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Yyyyyy x. yyyyyy

~ Expert in Multi-Party Claims Processes • Specialist in Training Strong Personnel • Team-Focused Can Do Attitude ~


0000 xxxxxx xxxx , xxxx , xxxxx 00000 • (xxx-xxx-xxxx •


Solutions-focused leader who contributes strong knowledge of the insurance industry, claims, and legal / regulatory compliance eager to offer 16 years of team training, process improvement, business communications, administrative support, and customer relations experience toward maximizing a progressive employer s success.


Profile of Qualifications


         Integral leader who analyzes and interprets statistical data to deliver solid assessments and procedural recommendations for cost-effective claims processes, along with anticipating customer needs while optimizing products / services delivery.

         Top performer who demonstrates strong experience with claims processing and can train company teams on major steps of claims adjustments processes while utilizing major tools and techniques for efficiently and accurately processing claims.

         Out-of-the-box thinker who proactively resolves technical issues by identifying root causes and providing key solutions, including educating multiple parties on various areas of claims processes and thoroughly training claims staff members.

         Fluent in Polish and English languages.


Key Areas of Expertise


   Claims Processing

   Bodily Injury Appraisals

   Physical Damage Appraisals

   Jurisdictional / Procedural Law

   Low- / Medium-Level Litigation

   Multi-Party Claims

   Team Building / Training

   Negotiations / Settlements

   Needs Analysis / Assessment

   Process / Product Improvement

   Diary Management

   Regulatory Compliance

   SBU Management Support

   Statutory Forms Completion

   Insured / Claimant Relations


Professional Synopsis


Zurich American Insurance, Schaumburg, IL                                                                              1997 C Present


Claims Specialist I (2005 C Present)

         Utilize broad scope of industry knowledge toward handling a high-volume of worker s compensation claims (e.g. bodily injury, physical damage), including interpreting policy language, verifying coverage, and applying company standards.

         Contribute strong communication skills toward contacting insureds and claimants, gathering key information, interviewing witnesses, documenting claim files pursuant to best practices, and providing updates to multiple parties.

         Anticipate, recognize, and respond to customer needs while cost-effectively negotiating settlements within authority limit.

         Improve processes, procedures, and / or products by providing recommendations and / or resolving technical problems.

         Recognize subrogation and fraud, and report activities to proper departments for further investigation and review.


Healthcare Cost Specialist (1997 C 2005)

         Applied sharp analytical abilities toward evaluating medical bills for accuracy of billing amounts, duplicate payments, and general appropriateness, including verifying missing data with medical providers and claims adjusters and investigating provider medical bills for payment adjustment in accordance with strict jurisdictional laws and / or diverse regulations.

         Wrote and updated detailed guidelines for workers compensation fee schedules and U&C states, along with demonstrating knowledge of medical terminology and medical specialties to promptly resolve customer / billing issues.

         Guaranteed medical records confidentiality and proper release of information by observing all policies and procedures.

         Supported the improvement of a new bill review system by identifying critical errors and system-wide queries.

Yyyyyy x. yyyyyy

~ Expert in Multi-Party Claims Processes • Specialist in Training Strong Personnel • Team-Focused Can Do Attitude ~


(xxx-xxx-xxxx • • Page Two


Professional Synopsis (continued)


Polmex Tool, Inc., Addison, IL                                                                                                        1994 C 1997


Administrative Assistant

         Optimized administrative processes by efficiently handling all secretarial and business support functions, including drafting correspondence, scheduling appointments, filing and producing reports, completing invoices, and expediting deliveries.

         Expertly performed wide-ranging accounting functions (e.g. journal entry postings, AP / AR, billing, bank deposits).

         Liaised among company president, operations manager, and various vendors to ensure seamless processes.


Education & Professional Credentials


Bachelor of Arts Degree



Extensive Business Studies

College of DuPage


Certified Professional Coder (Since 2004)

Physician Office Coding & Billing Certificate

American Academy of Professional Coders


Licensed Workers Compensation Adjuster

Texas / Oklahoma / Rhode Island / North Carolina / Kentucky / Florida

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