yyyyyy x. yyyyyy                                                    0000 xxxxxx xxxx , xxxx , xxxxx 00000

                                                                                                                                                  xxx-xxx-xxxx

                                                                                                                                               abc@xyz.com

objective

solutions-focused insurance industry claims professional eager to contribute technical expertise as well as dynamic management, customer service and operational enhancement abilities in a challenging assignment.

 

career profile

ø  over 12 years of relevant insurance industry experience, with the last five serving as claims representative.

ø  ny state insurance adjusters license - #1a-1032801 - bonded.

ø  fl state adjuster license, 2008.

ø  strong knowledge of regulation 68 and fl statute 627.

ø  proficient in working with claims for pip/med pay in ny, fl, ga, va, pa, md, il, wa, ca, tx and ct.

ø  expertise in no fault, property damage, bodily injury and liability areas.

ø  extensive training in customer service.

ø  highly effective in interfacing with insured, injured parties, providers and attorneys.

ø  strong evaluative, assessment and diagnostic capacity.

ø  contributor in increasing proficiency.

ø  well-organized multi-tasker with strong detail orientation.

 

professional experience

response/unitrin insurance company, melville, ny                                                                     2006 - present

claims representative

         recruited to evaluate coverage and relay relevant information to/interact closely with various interested segments, such as the insured, injured parties, providers and attorneys

         handle new as well as existing injury claim cases, with the ability to rule out um claims and evaluate and refer appropriate claims to the siu department; forward any necessary denials for claims.

         tasked with preparation of independent medical examination (ime) and peer reviews for utilization in handling of claims.

         knowledgeable in fl statute 627 and regulation 68.

         responsible for nf applications being sent within regulations.

         charged with review and processing of lost wage reimbursements.

         utilize knowledge of provider billing fee schedule.

         serve in customer assistance role by handling telephone claim information requests.

 

york claims services, melville, ny                                                                                                 2005 - 2006

claims representative

         tasked with managing various segments of claims approval process.

         closely interfaced with interested parties, on both new as well as existing claims, to receive relevant information regarding medical treatment(s), employment status, whether lost wage reimbursements were required, and forwarding, as necessary, any claim denials.

         when required, ordered ime and peer reviews to support proper handling of claims and worked closely with underwriting staff to verify coverage.

         forwarded appropriate nf applications within regulation.

         maintained timely knowledge of regulation 68 and provider fee schedules.

         assisted with telephone inquiries from clients.

 

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geico insurance, woodbury, ny                                                                                                   2004 - 2005

claims representative

         received five weeks of intensive pip training.

         trained six weeks on appropriate customer service skill sets as well as bodily injury and liability procedures.

         closely interfaced with interested parties, on both new as well as existing claims, to receive relevant information such as medical treatment(s), employment status, whether lost wage reimbursements were required, and forwarding, as necessary, any claim denials.

         oversaw all ime and peer reviews to assist accuracy in claim decision-making.

         forwarded appropriate nf applications within regulation.

         maintained timely knowledge of regulation 68 and provider fee schedules.

 

the robert plan corporation, bethpage, ny                                                                                   2000 - 2004

third party property damage claims examiner (2003-2004)

         charged with oversight of new property damage and bodily injury cases.

         prior to settlement, reviewed claims, forwarding any questionable or possibly fraudulent cases to special investigation unit for review.

         engaged in negotiations with attorneys and other interested parties over settlement details; held authority for monetary agreements.

 

special investigation unit fraud examiner (2002-2003)

         utilized fraud training to research and evaluate any suspicious claims or policies.

         developed files and documentation in support of investigative audits and prepared preliminary reports.

         encouraged use of fraud hotline for reporting of any suspicious activities.

 

claims first report unit/claims customer service representative (2000-2002)

         served as first point-of-contact in assisting customers with telephone inquiries as well as receiving accident descriptions

         maintained thorough knowledge of insurance coverage and terminology to better address customer service needs.

         ensured that all appropriate forms were sent to both the insured and claimant.

         handled processing of claims for no fault, property damage and bodily injury cases, working closely with underwriting department to assure coverage verification.

 

 

 

education

west islip high school, west islip, ny

graduate, 1997