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Top 50 Claims Representative Skills

Below we've compiled a list of the most important skills for a Claims Representative. We ranked the top skills based on the percentage of Claims Representative resumes they appeared on. For example, 36.6% of Claims Representative resumes contained Insurance Companies as a skill. Let's find out what skills a Claims Representative actually needs in order to be successful in the workplace.

These Are The Most Important Skills For A Claims Representative

1. Insurance Companies
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high Demand
Here's how Insurance Companies is used in Claims Representative jobs:
  • Partnered with Nationally ranked insurance companies to verify coverage/deductible amounts and completed follow-up communications with patrons.
  • Collaborated with insurance companies to correct errors, rectify omissions and investigate questionable issues.
  • Communicate effectively with various insurance companies to verify and resolve any discrepancies.
  • Negotiated liability responsibilities with claim representatives from other insurance companies.
  • Determined liability and negotiated with other insurance companies.
  • Communicated with witnesses, agents, other insurance companies, repair shops and others in the course of conducting investigations.
  • Provide outstanding customer service to patients, vendors, insurance companies, as well as colleagues.
  • Called patients and insurance companies, kept track of account receivables, aging reports and correspondence.
  • Followed up on balances due from insurance companies, and typed invoices to insurance companies.
  • Interacted with; clients, third parties, attorneys, insurance companies and collection agents.
  • Worked with both insurance companies and patients on the phone and in person.
  • Attached information to claim files for transmittal to insurance companies for payment.
  • Follow up on denied and delinquent claims with major insurance companies.
  • Draft and mail letters to insurance companies and patients.
  • Evaluated cargo damage claims on behalf of insurance companies.
  • Correspond with insurance companies to receive updated reports.
  • Call Insurance Companies to set up auto claims.
  • Followed up with insurance companies on outstanding claims.
  • Bill insurance companies for several hospitals.
  • Reviewed claims adjustments with insurance companies, examining condition reports to achieve the highest settlement for the company.

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51 Insurance Companies Jobs

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2. Customer Service
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high Demand
Here's how Customer Service is used in Claims Representative jobs:
  • Received Perfect 10 designation for customer service satisfaction and problem resolution consistently, which was awarded monthly.
  • Care Team support person handling fatality loss with compassion and empathy while providing excellent customer service overall.
  • Provided a friendly, efficient and respectful customer service experience for customers and insurance representatives.
  • Attended a customer service recognition program for demonstrating excellent customer service skills.
  • Provided excellent customer service to customer external and internal with information.
  • Provide the very best customer service to internal/external customers.
  • Provide polite, efficient customer service while being sensitive to the needs of our aged, blind, and disabled clientele.
  • Provide excellent customer service to meet the needs of the insured, agent and all other internal and external customers.
  • Processed auto and homeowner insurance claims and provided general customer service regarding insurance policies, plans and premiums.
  • Provide high level of integrity and customer service while interacting with a variety of people.
  • Honored with a Customer Service Award in 2007 for outstanding performance.
  • Addressed customer service inquiries in a timely and accurate fashion.
  • Ensured excellent customer service is provided at all times.
  • Ensured proper claim handling and excellent customer service.
  • Provided a high level of customer service.
  • Demonstrated mastery of customer service call script within specified timeframes.
  • Processed appeals, claims, and fraudulent disputes with merchants for 1 year Credit Card Customer service
  • Investigate and settle claims using outstanding customer service, Xactimate and other software as required.
  • Provide fair and equitable customer service for settlement of claims in a timely manner.
  • Hunt Valley, MD I provided telephone, online and face-to-face customer service/support within high- volume brokerage.

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457 Customer Service Jobs

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3. Total Loss
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high Demand
Here's how Total Loss is used in Claims Representative jobs:
  • Handled physical damage estimates, total losses, and attorney- represented/auto bodily injury claims.
  • Assisted customers and insurance agents to positive and timely resolution of customer total loss
  • Total losses on large/heavy duty commercial equipment.
  • Handled claim negotiation of total loss vehicles and assists customers over the phone with any questions regarding the claim process.
  • Experienced claim handling in complex claims including total loss, specialty vehicles, commercial policies and personal umbrella policies.
  • Total loss evaluations completed which include obtaining mileage, determining vehicle condition ratings, and verifying vehicle options.
  • Review Auto claims and process total loss claims; process paperwork and contact insured when needed.
  • Settled total losses, ensured salvage paperwork was completed properly, and arranged movement of salvage.
  • Handled total loss automobile claims for State Farm Insurance in call center team environment.
  • Use of state specific guidelines for fair and accurate total loss settlements.
  • Handled all secretarial tasks involving salvage procedures for total loss vehicles.
  • Obtain actual cash value and handle all total losses to conclusion.
  • Assisted co-workers with settlement on total loss claims.
  • Negotiated all settlements, total losses and salvage.
  • Negotiate and settle total loss auto claims.
  • Handled claims in non-written states from date of loss thru finalization and potentially sell of salvage on total loss settlements.
  • Total loss Claims Representative Identify and negotiate total loss claims.
  • Participated in training current and new total loss staff in regards to new software and other insurance workflows and policies.
  • Damage Appraisals- Autos and Special Lines, Total Loss Settlements, Salvage Disposal, Subrogation,
  • Set Up Appraisers on vehicles Handle all the total loss paperwork Negotiate bodily injury settlements

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100 Total Loss Jobs

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4. Medical Records
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high Demand
Here's how Medical Records is used in Claims Representative jobs:
  • Analyzed medical bills and medical records determine motor vehicle injury association, coding and charge accuracy, and prepared payments accordingly.
  • Reviewed medical records and consulted with medical providers to determine injuries are related to motor vehicle accident.
  • Trained in the evaluation of medical records and successfully negotiated third party bodily injury liability claims.
  • Collaborate with medical offices and hospitals by requesting additional medical records.
  • Reviewed and collected recorded statements and medical records.
  • Reviewed client's medical records to ensure that all conditions of care, operations, and procedures are properly documented.
  • Reviewed medical records and consulted with medical providers to determine the course of treatment on injuries.
  • Review medical records and pay medical bills per FL Statute using Mitchell Decision Point.
  • Review medical records for accuracy and errors to determine payment for the services rendered.
  • Apply medical guidelines for approval or denial and review medical records and notes.
  • Review medical records and treatment plans for verification of claim relatedness.
  • Reviewed medical records to determine the nature and extent of injuries.
  • Review of medical bills and all related medical records.
  • Evaluated medical records of claimants involved in auto loss.
  • Requested and reviewed medical records and bills.
  • Review medical records for determination of pre-existing conditions.
  • Evaluate patient diagnoses to ensure claim is compliant with policy criteria * Review medical records from various medical facilities to assess claims
  • Review the injured worker(s) medical records for ongoing treatment & further medical Care.
  • Conducted field investigations including accident scene, witness statements, collection and review of medical records and attending mediations.
  • Utilized Clindesk/Phydo/Gaffey to obtain insurance information and medical records.

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23 Medical Records Jobs

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5. Bodily Injury Claims
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high Demand
Here's how Bodily Injury Claims is used in Claims Representative jobs:
  • Investigated, evaluated, negotiated and equitably settled liability/bodily injury claims cases at values commensurate with damages sustained.
  • Handled attorney represented and non-attorney represented high dollar bodily injury claims valued up to 25,000 without supervisor authority.
  • Evaluated and resolved bodily injury claims from early settlement up to litigation.
  • Obtained all necessary information to complete proper evaluation of bodily injury claims.
  • Researched injuries to evaluate bodily injury claims.
  • Negotiate final settlement of bodily injury claims.
  • Negotiated bodily injury claims resulting from auto accidents
  • Scoped and evaluated bodily injury claims.
  • Managed the claims process for physical damage claims and bodily injury claims covering Ohio, Kentucky, and West Virginia.
  • Managed 100% third party bodily injury claims and set appropriate and timely file reserves.
  • Negotiate and resolve bodily injury claims with attorneys and claimants on minor injury claims.
  • Managed 100% third party none attorney and attorney represented bodily injury claims.
  • Handled large volume of automobile, general liability, and bodily injury claims.
  • Level 2 certified in both Auto Damage appraisal and Bodily Injury claims negotiation.
  • Resolve bodily injury claims for minimal, moderate and severe impacts.
  • Negotiated bodily injury claims with injured parties or their attorneys.
  • Assessed and paid first party bodily injury claims.
  • Maintained over 150 personal bodily injury claims.
  • Handle bodily injury claims ranging from soft tissue injuries to fatalities Intermittently handle other types of injury claims, i.e.
  • Recorded Interviews Settle property claims Settle bodily injury claims Set up inspections Handle daily diary

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83 Bodily Injury Claims Jobs

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6. Phone Calls
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high Demand
Here's how Phone Calls is used in Claims Representative jobs:
  • Supported existing policy holders through answering telephone calls, responding to inquiries, fulfilling customer requests and performed required administrative functions.
  • Refer all disputed accounts/sensitive telephone calls to Supervisor or Manager.
  • Executed follow up phone calls to insurance carriers, POB's, and patients for a third party medical billing company.
  • Attend meetings, answer emails, handle inbound/outbound phone calls, process invoices, request checks and assist co-workers.
  • Answer phone calls, determine liability on new claims, set up repair shop and rentals for customers.
  • Managed incoming mail, faxes, phone calls, legal correspondence, conference calls, and meetings.
  • Work in a collaborative team environment to handle a large volume of claims and telephone calls.
  • Received inbound telephone calls or paper and electronic claims from medical insurance members and providers.
  • Pursue appropriate reimbursement from payers, via correspondence, phone calls and web sites.
  • Answer phone calls from policyholders, examine photographs and statements related to claims.
  • Handle phone calls for critical claims issues that occur during after-hours and weekends.
  • Answer telephone calls, respond to routine questions and reroute calls when appropriate.
  • Handled heavy volume phone calls in an insurance claims call center environment.
  • Received and processed incoming phone calls from customer or client base.
  • Answer incoming telephone calls and assist members with appointments.
  • Assisted adjusters with filing and claimant phone calls.
  • Managed all customer related phone calls.
  • Monitor medical treatment, answer phones, take messages and return phone calls, back up receptionist with multi line switchboard.
  • Attend team meetings and offer up ideas on ways to improve team performance Redirect phone calls
  • Answer telephone calls in the scheduling queue in a timely manner.

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23 Phone Calls Jobs

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7. Property Damage
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high Demand
Here's how Property Damage is used in Claims Representative jobs:
  • Investigated and settled minor to severe bodily injury and property damage liability claims.
  • Specialize in investigation, evaluating, negotiating and settling property damage claims.
  • Investigated, evaluated and settled bodily injury and property damage claims.
  • Negotiated and finalized property damage settlements.
  • Settled claims of insured and claimants relative to their property damage, and coverage in force on the date of loss.
  • Assessed damages, evaluated and negotiated Property Damage, Auto Liability, Bodily Injury and Home Owners liability claims to completion.
  • Scoped and assessed property damage, autos, boats, motorcycles, heavy equipment, farm equipment and RV's.
  • Handled all aspects of investigating claims including bodily injury, property damage to vehicle and rental car reimbursement.
  • Identify and pursue all potentially responsible parties and assert theories of liability regarding property and property damage.
  • Assisted Auto Claim Central in processing of liability property damage claims during time of low staffing.
  • Reviewed medical bills and records for injury claims and property damages for property claims.
  • Focused on same day settlement of covered, non severity property damage claims.
  • Handled auto claims for property damage and bodily injury.
  • Updated Excel spreadsheet for all property damage claims.
  • Resolved claims for property damage claims within authority.
  • Inspect residential and commercial property damage losses.
  • Handled Litigated Bodily Injury & Property Damages Claims in the Southeast Reviewed Complex Coverage Issues
  • Adjusted property damage claims over the phone Provide customer service to insureds and claimants
  • Process claims in regards to property damage in a catastrophic environment.
  • Adjusted first party Commercial Lines property damage claims Interpreted policies and contracts Used estimating software to write real property damage estimate

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84 Property Damage Jobs

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8. General Liability
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high Demand
Here's how General Liability is used in Claims Representative jobs:
  • Handled commercial lines general liability and automobile claims in accordance with company standards, procedures and state regulatory requirements.
  • Conducted investigation and settlement of property, automobile and general liability claims for commercial accounts.
  • Investigated, analyzed and concluded settlements or denials on general liability, personal and commercial.
  • Managed litigated and non-litigated General Liability files arising out of our Milwaukee underwriting branch.
  • Performed direct investigations in first party property, transportation, and general liability claims.
  • Evaluated and verified coverage pertaining to General Liability and Business Auto policies.
  • Investigated and settled commercial general liability and products liability claims.
  • Handled commercial general liability claims for self-insured clients.
  • Handled Workmen's Compensation and General Liability claims
  • Addressed commercial general liability related claims.
  • Investigated and settled personal and commercial lines losses, including homeowners, automobile, property and general liability claims.
  • Handled general liability property damage and bodily injury, auto, and construction defect claims including Chinese Drywall claims.
  • Perform investigation, evaluation and resolution of Commercial General Liability BI, Construction, Products and Auto claims.
  • Handle Commercial General Liability Claims with complex first party coverage issues, supervise litigated claim files
  • Handled automobile, workers' compensation, and general liability claims including those in litigation.
  • Collect on property damage claims and submit to auto and general liability claims to insurance.
  • Dedicated to the handling of construction general liability claims.
  • Investigated, evaluated and negotiated General Liability and Product Liability, Premises Liability claims and Automobile/Trucking losses.
  • Complete train courses in General Liability, Products Liability and Advanced Property in top of class
  • Handled pharmacist negligence and general liability claims ("slip and falls") occurring in Rite Aid stores throughout country.

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112 General Liability Jobs

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9. Data Entry
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high Demand
Here's how Data Entry is used in Claims Representative jobs:
  • Led 18-person team tasked with data entry processing to deliver improved results from combined computer- and paper-based claims submissions.
  • Take inbound calls *Data entry *Handle confidential information *Assist claimant with filing unemployment claim *Other duties as assigned
  • Processed data entry and health insurance claims, handled incoming calls, customer service, and problem solving
  • Utilize data entry, math, and computer skills including Microsoft works on a daily basis.
  • Filed insurance claims, provided customer service, data entry, and updated client's files.
  • Implement and improve customer care through process improvements -Data Entry processing from electronic claims submissions.
  • Worked with computers and data entry along with all the Microsoft Office tools.
  • Perform data entry, filling, typing, and work processing and record-keeping.
  • Performed data entry of claim reports and secured photos of auto damage.
  • General clerical duties, heavy data entry in a call center environment.
  • Prioritized data entry daily to ensure customers' needs were met.
  • Handled 70-100 inbound calls daily as well as data entry.
  • Job included heavy typing and data entry.
  • Entered notes in company data entry system.
  • Performed Data entry functions on a daily.
  • Processed and paid claims, data entry
  • Processed information regarding flexible spending and dependent accounts Clerical duties included data entry, filing and copying
  • Developed knowledge of the New Jersey fee schedule used in auto accident claims Data Entry, all incoming calls from clients.
  • maintained claims processing data, data entry of updated information, maintained Liability Claim updates and strategic handling for clientele.
  • Processed claims Data entry Corrected claims when necessary.

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82 Data Entry Jobs

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10. Workers Compensation
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high Demand
Here's how Workers Compensation is used in Claims Representative jobs:
  • Retrieve information involving welfare, unemployment, workers compensation, disability or insurance claims.
  • Plan and execute property and casualty investigations, including workers compensation.
  • Review and process workers compensation claims within reserve authority.
  • Correspond with insurers for collection of Workers Compensation claims
  • Process Washington Workers Compensation Claims.
  • Acted as liaison between workers compensation policyholders, claimants, claims adjusters, lawyers, and health care administrators.
  • Experience working as an Investigative Claims Case Manager in the Workers Compensation department.
  • Utilize advanced skills to evaluate and resolve Workers Compensation.
  • Frequent training: Homeowners, commercial and workers compensation.
  • Oversee workers compensation bills from submission through completion.
  • Mediate between workers compensation department and claimants or attorneys Follows supervisory instructions and is flexible and adaptable to changing conditions and expectations
  • Minimized expenses risk managing workers compensation, general liability and auto claims.
  • Provide workers compensation benefits in a timely manner.
  • Job Skills/Responsibilities: Assisting customers with filing auto, property, workers compensation, and liability claims-Average 10 second answering speed.
  • Handle core level workers compensation claims for the states of Texas and Oklahoma.
  • Processed workers compensation claims, and appealed claims to insurance companies.
  • Prepared partial workers compensation forms when claimants returned to work part-time.
  • Utilized Medicode New York No Fault/Workers Compensation Fee Schedule.
  • Develop and manage workers compensation claims' action plans to resolution, coordinate return-to-work efforts Manage subrogation of claims and negotiates settlements
  • Selected Accomplishments Analyzed medical, minor lost time workers compensation and physical damage claims.

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230 Workers Compensation Jobs

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11. High Volume
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high Demand
Here's how High Volume is used in Claims Representative jobs:
  • Managed a high volume/low severity claim desk with active inventory of approximately 100 files.
  • Provided timely and accurate service in high volume environment.
  • Handled a high volume of claim traffic which will be a combination of mechanical claims submitted electronically, and by phone.
  • Managed high volume diary of varies lines of investigations and settlements as a road adjuster.
  • Handled high volume claims, phone calls and correspondence and ensured files were properly documented.
  • Handle a high volume of mail in addition to incoming and outgoing phone calls.
  • Answered a high volume of incoming calls and in-person inquiries from clients and colleagues.
  • Handle a high volume of incoming calls real time and addressing customer concerns.
  • Handled over 1,200 claims per month in a fast paced high volume atmosphere.
  • Adapted to working in a fast paced, high volume, responsive environment.
  • Maintained adherence and conformance levels during regular and high volume peek seasons.
  • Manage a high volume workload in a deadline driven environment.
  • Provided solutions to a high volume of clients daily.
  • Managed claim inventory during low and high volume.
  • Manage high volume claims desk.
  • Handled customers claims and complaints over the phone in high volume setting Performed data entry and routing of calls to appropriate personnel
  • Handled multi-task functions in a face paced, high volume environment in the investigations, negotiations and settlement of auto claims.
  • escalated customer inquiries and billing questions in a high volume call center.
  • Provide customer service in an high volume inbound financial call center environment.
  • Managed a claims desk in a high volume claims environment.

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21 High Volume Jobs

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12. Police Department
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high Demand
Here's how Police Department is used in Claims Representative jobs:
  • Establish incident reports with GEICO policyholder, claimants, witnesses, police departments and any other third party involved.
  • Communicate with the police department and other insurance agencies to collect all information needed to process claims.
  • Interacted with police departments, fire departments, experts, and in many cases attorneys and judges.
  • Research police reports online as well as by contacting local police departments for miscellaneous states.
  • Work with Lawyers, Police Department, Employers on Third Party Liability claims
  • Worked closely with police departments, attorney's and medical providers.
  • Managed Brackenridge Hospital Accounts Receivable, City of Austin Public Library and Police Department accounts.
  • Interviewed Insureds, claimaints, witnesses and Police Departments.

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13. Catastrophe
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high Demand
Here's how Catastrophe is used in Claims Representative jobs:
  • Identify coverage issues and policy revisions Adjust homeowner losses and non-structural damage claims resulting from catastrophes.
  • Participated as a member of the Northeast Catastrophe Contact Team, assisted with homeowner's losses after a Catastrophe was declared.
  • Sole remaining member of Katrina catastrophe team to resolve litigated cases with legal counsel and through mediation and settlement conferences.
  • Selected for National Catastrophe Response Team (NCRT) duty deploying to various cities to respond to natural disasters.
  • Perform other related job duties as directed or needed, such as service in emergency and catastrophe situations.
  • Worked catastrophe based property damage claims, therefore allowing the company to keep catastrophe work within organization.
  • Served on Catastrophe Claim Team assisting our customers who were impacted by storm damage from hurricanes.
  • Have been deployed to assist Property Unit in catastrophe situations as a member of ERT.
  • Managed claim inventory for daily claims and handled increased volume during Catastrophe duty.
  • Schedule inspections for damaged vehicles when a storm is coded a catastrophe.
  • Travel for Catastrophe Duty based on country and company needs.
  • Handled large volume of catastrophe claims when weather conditions warranted.
  • Process over 150 catastrophe claims in the auto division.
  • Field Claims Representative for the National Catastrophe Team.
  • Participated in catastrophe claim handling for 25 years.
  • Assist other offices on catastrophe duty when needed.
  • Process auto, home and catastrophe claims.
  • Worked on two hurricane catastrophe teams.
  • Worked on numerous Catastrophe teams and successfully ran Catastrophe office for one of company's largest catastrophes.
  • Inspected homeowner's damaged property and determine catastrophe related damage.

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321 Catastrophe Jobs

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14. Policy Holders
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high Demand
Here's how Policy Holders is used in Claims Representative jobs:
  • Collect and report auto accident information, listen for reporting irregularities and fraudulent claims, advise policy holders of coverage and limitations
  • Worked individually and in teams to provide leading customer service to Liberty Mutual automotive policy holders.
  • Handled in-coming calls from policy holders or claimants reporting accident and completing initial reports.
  • Communicate effectively with policy holders, insurance agents and other representatives regarding policy benefits.
  • Acquired information and maintained accurate records regarding accidents from policy holders and claimants.
  • Educated policy holders on coverage inclusions.
  • Processed automobile claims for policy holders.
  • Assist customers ranging from attorneys to non-policy holders in the claims reporting procedure by gathering and documenting loss information.
  • Assisted policy holders by reviewing and explaining their insurance coverage, the claims process, and next steps.
  • Investigate, evaluate, negotiate, and settles insurance claims with policy holders and customers alike.
  • Investigate auto claims by interviewing witnesses, attorneys, claimants, and policy holders.
  • Assisted attorneys, insurance agents, and policy holders during the claims process.
  • Guide policy holders during CAT events through the claims process.
  • Handled new personal property claims that involved policy holders only.
  • Transcribe calls between the Customer Service Representative and Policy Holders.
  • Assist policy holders with identifying any hazards.
  • Filed claims for policy holders.
  • Evaluated information received to insure all is legible and precise Responsible for making disability payments to policy holders on a daily basis
  • Submitted reimbursements to all policy holders of Geico insurance per state and policy guidelines.
  • changed information on life insurance policies for policy holders,sent out forms changes credit card information.

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35 Policy Holders Jobs

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15. State Farm
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average Demand
Here's how State Farm is used in Claims Representative jobs:
  • Work with customers, State Farm agents, attorneys and service providers through the process of settling personal property claims.
  • Worked with attorneys in defense of lawsuits against State Farm to validate decisions and policies used in making those decisions.
  • Serve on the in-office State Farm Green Committee to implement green activities on the local State Farm campus.
  • Answer inbound calls for State Farm; file claims on their insurance policy when a disaster happens.
  • Performed assigned job duties by using State Farm claims systems and other insurance rating systems.
  • Learned and implemented the Enterprise Claim System during State Farm Insurance Company's initial roll-out.
  • Provided outstanding customer service to State Farm policyholders through use of its Spanish Interpretation Service.
  • Handled automobile claims for State Farm Insurance as independent claim representative in team environment.
  • Championed a program to obtain referrals for State Farm Agents from numerous satisfied claimants.
  • Scheduled daily appointments with State Farm Insurance Company policyholders affected by the storm.
  • Handled around 200 calls daily while using State Farms proprietary ticketing system.
  • Created appropriate auto accident & theft claims for State Farm insured customer.
  • Served on the State Farm Employee Engagement Activities Association.
  • Completed State Farm training program in Fire Claims.
  • Provided customer service to State Farm customers.
  • Use State Farm systems and technology.
  • State Farm, founded in 1922, currently ranked number 34 on the Fortune 500 list of largest companies.
  • Process subrogation with third party to recover money paid by State Farm where appropriate.
  • Responded to natural disasters nationwide Adjusted claims due to wide spread damage Maintained relationship with State Farm agents and policyholders
  • STATE FARM INSURANCE COMPANY WEST ORANGE, N.J. MAY 1993 TO JANUARY 1996 Claims Representative Secretary Screened incoming calls.

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18 State Farm Jobs

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16. Medicaid
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average Demand
Here's how Medicaid is used in Claims Representative jobs:
  • Handled Medicaid and Medicare eligibility questions, including resolutions and referral's.
  • Provided Social Security Health and Economic Benefits, Medicaid and Medicare.
  • Work appeals and correspondence review for reprocessing per the Medicaid/Medicare rules
  • Reprocessed claims following Kentucky Medicaid guidelines.
  • Identify and accurately resolve billing coding issues on commercial and Medicaid insurance claims to ensure claim is billable.
  • Researched, filed, and followed-up all claims involving state run insurance programs such as Medicaid and CHIP.
  • Guide caller through Medicaid claims processes and explain in detail all paid, denied, pending statuses.
  • Processed and submitted claims to Medicaid, commercial and third party companies, follow up to resolved.
  • Educate callers on Medicaid policies and procedures via email, chat, telephone and other correspondence.
  • Billed Medicare, Medicaid, Third Party Insurance, and Self-pay for past due medical accounts.
  • Required to attend classes on new state policy as it pertained to Medicaid claims.
  • Facilitate corrections for premium over payments and State Buy-In coordination with Medicaid programs.
  • Used standard operating procedures for the payment of Medicaid and Medicare claims.
  • Reviewed claims processing for commercial, Medicare and Medicaid carriers.
  • Follow a designated set on instructions to pay Medicaid claims.
  • Identify Medicaid, Medicare or private medical insurance program needs.
  • Process and adjust Medicare and Medicaid health claims.
  • Completed voluntary customer service and product training to learn ways to enhance customer satisfaction with BlueCross BlueShield Medicaid product.
  • Evaluate medical bills, records, Medicare, Medicaid, & Tricare documents and process according to statute/regulations.
  • Experienced on Emdeon Revenue Cycle Portal (Home) Medicare Experienced on ePaces/Medicaid

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32 Medicaid Jobs

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17. Social Security
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average Demand
Here's how Social Security is used in Claims Representative jobs:
  • Developed, investigated, and resolved various social security entitlement actions resulting in the accurate and timely payments to claimants.
  • Job duties were processing applications under Social Security Administrations jurisdiction including Retirement, Disability, Medicare and Survivor benefits.
  • Apply skill and expertise in assisting clients in establishing entitlement to benefits under Social Security programs.
  • Interviewed claimants and processed claims to completion for Social Security Disability, Retirement, and Medicare.
  • Process Social Security Claims - Interviewed social security applicants determined eligibility requirements.
  • Interview public for Social Security retirement and disability and Supplemental Security Income.
  • Assist individuals in entitlement to benefits under Social Security programs.
  • Elected Vice President to Social Security Commissioner's advisory council.
  • Assisted the public in person, by mail, or by phone to establish entitlement to Social Security benefits.
  • Explained complex rules, policies and regulations of the Social Security System to the those who were applying.
  • Investigated claims of fraud and up-channel them to Social Security Administration Office of Inspector General for prosecution.
  • Interviewed and informed members of the public about their rights and responsibilities regarding Social Security programs.
  • Called clients, answered questions over the phone, helped start application for social security
  • Take claims for potential beneficiaries under title II of the Social Security law.
  • Process the most complex Social Security Number applications.
  • helped applicants apply for Social Security benefits and Medicare through the Social Security application system.
  • Processed and adjudicated cases for payment of benefits accurately and in a timely manner, according to Social Security Act.
  • Experience Social Security Administration, Frankfort, KY Nov. 2009 to Apr.
  • Interviewed Social Security applicants to determine eligibility for benefits * Verified eligibility requirements * Adjudicated claims for payment
  • EXPERIENCE: 07/1989 07/2013 Social Security Administration, San Bernardino, CA.

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45 Social Security Jobs

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18. Personal Lines
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average Demand
Here's how Personal Lines is used in Claims Representative jobs:
  • Investigated and properly resolved personal lines material/physical damage claims.
  • Reviewed commercial and personal lines property claims submissions.
  • Field adjuster handling commercial/personal lines property and casualty.
  • Complete handling of Florida, Georgia, North Carolina and South Carolina Personal Lines Bodily Injury claims from inception to settlement.
  • Managed moderate to Complex Personal Lines, Commercial Lines, Auto, General Liability, and Product claims.
  • Handled all types of personal lines losses, including Homeowners and Auto damage appraising.
  • Handle commercial and personal lines incoming claims and submit to appropriate insurance companies.
  • Handled a high volume of auto liability claims for commercial and personal lines.
  • Adjusted caseload of commercial and personal lines liability claims.
  • Handled Personal Lines (Auto and Homeowners) claims.
  • Adjusted claims in both personal lines and commercial lines.
  • Investigate and resolve complex Personal Lines property claims.
  • Handled advanced commercial and personal lines claims.
  • Worked as a multi-line field representative conducting internal and external investigation for personal lines and commercial lines.
  • Investigated Policy Coverages as well as determined liability on Personal Lines and Homeowners Claims.
  • Analyze and investigate 1st party personal lines homeowner's claims for both large and small losses.
  • Handled all aspects of automobile and homeowners' liability claims for personal lines insurer.
  • Pursued culpable parties in subrogation matters for Personal Lines.
  • Reviewed and paid personal lines auto property claims.
  • Investigated, evaluated, documented, negotiated and settled bodily injury claims for the personal lines department.

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89 Personal Lines Jobs

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19. Body Shops
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Here's how Body Shops is used in Claims Representative jobs:
  • Collaborated with insurance agents, body shops and interviewed claimants to investigate questionable issues.
  • Ordered auto appraisals, made payments to insured's, claimants, medical providers, body shops and rental car companies.
  • Complete auto estimates, negotiate estimates with body shops, determine actual cash values on total losses and monitor rentals.
  • Negotiated and communicated effectively both verbally and in writing with body shops, attorneys, customers, and vendors.
  • Handled collision and property damage claims, reviewed submitted in-line estimates from body shops and appraisers.
  • Write repair estimates, verify coverage, negotiate with body shops and pay parties for repairs.
  • Prepare accounts receivable and accounts payable to vendors, body shops, insured's and claimants.
  • Negotiated with body shops and customers each settlement for loss and authorize repairs to be started.
  • Issue payments and create auto estimates to provide to body shops to complete bodywork repairs.
  • Reviewed damages on vehicles and estimates written by body shops to repair damages on vehicles.
  • Monitor rentals, setup appraisals and work closely with body shops and independent appraisers.
  • Answer questions for customers, body shops, medical providers, insurance companies etc.
  • Create supplements of their estimated damage for body shops in the US and Canada.
  • Maintained and developed relationships with insurance companies, dealership and body shops.
  • Assigned body shops, estimates, doctor visits and investigators as needed.
  • Communicated with policyholders, claimants, medical insurers, and body shops.
  • Negotiated cost and repair fees with contractors and body shops.
  • Negotiate with body shops for the most cost effective repairs.
  • Skilled at negotiating settlements with customers and body shops.
  • Handled estimates and repairs for the body shops.

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185 Body Shops Jobs

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20. Personal Injury
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Here's how Personal Injury is used in Claims Representative jobs:
  • Specialized in Personal Injury Protection medical claims for customers while providing confidential, knowledgeable and fast customer care service.
  • Negotiated personal injury protection, medical payments and worker's compensation liens in a timely and professional manner.
  • Job responsibilities included managing a file load of approximately three hundred personal injury files.
  • Investigated, evaluated and assessed property damage, personal injury and personal loss.
  • Negotiated and settled personal injury claims with attorneys or unrepresented injured parties.
  • Investigated claims of public personal injury and property damage to determine liability.
  • Manage Personal Injury Protection/Medical Payment insurance claims, utilizing various systems.
  • Gained significant exposure to personal injury practice from defense perspective.
  • Administered Personal Injury Protection claims.
  • Handled approximately 100 Personal Injury Protection, Auto, and Bodily Injury files per month to satisfactory conclusion.
  • Maintained a daily diary on about 200 open auto personal injury and property damage claims monthly.
  • Investigated, processed and resolved Personal Injury Protection (PIP) automobile claims in New Jersey.
  • Investigated, appraised and settled both vehicle and personal injury claims.
  • Negotiated personal injury claims on both first and third party claims.
  • Evaluated and settled Personal Injury Protection and Medical Payment Claims.
  • Handled Personal Injury Protection and Medical Payments claims.
  • Resolved Med Pay and Personal Injury Protection claims.
  • Negotiated personal injury and property damage claims with plaintiff attorneys and non-represented claimants.
  • Key Contributions: Evaluated coverage, liability and claim value for personal injury and property damage claims.
  • Administered MA Personal Injury Protection claims adhering to state and company guidelines.

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20 Personal Injury Jobs

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21. State Regulations
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Here's how State Regulations is used in Claims Representative jobs:
  • Communicate offers/denial to proper persons in compliance with state regulations.
  • Determined liability based on facts reported and state regulations.
  • Learned the fundamental basics about each aspect of the insurance industry including claims, underwriting, state regulations and risk management.
  • Resolved complex, non-routine, questionable, and severe exposure claims within authority level, policy contract and state regulations.
  • Peer trainer to newly hired claim representative trainees on claim handling processes, procedures, state regulations and statues.
  • Investigated, evaluated and resolved claims at the most reasonable cost, while maintaining company and state regulations.
  • Interpreted and adhered to multiple guidelines and lender contracts, and followed various state regulations and statutes.
  • Review vehicle damages and coordinate with salvage vendors to brand titles in compliance with state regulations.
  • Managed file inventory, controlled damages and expenses, handled files in compliance with state regulations.
  • Conducted file reviews and audits to guarantee compliance with corporate standards and state regulations.
  • Adhered to company policies, guidelines, and state regulations to resolve claims efficiently.
  • Handled claims in accordance to state regulations, company policies and claim handling guidelines.
  • Initiated letters and state forms congruence to state regulations for claimants to complete.
  • Position required strict filing deadlines and strict adherence to state regulations.
  • Comply with state regulations, company policies and claim handling guidelines.
  • Handled cases in compliance with state regulations, where applicable.
  • Handle files in compliance with state regulations.
  • Release by deadline to meet Company, state regulations, contractual agreements and group performance standards.
  • Comply with the multi- state regulations and statutes that adhere to company guidelines.
  • Maintained compliance with state regulations relating to claims handling practices.

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9 State Regulations Jobs

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22. SIU
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Here's how SIU is used in Claims Representative jobs:
  • Coordinated all special investigation referrals between adjusters and the SIU Investigator.
  • Partner with SIU and Appraisers to determine legitimacy and makes decision on claim resolution or denial based on results of investigation.
  • Submit referrals to the Special Investigating Unit (SIU) or risk reviews to the Underwriting Department when applicable.
  • Identified fraud indicators, perform background checks and coordinate with SIU to assist in trend identifications or fraudulent activity.
  • Worked closely with fellow property adjusters, SIU, and Unit Claims Coordinator to resolve coverage and indemnity issues.
  • Recommended referral to SIU where appropriate and assisted the SIU in their investigation and settling of the claim.
  • Investigate each claim, monitor for fraud or deception referring suspicious claims to SIU for further investigation.
  • Interacted with SIU, Cause and Origin investigators, attorneys, and local law enforcement agencies.
  • Identify questionable claims and consult with SIU for further direction as appropriate.
  • Investigate potential fraud activity and refer them to the SIU department.
  • Attended anti-fraud training, client SIU training and industry seminars.
  • Refer claim to under-writing and SIU for potential fraud.
  • Identified and reported suspected fraud claims to SIU Department.
  • Worked closely with SIU on suspected fraud files.
  • Assigned to handle complex and SIU claims.
  • Investigated claims for SIU referrals.
  • Reviewed claims for SIU referrals Audited main office claim files for any type of BI exposure, PIP recovery, and closures
  • State Farm Malta, NY Handle SIU litigation files related to Multi Claim Investigative Unit (MCIU) investigations.
  • Determine when to refer files to SIU, Council, and Underwriting Investigate claims for Material Misrepresentation.
  • Attended various company training seminars including Xactimate estimating, anti-fraud trainings, conferences, and SIU trainings.

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53 SIU Jobs

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23. Auto Accidents
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Here's how Auto Accidents is used in Claims Representative jobs:
  • Conducted recorded interviews, analyzed police reports, accident photos and other evidence in order to determine negligence auto accidents.
  • Investigated auto accidents and determined liability by taking recorded statements from all parties involved including drivers, passenger and witnesses.
  • Reviewed files of seriously injured in auto accidents and made long-term recommendations relative to claimants' maximum medical improvement.
  • Interact with policyholders and others involved in auto accidents to provide needed assistance after a collision.
  • Investigate auto accidents and determine liability by obtaining recorded statements from drivers and witnesses.
  • Evaluated facts of auto accidents and provided liability analysis to determine appropriate settlement options.
  • Settled minor bodily injury and medical payment claims resulting from auto accidents.
  • Resolved non-injury related auto accidents after completing coverage and liability investigations.
  • Investigated auto accidents to determine liability and settled property damage claims.
  • Determined liability for minor auto accidents according to state specific laws.
  • Investigated and analyzed auto accidents and homeowner property damage claims.
  • Investigate auto accidents that involve liability disputes.
  • Interview parties involved in auto accidents to interpret facts of loss and decide liability for disputed incidents.
  • Investigated auto accidents involving bodily injury, homeowner slip and fall cases and dog bite liability claims.
  • Conducted investigation on auto accidents to find whom the out fault party is.
  • Determine Fault in auto accidents, set up claim files and rental reservations.
  • Take inbound calls for Auto accidents for USA veterans and there family.
  • Investigated auto accidents, assessed coverage/liability and negotiated settlement of claims.
  • Investigated liability of auto accidents Licensed by Department of Insurance in 32 states Used Multiple Databases to obtain information for investigation
  • Provided customer service Handled accident cases Investigated all circumstances for auto accidents for personal injury and property damage claims

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7 Auto Accidents Jobs

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24. Xactimate
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Here's how Xactimate is used in Claims Representative jobs:
  • Prepared computer generated reports including estimates utilizing the latest version of the Xactimate estimating system.
  • Handled, investigated, evaluated, and negotiated residential property claims using Xactimate software.
  • Prepare estimates for homeowners and commercial lines via xactimate estimating system.
  • Trained and experienced in Xactimate estimating program.
  • Prepared building estimates on Xactimate software.
  • Inspect and write estimates using Xactimate program for various types of property losses including personal and commercial lines of insurance.
  • Completed estimates in the field using the Xactimate estimating system and settled most claims on site.
  • Assisted with training new hires including policy reviews, Xactimate training and company claim system.
  • Reviewed quotes for structural damages and completed estimates for content losses using Xactimate.
  • Inspect and assess all damages and produce and estimate on Xactimate software.
  • Estimate claims using Xactimate, negotiate settlements of covered claims.
  • Trained several team members on Xactimate estimate program.
  • Used Xactimate software to estimate building damage.
  • Trained in Impact, EPW and Xactimate.
  • Investigated and determined coverage for losses Prepared complete repair estimate of damages using loss estimating system Xactimate.
  • Experienced with Xactimate estimatic platform for structural damage repairs affecting both residential and commercial construction.
  • Experienced in both Integriclaim and Xactimate estimating programs.
  • Experience with Xactimate and Symbility estimating programs.
  • Inspect, scope, photograph and document damages, prepared detailed estimates on Xactimate of damages for client insurance companies.
  • Adjusted homeowner's claims Adjusted commercial claims Deployed as CAT adjuster Proficient with the Xactimate estimating program.

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231 Xactimate Jobs

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25. Communication
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Here's how Communication is used in Claims Representative jobs:
  • Negotiated and settled claims through written and oral communications, public relations, telephone and face-to-face interviews with policyholders and claimants.
  • Provided timely coverage analysis and communication with insureds based on application of policy information, and facts or allegations.
  • Work collaboratively and effectively with team members and demonstrate effective communication with all the providers.
  • Frequent oral and written communication with customers in a timely and professional manner.
  • Participated in committees to develop and improve communications and quality customer service.
  • Maintained communication with claimants regarding claiming process.
  • Provided outstanding service through effective client communication.
  • Analyzed potential legal, liability, and conflict of interest issues of insurance claims through effective planning and communication with clients.
  • Acquired excellent organizational skills, written and verbal communication, and able to remain calm in stressful situations.
  • Directed communication with employers and physicians to monitor claimants until they were able to return to work.
  • Demonstrate communication skills by working closely over the telephone with beneficiaries to resolve their claims issues.
  • Maintain open lines of communication with coworkers as well as members of management.
  • Foster and maintains relationships with lenders through communications and customer service skills.
  • Facilitate communication between insured and body shop, rental companies or tow yard
  • Provided excellent communication and service while maintaining highest levels of confidentiality.
  • Coordinated communication with a variety of clients, internal and external, by preparing written and oral communication.
  • Organized in all work to prevent errors or miscommunication.
  • Experience working with automated claim-paying system Accurately code & process payments Effective oral and written communication skills and human relations skills
  • Researched, processed and resolved business claims Professional written and verbal communication skills Successfully completed SAP training and assessments
  • Assigned as a collector based on superior communication, analytical and negotiating skills Lead March of Dimes fundraising 2003, 2004

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80 Communication Jobs

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26. Repair Shops
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Here's how Repair Shops is used in Claims Representative jobs:
  • Negotiated and compensated repair shops and completed rental contracts and settlements.
  • Facilitated and maintained company rapport with body repair shops.
  • Arrange appraisals, review appraisal reports and communicate with policyholders, claimants, medical providers, attorneys and repair shops.
  • Maintained contact with insureds, claimants, attorneys, various agents, repair shops, salvage vendors and Lien Holders.
  • Mediated between company, clients, and body repair shops to determine the most seamless processing of existing claims.
  • Worked with independent adjusters, repair shops, replacement sources, and claimants as necessary to properly complete settlement.
  • Communicate with policyholders, claimant s, attorneys and repair shops regarding status of claim and liability decision.
  • Arranged and rescheduled appraisals, reviewed appraisal reports and communicated with customers, and repair shops, etc.
  • Work with customers, attorneys, medical providers, vendors and repair shops to settle automobile claims.
  • Reviewed repair cost estimates with automobile repair shops to secure agreement on the cost of repairs.
  • Established relationships and acted as a liaison with vendors, auto repair shops and parts providers.
  • Contacted auto repair shops and appraisers to facilitate vehicle repairs/total loss claims.
  • Arrange and review appraisal reports with policyholders, appraisers and repair shops.
  • Contacted local glass repair shops for client to arrange repair or replacement.
  • Assisted in selecting repair options and sending electronic assignments to repair shops.
  • Issue payments to policyholders and/or repair shops within a timely manner.
  • Scheduled appointments between customers, technicians, and authorized repair shops.
  • Created positive relationships with repair shops and other vendors.
  • Lead HEART (claims software) trainer for Nevada field claims and direct repair shops (Las Vegas and Reno)
  • Conducted analysis of estimates and appraisals written by independent appraisers, network and non- network repair shops.

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63 Repair Shops Jobs

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27. Casualty Claims
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Here's how Casualty Claims is used in Claims Representative jobs:
  • Investigated, evaluated, negotiated and equitably settled all assigned liability/casualty claims.
  • Performed investigation, negotiation and settlement of property and casualty claims.
  • Licensed North Carolina Property and Casualty Claims Representative.
  • Investigated and analyzed property and casualty claims.
  • Investigated and handled to conclusion all lines of property and casualty claims in a seven county territory in eastern North Carolina.
  • Adjusted first and third-party personal property claims; adjusted personal and commercial property and casualty claims including PIP.
  • Handled property casualty claims for a five state territory, including the state of Minnesota No-fault/PIP state.
  • Processed and settled all aspects of Homeowner's Fire and Casualty Claims for the Northern NJ area.
  • Investigate coverage and determine liability for large and small commercial and personal lines casualty claims.
  • Started as a customer service representative and advanced to casualty claims after just two years.
  • Investigate, negotiate and settle property and casualty claims for St. Louis Metro/Bi-State Development Agency.
  • Position required an all lines insurance license to handle Fire and Casualty claims.
  • Adjusted homeowner and commercial property claims, casualty claims, including tractor-trailers.
  • Excelled in position and was offered the promotion of Casualty Claims Representative.
  • Handled property and casualty claims as assigned within given claims territory.
  • Investigated and evaluated $4,000,000 in casualty claims per year.
  • Earned KY license to adjust property & casualty claims.
  • Managed high volume of property and casualty claims.
  • Handled multi-line property and casualty claims to include personal and commercial property, automobile and liability claims, and bodily injury.
  • Adjusted commercial auto, property and casualty claims in a timely manner.

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145 Casualty Claims Jobs

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28. Complex Claims
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Here's how Complex Claims is used in Claims Representative jobs:
  • Investigated, evaluated and monitored highly complex claims.
  • Applied stellar research skills in investigating complex claims that require attention to detail and excellent data entry accuracy.
  • Leveraged the appropriate job aids, expertise, and tools to accurately and consistently process more complex claims.
  • Documented claims, and investigated complex claims and facts of loss for customers from inception to resolution.
  • Experience includes negotiating and resolving complex claims for vehicle total loss and bodily injury.
  • Handle complex claims including but not limited to moderate to severe bodily injury claims.
  • Meet with clients as needed to discuss specific complex claims and possible coverage issues.
  • Reviewed more complex claims and adjudicated claims as appropriate to resolve payment issues.
  • Handled all incoming claims and assigning complex claims to the field.
  • Reported complex claims to a higher level of expertise if needed.
  • Managed claims handling activities and resolved less complex claims as assigned.
  • Manage complex claims and small to midsize commercial losses.
  • Trained in complex claims handling, evaluations and resolution.
  • Investigated more complex claims that involve liability disputes.
  • Handled complex claims involving PA's and attorneys.
  • Establish liability for these complex claims.
  • Investigate and evaluate complex claims issues.
  • Handled large and complex claims.
  • Handled complex claims and inspected coverages for accuracy.
  • Full time employee - 40 hrs/week 304-596-9354 I am assigned general liability and more complex claims.

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284 Complex Claims Jobs

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29. CPT
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Here's how CPT is used in Claims Representative jobs:
  • Respond to correspondence, appeals, denial, re-code CPT & modifiers, research payment posting errors and customer service issues.
  • Utilized full knowledge of Medical & insurance terminology such as CPT, ICD-9, HCPCS of hospital/physician billing.
  • Evaluate medical bills for proper billing amount per CPT codes, and proper ICD-9 codes for treatment provided.
  • Determine if primary or secondary coverage and if diagnosis and/or CPT codes are covered under the plan.
  • Utilized resources to insure proper CPT-4, ICD-9 modifiers, and diagnosis codes were attached to claims.
  • Posted adjustments, charges, balanced reports, and completed CPT coding as needed for billing.
  • Performed Medicare claims processing and medical claims, CPT ICD9 & RVS coding for medial payment.
  • Utilized knowledge of medical terminology, CPT and ICD9 coding to understand and process accurate claims.
  • Provided superior customer service and entered medical billing codes according to ICD-9 & CPT standards.
  • Verify all coding is correct and all the CPT / ICD-9 guidelines are being followed.
  • Index incoming record verifying correct ICD-9, CPT coding per injury.
  • Research unprocessed claims by verifying CPT as well as ICD-9 codes.
  • Recorded physician procedural charges using ICD-9 and CPT codes.
  • Review all Medical bills ICD-9 & CPT-4 procedures.
  • Worked with ICD9 and CPT coding
  • Experienced in 3rd party billing including ICD-9, CPT-4 coding, UB92 and HCFA 1500 Claim forms.
  • Use ICD-9, ICD-10, CPT, HCPCS, and NDC manuals to code properly.
  • Research medical condition codes: HCPCS/CPT, DX using various resources such as cms.gov.
  • Verified correct contractual payments, adjustments, and patient liabilities for both inpatient and outpatient services based on CPTs and DRGs.
  • Increased knowledge with ICD-9 and CPT coding Manage and review work files on a daily basis Development of Radiology terminology Medical Billing

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4 CPT Jobs

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30. PIP
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Here's how PIP is used in Claims Representative jobs:
  • Determined benefits available under PIP coverage.
  • Handled all aspects of General Liability, Automobile, Homeowners, PIP, Business Owner claims and House of Worship claims.
  • Verified eligibility requirements for those seeking PIP and UM benefits against the state of New Jersey Unsatisfied Claim and Judgment Fund.
  • Investigated and settled auto bodily injury, PIP and property damage claims for first party and third party coverage.
  • Order Police report, send contact letters, PIP package, Disclosures to Attorneys and set up EUO's.
  • Take recorded statements, review loss reserves, discusses settlement of PIP or MP and extends offers.
  • Handled PIP claims including: first contact, follow ups, correspondence, Medical payments, Closure.
  • Conducted investigation to determine if coverage applies and company exposure on PIP and Property Damage claims.
  • Achieved balance between delivering customer service and minimizing expense when evaluating PIP claims for 5 states
  • Managed and resolved Michigan, Maine, South Carolina, and MACF Med/PIP claim files.
  • Analyzed and resolved protection injury protection (PIP) claims in Minnesota and Michigan.
  • Review PIP arbitration/Suit files to determine if they should be settled or defended.
  • Handled Med/PIP cases with possible policy discrepancies, to review and determine eligibility.
  • Maintained a caseload of both combined Med Pip & litigation claims.
  • Handled an inventory of complex PIP claims.
  • Claim Intake/PIP insurance research/Litigation review * Medical Billing/Triage/Collision Review Fatally file Management
  • Maintained a diary per company requirements; Sent Reservation of Rights letters where required; identify PIP subrogation.
  • Investigated and settled auto, PIP, BI, property, medpay and general liability claims.
  • Processed, paid and subrogated property damage, med pay/PIP claims.
  • Referred files to dedicated claims groups as needed (Subrogation, Total Loss, PIP/Med Pay, ).

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17 PIP Jobs

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31. Quality Standards
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Here's how Quality Standards is used in Claims Representative jobs:
  • Directed and coordinated daily operational activities to ensure adherence to quality standards, deadlines and procedures.
  • Meet and maintain required productivity and quality standards for daily performance measures
  • Meet established productivity, schedule adherence, and quality standards
  • Resolve claims problems within established production and quality standards.
  • Performed at established production and quality standards.
  • Adhere to established productivity and quality standards.
  • Maintained quality standards while exceeding production requirements.
  • Provide excellent customer service skills, and constantly meet established productivity, schedule adherence, and quality standards.
  • Meet all quality standards and expectations per company best practices and comply with state specific regulations.
  • Recognized as a top achiever in production and quality standards.
  • Meet all quality standards and expectations per Best Practice guidelines.
  • Organized files to adhere to Department of Insurance quality standards.
  • Maintain stringent production and quality standards.
  • Meet department production and quality standards.
  • Analyze and identifies trends and provides reports as necessary Constantly meet established productivity, schedule adherence, and quality standards
  • Maintained rigorous information and service quality standards to facilitate effective claim handling.
  • Handled complex and time sensitive cases under strict deadlines with established production and quality standards.
  • Provide the best customer service, and uphold Vangent's quality standards.
  • Maintain file quality standards as outlined in the company Best Practices.
  • Adhere to company Best Practices to ensure quality standards.

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54 Quality Standards Jobs

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32. Special Projects
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Here's how Special Projects is used in Claims Representative jobs:
  • Marked as leadership ready and participated in leadership development courses and other special projects.
  • Render hands-on direction in organizing and overseeing assigned special projects.
  • Perform additional daily tasks and/or special projects as necessary.
  • Participate in special projects as outlined by management.
  • Complete 130 adjustment per HCFA Handled special projects as assigned and required by changes in claims payment policies or contracting.
  • Requested to work on special projects because of my quick learning, adapting skills and willingness to learn and succeed.
  • Assist coworkers with special projects in the department and other duties as assigned.
  • Complete field work as assigned and assist with special projects as assigned.
  • Assist management with special projects, as needed other duties as assigned.
  • Worked on high dollar accounts and special projects as assigned from management.
  • Work special projects as needed which require in-depth research and resolution.
  • Assist with special projects and other daily clerical duties.
  • Assist Supervisors and Subject Matter Experts with Special Projects.
  • Assisted with special projects as assigned by management.
  • Handled special projects assigned by the manager.
  • Completed special projects on aged claims.
  • Coordinate and participate in special projects.
  • Coordinated and led special projects.
  • Completed special projects as assigned.
  • Trained new hires Assisted manager with special projects

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18 Special Projects Jobs

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33. Repair Facilities
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Here's how Repair Facilities is used in Claims Representative jobs:
  • Position included coaching and developing relationships with independent appraisers, repair facilities, salvage yards, and third party administrators.
  • Repair management and estimating experience - both working directly in repair facilities and remotely.
  • Coordinated payment processes for customers and repair facilities.
  • Negotiated vehicle repairs with repair facilities.
  • Provide customer service, such as limited instructions on proceeding with claims or referrals to auto repair facilities or local contractors.
  • Communicated with a number of different vendors to either set up towing, car rentals, and repair facilities.
  • Completed claims investigations, settled bodily injury claims, and completed damage appraisals on vehicles through network repair facilities.
  • Performed field inspections audits at various contracted & non-contracted repair facilities to ensure the legitimacy and quality of repairs.
  • Negotiate with auto repair facilities, 1st parties, and 3rd parties to settle the claim.
  • Coordinate efficient flow of claims process with agents, customers, and auto repair facilities.
  • Worked daily with insured's, claimants, doctors, attorneys and auto repair facilities.
  • Negotiated vehicle repairs with repair facilities processed total losses for all types of vehicles.
  • Negotiated agreed prices with a variety of collision repair facilities and automotive service shops.
  • Resolved inquiries from Repair facilities and Agreement Holders regarding claim and/or payment status.
  • Assist repair facilities in ensuring rapid and fair claim handling.
  • Negotiate and secure repair costs with repair facilities.
  • Dispatched appraisal assignments to Direct Repair Facilities and Independent Appraisers Arranged the transfer of total loss vehicles to designated salvage yards.
  • Mentor and trainer for new hires and repair facilities, conducting training classes on repair processes and shop performance reviews.
  • Assist customers with VSC or claim inquiries Assist repair facilities with VSC claim authorizations Assist customers with conflict resolution Gap claims/cancellations
  • Skillfullynegotiated withauto repair facilities,insureds, and claimantsinorder toexpedite and facilitate the settlement ofclaims.

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47 Repair Facilities Jobs

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34. Fraudulent Claims
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Here's how Fraudulent Claims is used in Claims Representative jobs:
  • Investigated fraudulent claims by taking recorded statements, speaking with law enforcement, and reporting suspicious activity.
  • Provided optimum service to policyholders, negotiated fair settlements & identified fraudulent claims.
  • Directed potentially fraudulent claims to departments for special investigation and action.
  • Referred potentially fraudulent claims to Special Investigations Unit.
  • Reviewed and analyzed data regarding fraudulent claims.
  • Recognized and identified potential fraudulent claims.
  • Learned and used policy language and Florida statutes to assist in the investigation and resolution of fraudulent claims.
  • Worked in a specialized unit that investigated fraudulent claims that were later referred to the Special Investigation Unit.
  • Recognized suspicious and/or possible fraudulent claims and transferred claims to Special Investigations Unit for further handling.
  • Gather information on suspected fraudulent claims through the use of recorded statements and other investigative tools.
  • Investigated any potentially fraudulent claims with a focus on thoroughness, quality and cost control.
  • Deter fraudulent claims by collaborating with the Special Investigating Unit to reduce company loss.
  • Be able to identify any fraudulent claims for referral to special investigation unit.
  • Identified and investigated fraudulent claims of damage, coverage and injury.
  • Worked to identify fraudulent claims; negotiated and processed payments.
  • Referred possible fraudulent claims to the Special Investigation Unit.
  • Negotiated settlement of claims based on the contract language Reported any potential fraudulent claims to the proper bureaus.
  • Reviewed the policies for each loss to ensure coverage existed and analyzed any potentially fraudulent claims.
  • Followed up on potentially fraudulent claims and when required assigned to outside legal counsel.
  • Identify, pursue, and monitor subrogation and fraudulent claims.

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19 Fraudulent Claims Jobs

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35. Counsel
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Here's how Counsel is used in Claims Representative jobs:
  • Monitored and coordinated communication between outside counsel, opposing counsel and claim office.
  • Managed defense counsel and ensured adherence to approved litigation plan and budget.
  • Determined need for and direct defense counsel, independent adjusters, other experts; monitor and controlled their costs.
  • Managed litigation files, counseling defense attorneys in utilization of contractual defenses, case law and statute.
  • Assigned to settle all aspects of litigated files currently in suit and worked with in-house staff counsel.
  • Refer to defense counsel as required and work with defense counsel through mediation and trial if needed.
  • Counseled clients with issues relating to: Conducted face-to-face and telephone interviews from applicants applying for benefits.
  • Work with defense counsel on pretrial preparation for litigated claims from initial discovery through trial result.
  • Obtained medical bills and records, Worked with any legal counsel and prepared settlement releases.
  • Counseled claimants on options to recover monies left behind by deceased family members.
  • Speak directly with defense counsel and give independent judgment and case direction.
  • Formed and distributed all litigation files to staff and outside legal counsel
  • Oversee litigated files, working with defense counsel to resolve cases.
  • Attended mediation and worked with defense counsel to resolve claims.
  • Work in tandem with legal counsel to settle high exposure cases
  • Responded to inquiries posed by insureds and related counsel.
  • Confer with legal counsel on claims when needed.
  • Partnered with legal counsel on litigation cases.
  • Maintained proper file reserving, established litigation plans, and attended mediations with defense counsel and policyholders.
  • Assist claimants with unemployment questions and concerns Assist with career counseling Process claims, audits, and appeals.

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118 Counsel Jobs

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36. Policy Language
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Here's how Policy Language is used in Claims Representative jobs:
  • Interpreted insurance policy language to determine how coverage applies to individual loss scenarios.
  • Investigated and determined liability, interpreted policy language, and resolved coverage questions.
  • Provided customer service by helping clients understand policy language and claims determinations.
  • Developed a proficiency in litigation, coverage issues and policy language.
  • Assess detailed policy language and effectively communicate to members.
  • Reviewed policy language and coverage provided by individual policies.
  • Interpreted policy language with multiple endorsements and audited estimates.
  • Interpret policy language to determine coverage.
  • Conducted research and investigations to ensure proposed claim decisions are consistent with laws, regulations, and current policy language.
  • Review policy language when applicable for coverage issues and other related matters and request legal review.
  • Review auto policy language to determine whether the coverage's are applicable to the accident.
  • Deny non covered claims verbally and in writing according to applicable policy language.
  • Analyzed company policy language in relation to case and statutory law.
  • Interpret policy language to determine policy coverage, or lack thereof.
  • Examined accident and hospital income claims for compliance with policy language.
  • Experienced in meeting with insureds and claimants and discussing policy language.
  • Review and interpret policy language to confirm coverage for claims.
  • Gained great knowledge in policy language.
  • Interpreted policy language upon receipt of a subrogation demand to determine if reimbursement is owed.
  • Interpreted coverage based on policy language and recommended settlement options including defending in small claims.

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41 Policy Language Jobs

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37. Icd-9
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Here's how Icd-9 is used in Claims Representative jobs:
  • Coded all medical bills for processing using CPR rates, ICD-9, and MRSC (Mass Rate Setting Commission) Guidelines.
  • Maintain current knowledge of medical insurance billing practices, claims processing guidelines, medical terminology, CPT, and ICD-9 coding.
  • Ensured proper ICD-9 CM, CPT-4, and HCPCS codes were in use for specific services rendered, diagnosis and treatments.
  • Handled first party medical payment claims and have in-depth knowledge of diagnostic, procedure, CPT and ICD-9 codes.
  • Achieved proficiency with CPT / ICD-9 codes, outpatient facility, and hospital revenue / HCPC codes.
  • Maintained a working knowledge of medical terminology and ICD-9 in order to interpret medical reports and bills.
  • Implement knowledge of medical terminology, and the National Drug Codes, and ICD-9 codes.
  • Position required extensive knowledge of ICD-9 coding and ability to work with attorneys and adjusters.
  • Use of ICD-9 & CPT codes in response to insurance inquiries and payments.
  • Experience working with medical terminology CPT codes, ICD-9, ICD-10.
  • Provided overview of ICD-9 Codes, HCPCS and CPT to beneficiaries.
  • Expanded knowledge of ICD-9/CPT Codes and processed medical claims for payment.
  • Investigated CPT/procedure codes, HCPCS, modifiers and ICD-9/diagnosis codes.
  • Processed and adjusted claims using ICD-9 and HCPCS coding manuals.
  • Assist in ICD-9 and coding and performs other job duties
  • Used the HCPCS, ICD-9-CM and the CPT AMA coding books.
  • Experienced with ICD-9s, CPT-4, and HCPCS codes.
  • Use of ICD-9, 10 codes and CPT coding terminology.
  • clerk -CSA-Pharmaceutical packaging clerk-claim processing-ICD-9 coding, shuttle bus
  • Use of ICD-9 and 10 coding terminology, indentifies and communicates any potential issues with the system functions or configurations.

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38. Subrogation Potential
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Here's how Subrogation Potential is used in Claims Representative jobs:
  • Obtained police report records to assist in liability assessment and identify subrogation potential against responsible parties.
  • Investigated claims to determine handling department, subrogation potential and possible referrals to special investigation unit.
  • Report subrogation potential, salvage opportunities and fraud indicators to positively impact the combined ratio.
  • Identify subrogation potential for recovery of damages incurred on behalf of the insured.
  • Established claim settlement reserves, settlement valuation and subrogation potential.
  • Review and evaluate collision liability claims to identify subrogation potential.
  • Identified subrogation potential and took necessary steps for recovery.
  • Identified subrogation potential in an effort to maximize recovery.
  • Investigated subrogation potential and addressed salvage on each loss.
  • Identified subrogation potential through research involving third-party liability.
  • Identified on a daily basis subrogation potential.
  • Determine and reports on subrogation potential.
  • Investigate claims for any subrogation potential.
  • Identified and recognized subrogation potentials.
  • Worked with third party insurance carriers to determine subrogation potential and settle the claim accordingly.
  • Reserve files adequately for claim exposure, Notice and address subrogation potential.
  • Establish reserves, recognize and develop subrogation potential of assigned cases.
  • Determine files with subrogation potential and handle collection on medical claims.
  • Achieved above-average results regarding acknowledgment of subrogation potential within assigned caseload.
  • Determined subrogation potential, forwarded subrogation notice and lien letter to responsible party.

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48 Subrogation Potential Jobs

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40. Liability Investigations
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Here's how Liability Investigations is used in Claims Representative jobs:
  • Handled all aspects of auto claims including thorough liability investigations and negotiation of injury claims at a non-standard auto insurance company.
  • Investigate coverage issues and contact all necessary parties to complete coverage and liability investigations in a timely and efficient manner.
  • Obtained detailed recorded statements from policyholders, claimants and witnesses to assist with liability investigations.
  • Negotiate and complete comprehensive coverage and liability investigations on all vehicular accident claims.
  • Investigate, evaluate and negotiate auto claims, including coverage and liability investigations.
  • Completed liability investigations and paid property damage claims to customers or repair facilities.
  • Conducted liability investigations and assessments as the third party administrator for CenturyLink.
  • Handled auto physical damage and medical payment claims, including liability investigations.
  • Trained in basic auto accident handling which included coverage and liability investigations.
  • Conducted coverage and liability investigations for non-standard auto business.
  • Formulated thorough liability investigations using solid decision-making skills.
  • Conducted liability investigations to determine liability.
  • Secured statements and completed liability investigations.
  • Conducted coverage and liability investigations.
  • Conducted scene and liability investigations.
  • Obtain statements from insured's, claimants, and witnesses to resolve liability investigations for first and third party claims.
  • Managed a daily schedule to accommodate scene/liability investigations, body shop visits, and other tasks.
  • Conduct coverage and liability investigations and how they apply under the policy.
  • Conduct through liability investigations Adjust appropriate reserves and settle or deny losses based on outcome of investigations.
  • Determine policy coverages Resolve liability investigations promptly Gathered all relevant information to make decisions Negotiated settlements with claimants

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9 Liability Investigations Jobs

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41. Safety Guidelines
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42. Crime Scenes
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43. Additional Information
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Here's how Additional Information is used in Claims Representative jobs:
  • Interpreted claims to determine primary or secondary liability and recognize when additional information is needed.
  • Identified and requested additional information as necessary to support adequate reimbursement for services rendered.
  • Reviewed claim notices and followed up with Insureds for additional information if necessary.
  • Review accounts to verify correct payments and any additional information as needed.
  • Initiate telephone or letter contact to patients to obtain additional information as needed
  • Prepare correspondence requesting additional information and process refund letters.
  • Complete all additional information requested.
  • Communicated via phone calls and emails with carriers, customers and agents in order to gather appropriate documentation and additional information.
  • Develop relationships with customers over the phone to answer questions, obtain additional information and provide support throughout the claims process.
  • Return patient calls and provide additional information as necessary while adhering to all HIPPA and Access polices regarding patient privacy.
  • Send letters to providers when additional information is needed on a claim or if a claim was submitted improperly.
  • Identify and obtain all additional information needed to make an appropriate determination of the appeal on the claim.
  • Contacted and interviewed claimants, doctors, medical specialists, or employers to get additional information.
  • Processed all commercials lines of health insurance as well as verify, and research additional information.
  • Contacted customer to ask additional information that to help resolve the claim.
  • Assist in follow-ups to obtain additional information from Assured.
  • Draft patient letters when additional information was needed.
  • Provide guidance and direction to claims staff for obtaining additional information necessary to pursue subrogation.
  • Informed customers of additional information required to process their claim or reimbursement.
  • Prepare claims for return to Provider/Subscriber when additional information is needed Help other claims team with Sendbacks when needed.

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14 Additional Information Jobs

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44. Hipaa
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Here's how Hipaa is used in Claims Representative jobs:
  • Maintain disability files with pertinent client information according to HIPAA privacy rules throughout the disability process.
  • Managed strict confidentiality of documents and comply with HIPAA regulations stipulated by the facility and government.
  • Maintained confidentiality and complied with all HIPAA regulations.
  • Followed standard operating procedures and maintained HIPAA.
  • Maintained HIPAA regulations updated annually.
  • Maintained the highest level of confidentiality and comply with all HIPAA regulations and TOG's Business Associate Agreements with its clients.
  • Maintain accurate patient demographics, insurance information, patient confidentiality (HIPAA) and routinely update accounts with detailed notes.
  • Ensured HIPAA compliance, completed Medicare lien investigations, and ensured proper State and Federal reporting including CMS and NPDB.
  • Work in a fast paced environment while keeping complete confidentiality and adhering to HIPAA laws.
  • Uphold and reinforce compliance with hospital policies and federal regulations such as HIPAA
  • Adhere to strict HIPAA laws with regards to patient privacy and confidentiality.
  • Exposed to confidential information, adheres to all HIPAA rules and regulations.
  • Comply with HIPAA guidelines when dealing with patient's protected information.
  • Required in-depth knowledge of all HIPAA rules and regulations.
  • Conducted investigations, and enforced HIPAA laws for benefits
  • Adhered to Federal HIPAA Laws.
  • Follow HIPAA guidelines when managing medical files Maintain 6-20 Adjusters license by keeping continuing education current throughout the year.
  • Maintained client privacy (HIPAA observance) while providing accurate information, problem resolution and direction.
  • Trained on HIPAA rules and regulations and procedures when handling sensitive patient information.
  • Maintain HIPAA practices on every record.

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2 Hipaa Jobs

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45. Computer System
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Here's how Computer System is used in Claims Representative jobs:
  • Handled incoming and outgoing customer service calls, process customer order information and enter into insurance database computer system.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Mentored and trained newly hired employees on computer systems, company policies, and customer service.
  • Communicated necessary data about claims from customer to computer system to begin or further the claims process
  • Verified that all customers' information in the computer system was up-to-date and accurate.
  • Enter and maintain accurate loss information on a computer system during the claim process.
  • Entered clients personal info also there dates of loss in computer system.
  • Enter all customer information into the computer system for future records.
  • Navigate through different web browsers and computer systems at one time.
  • Entered claim payments, reserves and new claims on computer system.
  • Handle high call volume, use multiple computer systems, answer phones
  • Review and research claims by navigating multiple computer systems and platforms.
  • Resolved customer issues using the computer system as reference.
  • Review and research claims by navigating multiple computer systems and platforms and accurately capturing the data/information necessary for processing (e.g.
  • Filed medical claims made by providers by entering and organizing data and inputting all informationinto the computer system.
  • Processed customer damaged product claims within specialized computer system to determine credit to be issued.
  • Worked on several different computer systems to process claims efficiently/effectively.
  • Work in extremely high work volume maintain quality work product and professionalism, utilize computer systems and other technologies.
  • Researched issues on various computer systems and databases to resolve complaints and answer inquiries.
  • Work in claims department Work with customers Computer systems Multitask on computer while on the phone with customer

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6 Computer System Jobs

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46. EOB
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Here's how EOB is used in Claims Representative jobs:
  • Reviewed primary insurance EOB's and billed secondary insurance as necessary.
  • Obtain payment and adjustment EOB's from motor vehicle insurance or health insurance to request posting of payments and adjustments.
  • Returned improperly filed EOB's to providers and informed leadership of trends that needed immediate attention.
  • Reviewed EOB's and contacted insurance companies to settle claims.
  • Calculated Medicare allowance amounts based off report balance from EOB.
  • Repriced medical claims on EOB's (Explanation of Benefits)
  • Verify patients insurance, EOB and LOA on file.
  • Provided detail understanding of EOB's
  • Reviewed EOB to Post, Adjust, or write off as stated.
  • Print EOB and request check trace.
  • Processed and mailed primary and secondary medical claims, ensuring accuracy by matching with Explanation of Benefits (EOBs).
  • Assisted customers with their EOB on their disability claims, filing medical recored, putting loss documents in correct file.
  • Receipt of EOBs daily from insurances and internal reports making sure they are processed correctly.
  • Read Patients EOBs and ensure that claim was either paid or denied properly.
  • Researched EOBs to see where the credit balance was coming from.
  • Review EOBs to insure proper payment.
  • Review EOBs to ensure appropriate posting payment and the ability to resubmit claims to obtain correct payment.
  • Follow up on insurance eobs in Chartmaxx and document in account.
  • Attach EOBs to claim forms, Input patient's demographics'.
  • Utilized PaySpan, Emdeon, and Navinet to pull electronic payments, ., Scanned and saved payments with EOB's.

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1 EOB Jobs

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47. Appropriate Parties
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Here's how Appropriate Parties is used in Claims Representative jobs:
  • Managed deductibles and coverage limits and contacted appropriate parties to obtain relevant facts necessary to determine coverage.
  • Corresponded with insureds, physicians, agents and other appropriate parties in order to obtain proper documentation and to finalize claim.
  • Contacted and established rapport with all appropriate parties to obtain relevant facts, satisfy customer needs and ensure file quality.
  • Obtain more complex information such as coverage, decisions, outcomes, negotiations, to all appropriate parties.
  • Contacted all appropriate parties to gather supporting documents necessary to negotiate and settle the claim within authority level.
  • Refer file to appropriate parties for medical management, special investigative needs and monitor status of work performed.
  • Deliver consistent service by contacting customers, explaining the claim process and settling claims with appropriate parties.
  • Handled all aspects of claims including replacement rental, inspection coordination and payment processing to appropriate parties.
  • Interviewed insureds, claimants, witnesses and other appropriate parties to determine claim eligibility and liability.
  • Make payments on claims to appropriate parties and apply surcharges when applicable.
  • Answered phone calls and direct calls to appropriate parties or take messages.
  • Identify suspected fraudulent claims and report to the appropriate parties.
  • Managed rental vehicles for appropriate parties and issued payment.
  • Transfer documentation to appropriate parties for handling and processing.
  • Routed phone calls to appropriate parties.
  • Handled refund transactions to appropriate parties.
  • Obtain releases from appropriate parties.
  • Secured releases from appropriate parties.
  • Work to coordinate resolution involving subrogation and or repairs to the vehicle and appropriate parties.
  • Processed health care claims from porviders Made sure each claim was coded correctly Filed claims with appropriate parties

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164 Appropriate Parties Jobs

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48. Policy Provisions
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Here's how Policy Provisions is used in Claims Representative jobs:
  • Provided information to customers regarding state regulations and policy provisions, and negotiated effectively with contractors hired to mitigate damages.
  • Negotiated settlements with homeowners, business owners, attorneys and public adjusters while abiding to policy provisions and conditions.
  • Settled claims by determining insurance carrier's liability and reaching agreement according to policy provisions.
  • Investigate and interpret policy provisions, endorsements and conditions to make a coverage determination.
  • Analyzed and interpreted policy provisions, negotiated claims settlements, and recorded accident information.
  • Examine insurance policy provisions, endorsements and statutory provisions to verify applicable coverage.
  • Negotiated settlements with claimants in accordance with policy provisions and company guidelines.
  • Interpreted and understood policy provisions and exclusions to determine claim eligibility.
  • Issued payments to medical providers and individuals according to policy provisions.
  • Interpret commercial policy provisions and loss circumstances to determine company liability.
  • Analyzed policy provisions and legal liability issues for determination of coverage.
  • Negotiated fair settlements in accordance with policy provisions.
  • Analyzed insurance claims to determine extent of insurance carrier's liability and settled claims with insureds in accordance with policy provisions.
  • Adjusted claims according to applicable law and policy provisions to comply with all Department of Insurance Regulations.
  • Make approval or denial decisions and negotiate settlements with claimants in accordance with policy provisions.
  • Evaluate and negotiate settlements in a timely fashion with claimants and attorneys in accordance with policy provisions.
  • Settle claims according to insurance policy provisions Maintain and update customer account records as needed.
  • Assigned defense counsel to represent and defend insureds pursuant to to policy provisions.
  • Received inbound calls/made outbound calls to several different providers and physicians Reviewed and apply policy provisions in processing of claims received.
  • Administered and resolved claims in a timely manner in accordance with legal statues, policy provisions, and company guidelines.

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77 Policy Provisions Jobs

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49. Pertinent Information
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Here's how Pertinent Information is used in Claims Representative jobs:
  • Compiled and analyzed all pertinent information required to successfully defend client's interest in medical malpractice law suits.
  • Gathered all pertinent information to thoroughly investigate all accident claims reported against existing policyholders.
  • Gathered all pertinent information to create reports for presentation on department objectives to management.
  • Investigated Personal Injury Protection losses to obtain pertinent information related to new claims.
  • Educated policy holders on their insurance coverage and advised them of pertinent information.
  • Obtained and provided pertinent information to process efficient operations of claims processing.
  • Communicated pertinent information to medical providers, attorneys, and claimants.
  • Obtained required and pertinent information to determine eligibility for benefits.
  • Served in procedure management by providing pertinent information.
  • Interview policyholders to gather pertinent information.
  • Initiated contacts with clients, or others who can supply pertinent information involving completion of claims for disability benefits.
  • Reinstated policies when pertinent information was received in the offices for various updates to the policies.
  • Display communication skills to convey pertinent information to customers as well as peers.
  • Filed claims by verbally collecting pertinent information from the customer over the phone.
  • Organized and selected pertinent information for defense counsel review and files.
  • Interview claimants and witnesses to gather pertinent information.
  • Verified coverages and investigate losses by gathering pertinent information, i.e.
  • Compiled, prepared and gathered pertinent information needed for submission of claims (i.e.
  • Processed Medical Claims upon first receipt Documented all investigation in automated system Verified coverage and investigates losses by gathering pertinent information
  • Researched and gathered all pertinent information to develop the "record" for claims investigation.

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50. Company Policies
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Here's how Company Policies is used in Claims Representative jobs:
  • Evaluated and processed claims in accordance with company policies and according to productivity and quality assurance.
  • Reviewed and adjudicated all medical claims in accordance with company policies and procedures.
  • Resolved both litigated and non-litigated casualty claims in accordance with company policies.
  • Make decisions within delegated authority per company policies and procedures.
  • Conducted presentations to introduce new company policies.
  • Obtain and review claim information, company policies and insurance policy details to make a decision on the approval and/or settlement.
  • Insure customer satisfaction by providing the most complete and accurate service as possible while maintaining company policies.
  • Adjust reserves or provide reserve recommendations to ensure that reserve activities are consistent with company policies.
  • Negotiate and resolve any outstanding issues in order to keep with company policies and profitability goals.
  • Demonstrated thorough knowledge of insurance products, company policies and procedures, and insurance information systems.
  • Complied with State Statute and company policies while maintaining a caseload of 100 claims on average.
  • Maintained up to date knowledge of company policies and procedures and various products offered to consumers.
  • Geared the activities for redress of customer complaints and enforcing company policies and Marketing Discipline Guidelines.
  • Settled all assigned physical damage claim cases in accordance with company policies and procedures.
  • Comply with company policies as well as those established by state law.
  • Supervised and trained new hires on industry procedures and company policies.
  • Ensured compliance with company policies and legal requirements.
  • Adhere to company policies and best claims practices to investigate, evaluate, and negotiate auto claims to meet strict deadlines.
  • Evaluate all information and company policies to determine how claim should be handled Negotiate with providers to settle claims
  • Create and adjust reserves in a timely manner to ensure reserving activities consistent with company policies.

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20 Company Policies Jobs

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Claims Representative Jobs

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20 Most Common Skills For A Claims Representative

Insurance Companies

43.2%

Customer Service

12.5%

Total Loss

8.2%

Medical Records

6.9%

Bodily Injury Claims

3.9%

Phone Calls

3.7%

Property Damage

2.8%

General Liability

2.4%

Data Entry

2.2%

Workers Compensation

1.8%

High Volume

1.8%

Police Department

1.4%

Catastrophe

1.4%

Policy Holders

1.3%

State Farm

1.1%

Medicaid

1.1%

Social Security

1.1%

Personal Lines

1.1%

Body Shops

1.1%

Personal Injury

1.0%
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Typical Skill-Sets Required For A Claims Representative

Rank Skill
1 Insurance Companies 36.6%
2 Customer Service 10.6%
3 Total Loss 6.9%
4 Medical Records 5.9%
5 Bodily Injury Claims 3.3%
6 Phone Calls 3.1%
7 Property Damage 2.4%
8 General Liability 2.0%
9 Data Entry 1.9%
10 Workers Compensation 1.5%
11 High Volume 1.5%
12 Police Department 1.2%
13 Catastrophe 1.1%
14 Policy Holders 1.1%
15 State Farm 1.0%
16 Medicaid 0.9%
17 Social Security 0.9%
18 Personal Lines 0.9%
19 Body Shops 0.9%
20 Personal Injury 0.9%
21 State Regulations 0.8%
22 SIU 0.7%
23 Auto Accidents 0.7%
24 Xactimate 0.7%
25 Communication 0.7%
26 Repair Shops 0.7%
27 Casualty Claims 0.7%
28 Complex Claims 0.7%
29 CPT 0.6%
30 PIP 0.6%
31 Quality Standards 0.6%
32 Special Projects 0.5%
33 Repair Facilities 0.5%
34 Fraudulent Claims 0.5%
35 Counsel 0.5%
36 Policy Language 0.5%
37 Icd-9 0.5%
38 Subrogation Potential 0.4%
39 Legal Liability 0.4%
40 Liability Investigations 0.4%
41 Safety Guidelines 0.4%
42 Crime Scenes 0.4%
43 Additional Information 0.4%
44 Hipaa 0.4%
45 Computer System 0.4%
46 EOB 0.3%
47 Appropriate Parties 0.3%
48 Policy Provisions 0.3%
49 Pertinent Information 0.3%
50 Company Policies 0.3%
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5,270 Claims Representative Jobs

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