthly; fix root causes, not just surface misses.
4. Role-based controls: Ensure permissions and approvals match policy thresholds and governance.
5. Plain-language letters: Required notices should be accurate, timely, and easily understood.

How to Display Regulatory Compliance Skills on Your Resume

9. Negotiation

Negotiation is the art of aligning policy obligations, facts, and expectations into a settlement both sides can live with.

Why It's Important

Done well, it trims dispute time, avoids litigation, and preserves relationships—without overpaying.

How to Improve Negotiation Skills

1. Preparation first: Know coverage, comparables, and the leverage points before the call starts.
2. Listen for interests: Beneath positions sit real needs—timing, clarity, certainty. Address those.
3. Anchor with evidence: Estimates, guidelines, medical reviews—use facts, not volume.
4. Trade thoughtfully: Concede low-cost items to gain agreement where it matters.
5. Set walk-away lines: Define your limits in advance and stick to them.

How to Display Negotiation Skills on Your Resume

10. Data Analysis

Data analysis in claims means interrogating your data—quality checks, pattern hunting, outcome tracking—to inform decisions and improve operations.

Why It's Important

It reveals anomalies, supports defensible decisions, reduces fraud exposure, and speeds up the right work.

How to Improve Data Analysis Skills

1. Level up tools: Go beyond basics—Excel Power Query/Power Pivot, plus SQL or Python for heavier lifts.
2. Define metrics that matter: Cycle time by segment, reopen rate, severity drivers, leakage sources.
3. Visualize: Build clear dashboards that spotlight exceptions, not noise.
4. Data hygiene: Fix upstream data entry and mapping issues; garbage in, garbage out.
5. Experiment: Pilot small process changes, measure impact, expand what works.

How to Display Data Analysis Skills on Your Resume

11. Microsoft Excel

Excel is the daily driver for organizing claim data, running analyses, and producing reports that make decisions obvious.

Why It's Important

Used well, it accelerates calculations, reduces errors, and turns raw data into insight you can act on.

How to Improve Microsoft Excel Skills

1. Advanced formulas: INDEX/XMATCH, SUMIFS, LET, and dynamic arrays—less manual work, cleaner models.
2. Pivot mastery: Quick summaries, drill-downs, and slicers for fast exploration.
3. Power Query: Import, clean, and combine messy data without endless VLOOKUP chains.
4. Data validation: Lock fields down to prevent sloppy entries.
5. Macros/VBA (where allowed): Automate repetitive formatting and report builds.
6. Shortcuts: Keyboard speed compounds over hundreds of files.

How to Display Microsoft Excel Skills on Your Resume

12. Customer Service

Customer service, in claims, is clear and timely guidance—empathetic, accurate, and honest—so people know what’s happening and why.

Why It's Important

Good service defuses tension, reduces complaints, and keeps expectations grounded in policy language.

How to Improve Customer Service Skills

• Communicate crisply: Plain language, specific next steps, no jargon fog.
• Empathy without promises: Acknowledge impact, stay factual, avoid overcommitting.
• Response time: Callbacks and emails within set windows; silence breeds escalation.
• Proactive updates: Don’t wait to be asked—set cadence and stick to it.
• Template smartly: Use templates as a base, then tailor to the person and claim.

How to Display Customer Service Skills on Your Resume