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Senior claims examiner skills for your resume and career

Updated January 8, 2025
4 min read
Senior claims examiner example skills
Below we've compiled a list of the most critical senior claims examiner skills. We ranked the top skills for senior claims examiners based on the percentage of resumes they appeared on. For example, 20.7% of senior claims examiner resumes contained customer service as a skill. Continue reading to find out what skills a senior claims examiner needs to be successful in the workplace.

15 senior claims examiner skills for your resume and career

1. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how senior claims examiners use customer service:
  • Prepared and facilitated local training material on on-site inspection methods, customer service issues, and quality examination.
  • Served as senior-level claims examiner and customer service representative for retirees of Missouri Pacific Employees Health Association.

2. Litigation

Here's how senior claims examiners use litigation:
  • Coordinated vendor referrals for additional investigation and/or litigation management
  • Investigated Commercial Auto liability/garage operations and General Liability claims, and managed litigation for Third Party Claims Administrators.

3. Property Damage

Property damage is the destruction or damage of tangible personal property. Property damage can be caused by negligence, irresponsible handling of the property, willful destruction, or any other destructure act of nature.

Here's how senior claims examiners use property damage:
  • Determined liability and handled settlements of bodily injury and property damage claims as well as investigation of fraudulent cases.
  • Investigated, evaluated, and resolved bodily injury and property damage claims for non-standard personal auto policyholders in CA.

4. Claims Handling

Here's how senior claims examiners use claims handling:
  • Conducted nationwide casualty claims handling.
  • Completed business case proposals that were approved by upper management that incorporated new processes that help streamline the claims handling process.

5. TPA

Here's how senior claims examiners use tpa:
  • Dedicated TPA for the handling of NC and SC claims.
  • Handle Fortune 500 clients as TPA.

6. Coverage Issues

Here's how senior claims examiners use coverage issues:
  • Identified and analyzed coverage issues; prepared coverage reports to insurance carrier and drafted coverage position letters to insureds.
  • Handled review of coverage issues to determine whether overlapping coverage existed for reported incidents.

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7. Medical Terminology

Here's how senior claims examiners use medical terminology:
  • Utilize comprehension of medical terminology, treatment and diagnostic testing for necessary for claim adjudication.
  • Used efficient computer/data entry skills and knowledge of medical terminology to increase claims processing productivity.

8. Medical Management

Medical management helps navigate all facets of health care to improve the quality and outcomes of health care delivery for health, disease, nursing, and case management functions. The goal of medical management is to improve the delivery of all medications, improve patient use, reduce side effects and interactions of drugs, and provide peace of mind to patients as they can be confident that medications are being taken correctly.

Here's how senior claims examiners use medical management:
  • Worked claims in the Medical Management Department that had special negotiations per our registered nursing team.
  • Project Medical Management Processing health claims; adjudication cycling; verifying provider, vendor information validity.

9. Defense Counsel

A defence attorney is a counsel representing the defendant in a criminal prosecution or lawsuit. A defence attorney aims to solve court cases as swiftly and satisfactorily as possible. Client representations at arraignments, hearings, and court trials along with preparing and drafting legal documents, including legal briefs and appeals is all part of their job description. They are responsible for presenting convincing evidence to a jury and/or judge if the case goes to trial.

Here's how senior claims examiners use defense counsel:
  • Marshaled continued development of critical facts and/or arguments of cases with management and defense counsel as warranted.
  • Worked closely with defense counsels giving them instructions regarding defense strategy.

10. Insurance Claims

Here's how senior claims examiners use insurance claims:
  • Analyzed and administered benefits for credit disability, unemployment, and life insurance claims based on Certificates of Insurance.
  • Examine credit insurance claims in accordance with policy wording in fast-paced environment while ensuring accuracy and timeliness.

11. Medical Treatment

Here's how senior claims examiners use medical treatment:
  • Discussed appropriateness of medical treatment with medical case managers.
  • Monitored medical treatment and indemnity benefits paid out manually.

12. Excellent Negotiation

Here's how senior claims examiners use excellent negotiation:
  • Developed excellent negotiation skills by directly engaging in negotiations and claim settlement discussions with claimants opposing counsel on a daily basis.
  • Recognized by supervisor for Having excellent negotiation skills and extremely organized, detailed negotiation points.

13. CPT

CPT is a medical term that stands for Current Procedural Terminology. Whenever a procedure like surgery or diagnosis occurs or some other medical service is rendered to a patient, it is reported to the concerned physician, insurance company, or organization. The aforementioned practice is widely referred to as CPT.

Here's how senior claims examiners use cpt:
  • Review and process professional claims for correct CPT and ICD-10 coding and pay or deny claims accordingly.
  • Exhibit an understanding of CPT, HCPCS, Revenue Codes, ICD.9 diagnosis and procedure coding guidelines.

14. Litigation Management

Here's how senior claims examiners use litigation management:
  • Developed staff in areas of coverage, investigation, evaluation, litigation management, negotiation, and settlement.

15. Commercial Property

Here's how senior claims examiners use commercial property:
  • Analyze commercial property insurance policies and endorsements to evaluate coverage.
  • Handled homeowner property and commercial property claims.
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List of senior claims examiner skills to add to your resume

The most important skills for a senior claims examiner resume and required skills for a senior claims examiner to have include:

  • Customer Service
  • Litigation
  • Property Damage
  • Claims Handling
  • TPA
  • Coverage Issues
  • Medical Terminology
  • Medical Management
  • Defense Counsel
  • Insurance Claims
  • Medical Treatment
  • Excellent Negotiation
  • CPT
  • Litigation Management
  • Commercial Property
  • Property Claims
  • Disability Claims
  • Medical Claims
  • Claims Reviews
  • Social Security
  • Insurance Policies
  • Medicaid
  • Independent Adjusters
  • Process Claims
  • Settlement Conferences
  • Bodily Injury Claims
  • Policy Provisions
  • Provider Contracts
  • State Laws
  • ICD-9
  • Quality Standards
  • HMO
  • Workers Compensation Claims
  • Defense Attorneys
  • Adjudicate Claims
  • HCPCS
  • CMS
  • SIU
  • Interrogatories
  • DRG
  • Policy Holders
  • Claims Issues
  • Dental Claims
  • Status Reports
  • PPO
  • Facets
  • COB
  • Liability Claims

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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