CLAIMS ASSESSOR RESUME EXAMPLE

Job Summary: 

• Assess claims through the practical application of the policy terms and conditions
• Deploy reasonable application of claims management tools, resources and requirements in assessing a claim
• Ensuring that the client is given a fair assessment without compromising reputation and/or brand in any way
• Communicate effectively in writing and over the phone using effective techniques when liaising with members for positive claim outcomes
• Pro-actively manage claims duration and engage with appropriate third parties such as rehabilitation to ensure sustainable return to work outcomes are facilitated.
• Investigate and resolve disputes
• Ensure Data Integrity is maintained in the claims system
• Effectively manage a portfolio of claims within a required SLA standard
• Assist Manager and legal team with litigated claims related queries
• Assist with the management of internal complaints within legislative timeframes

Skills on Resume:

• Policy Application (Hard Skills)
• Claims Management (Hard Skills)
• Fair Assessment Practices (Hard Skills)
• Effective Communication (Soft Skills)
• Proactive Claims Duration Management (Hard Skills)
• Dispute Resolution (Hard Skills)
• Data Integrity Maintenance (Hard Skills)
• Portfolio Management (Hard Skills)

Job Summary: 

• Participate in on-the-job, computer-based and classroom training 
• Undertake claims investigations under various Federal Acts
• Manage a caseload of claims to meet timeliness and quality targets in a busy processing environment.
• Work productively with clients and external organisations to reach timely and accurate outcomes for clients.
• Work with individuals suffering from physical and/or mental health conditions. 
• Assess claims through the practical application of the policy terms and conditions and analysis of medical, financial and other relevant information
• Manage ongoing claims through the regular analysis of medical, financial, and other relevant information
• Confirm, and where appropriate, substantiate claim decisions to members, Trustees, and/or intermediaries 
• Deploy reasonable application of resources and requirements in assessing a claim
• Ensuring that the client is given a fair assessment without compromising AIA in any way

Skills on Resume:

• Claims Investigation (Hard Skills)
• Caseload Management (Hard Skills)
• Stakeholder Collaboration (Soft Skills)
• Client Support (Soft Skills)
• Policy Application (Hard Skills)
• Ongoing Claims Analysis (Hard Skills)
• Decision Substantiation (Hard Skills)
• Resource Management (Hard Skills)

Job Summary: 

• Assess each claim on the insurance administration system
• Assess the validity of the claim and documentation
• Notify/Communicate any possible invalid claims
• Assure capturing of claims is done accurately and correctly
• Assure all criteria are met to pay the claim
• Assure the quality of feedback (written and verbal) to clients
• Ensure that clients are provided with real time information on the status of the claim
• Assure feedback on requirements for successful claims payment is done timeously
• Asses claims for possible fraud risks
• Investigate and resolve disputes pertaining to expectations of the client/adviser versus the reality of product rules, policy terms and conditions industry/business practice and data

Skills on Resume:

• Claims Assessment (Hard Skills)
• Documentation Verification (Hard Skills)
• Communication of Findings (Hard Skills)
• Data Entry Accuracy (Hard Skills)
• Compliance Verification (Hard Skills)
• Quality Assurance in Feedback (Hard Skills)
• Real-Time Information Provision (Hard Skills)
• Dispute Resolution (Hard Skills)

Job Summary: 

• Signing off on large-sum claim decisions
• Leads training sessions with the claims team
• Assessing claims thorough questioning around claims and managing the caseload from start 
• Finish keeping the customer up to date at all time
• Problem solving, assessing the information provided to ensure processes are followed and correct decisions are made
• Liaising with insurance providers, obtaining premiums and policy wording from underwriters
• Providing a high level of customer service via telephone, email and web chat
• General Administration, sending correspondence and general ad-hoc duties
• Ensure that the agreed Individual processing Turn Around Times (TAT) are met or exceeded
• Ensure that the quality, including presentation, accuracy and detail of claims assessment meets or exceeds the business unit minimum performance standards

Skills on Resume:

• Decision Making (Hard Skills)
• Training Delivery (Hard Skills)
• Case Management (Hard Skills)
• Problem Solving (Hard Skills)
• Stakeholder Liaison (Hard Skills)
• Customer Service (Soft Skills)
• Administrative Skills (Hard Skills)
• Quality Control (Hard Skills)

Job Summary: 

• Full processing and following up of all Group Benefit claims within the required SLA
• Processing 15 claims per day and launching claims on the system
• Provide feedback to clients on finalisation of claims (email and telephonic communication)
• Ensure that all criteria are met to pay valid claims, and invalid claims are repudiated 
• Ensure the proper processes are followed and that it is of high quality
• Ensure that clients are provided with real time information on the status of the claims and policy changes, in line with Treating Clients Fairly policy of Sanlam and Legislation
• Daily follow-ups on pending claims
• Drafting of repudiation letters and drafting proof of payment letters
• Managing the team to make sure the claims assessments are accurate, high quality and within the agreed practice and process of the company

Skills on Resume:

• Claims Processing (Hard Skills)
• Communication (Soft Skills)
• Criteria Verification (Hard Skills)
• Quality Assurance (Hard Skills)
• Client Information Management (Hard Skills)
• Follow-up Coordination (Hard Skills)
• Document Drafting (Hard Skills)
• Team Management (Soft Skills)

Job Summary: 

• Managing and assessing a portfolio of Retail Life Insurance claims
• Management of a mix of Income Protection (IP) and Total and Permanent Disability Claims (TPD)
• Liaising with doctors, rehabilitation providers and advisors
• Requesting medical and financial information
• Assessing new claims daily and initiating claims investigations
• Processing payments of ongoing claims and reviewing incoming correspondence
• Prepare accurate weekly and monthly reports for the Management Team and Directors.
• Carry out any other tasks deemed necessary by the Management Team.
• Performing Root Cause Analysis on complaints
• Continues review of the overall claims process with the objection of identifying areas of improvement and innovation

Skills on Resume:

• Claims Management (Hard Skills)
• Stakeholder Liaison (Soft Skills)
• Information Gathering (Hard Skills)
• Claims Processing (Hard Skills)
• Financial Reporting (Hard Skills)
• Task Execution (Hard Skills)
• Root Cause Analysis (Hard Skills)
• Process Improvement (Hard Skills)

Job Summary: 

• Responsible for the assessments of claims, pending claims, and being responsible for monthly reporting and analysis of data.
• Responsible for the capturing of all claims into the Claims System.
• Attending to ad-hoc tasks and managing allocation of work.
• Handling of complaints from internal escalations/OLTI/FSCA/FAIS Ombud.
• Assessing claims landing in the Life-Claims inbox and Assessing all 3rd party claims
• Performing analysis on data for trend identification and feedback
• Emailing messages to relevant person/department/cell captive
• Assistance with ad-hoc projects from time to time
• Assistance with filing and record-keeping
• Responding to complaints and monthly reporting

Skills on Resume:

• Claims Assessment (Hard Skills)
• Data Entry and Management (Hard Skills)
• Task Management (Hard Skills)
• Complaint Handling (Soft Skills)
• Data Analysis (Hard Skills)
• Communication Coordination (Hard Skills)
• Project Support (Hard Skills)
• Record-Keeping (Hard Skills)

Job Summary: 

• Reviewing tribunal papers to identify the core issues and assessing same against detailed logs of advice given to respondents.
• Analysing claims made by clients on foot of such tribunal papers and determining coverage under relevant legal protection products.
• Liaising with clients and explaining coverage decisions and preparing coverage reports.
• Monitoring the progress of claims and ensuring prompt settlement (of valid claims) and closure of claims.
• Working with Litigation team in identifying the appropriate reserve to be set aside for valid claims as those claims progress.
• Ensuring the clients are treated fairly and receive excellent service in accordance with industry and company guidelines.
• Ensure that all claims related intelligence is recorded accurately on internal systems.
• Communicate effectively and build and maintain relationships both internally and with clients.
• Foster excellent working relationships with all departments, particularly advisory department
• Ensure that service delivery is reflective and consistent with legal protection products.

Skills on Resume:

• Issue Identification (Hard Skills)
• Claims Analysis (Hard Skills)
• Client Communication (Soft Skills)
• Claims Monitoring (Hard Skills)
• Reserving Strategy (Hard Skills)
• Client Service Management (Soft Skills)
• Data Recording Accuracy (Hard Skills)
• Relationship Building (Soft Skills)

Job Summary: 

• Assess, analyse and manage claims received to a high standard.
• Always demonstrate outstanding customer handling skills
• Demonstrate a positive, proactive can-do attitude
• Provide accurate technical claims support and guidance to customers, advisers, colleagues and reassurers 
• Support culture of continuous improvement – identifying and suggesting areas for improvement.
• Support the development of fellow team members
• Highlight any problem or potential complaint matters to Claims Manager
• Deal with all telephone calls received
• Process claim form requests promptly
• Provide timely accurate advice to members anticipating potential problems

Skills on Resume:

• Claims Management (Hard Skills)
• Customer Service (Soft Skills)
• Proactive Problem Solving (Soft Skills)
• Technical Support (Hard Skills)
• Continuous Improvement Identification (Hard Skills)
• Team Development Support (Soft Skills)
• Issue Escalation (Soft Skills)
• Claims Processing (Hard Skills)

Job Summary: 

• Receiving and handling inquiries/correspondence in relation to health claims.
• Taking responsibility for a timely and accurate assessment of an allocated case load of claims
• Dealing with all matters pertaining to claims
• Being the first point of contact for the claimant and calculating benefit entitlement
• Validating financial evidence/documentation
• Identifying and investigating potential fraudulent claims
• Dealing with all documentation in a systematic, accurate, professional, and timely manner  
• Ensuring that claimants are kept informed of the progress of claim
• Ensuring all correspondence is responded to within agreed timescales
• Process claims in accordance with agreed practices

Skills on Resume:

• Claims Assessment (Hard Skills)
• Case Load Management (Hard Skills)
• Fraud Detection (Hard Skills)
• Financial Validation (Hard Skills)
• Documentation Management (Hard Skills)
• Claimant Communication (Soft Skills)
• Correspondence Handling (Hard Skills)
• Claims Processing (Hard Skills)

Job Summary: 

• Support the implementation of the Claims strategy
• Process claims in a compliant manner
• Support the Head of Trade Credit Claims as required with regard to process improvement & training
• Maintain all files, systems and databases to depict accurately the Claim Management process and enable accurate statistical data
• Conduct all written and verbal communications with clients in a professional manner and maintain customer service focus when managing a difficult situation
• Share information with team on competitor customer activity and market issues
• Provide team support and contribute to a professional and cohesive approach to meeting QBE and customer expectations
• Re-assessment of complex claims or complicated circumstances.
• Actively managing workload to ensure department service levels are met and customers are kept pro-actively informed of progress.
• Providing an excellent quality and standard of service at all times to all customers and vets.

Skills on Resume:

• Claims Processing (Hard Skills)
• Process Improvement (Hard Skills)
• Training Development (Hard Skills)
• Data Management (Hard Skills)
• Professional Communication (Soft Skills)
• Market Analysis (Hard Skills)
• Team Collaboration (Soft Skills)
• Workload Management (Hard Skills)

Job Summary: 

• Research and keep up-to-date with current trends within the medico-legal sphere
• Build relationships with clients, Insurers, external providers & trustee
• Plan and manage approved changes within nominated timeframes
• Maintain contracted duration based service standards – Income Protection Claims within 30 days of receipt and Total and Permanent Disablement within 3 mths of receipt
• Maintain service level standards of next day turnaround for BAU work items    
• Deliver improved levels of customer service and contracted services by innovation and the use of best practice processes.
• Providing solutions to rectify the trends identified in order to reduce the amount of work received.
• Identifying process improvements to reduce errors with future assessing.
• Ensure any third party recoveries are pursued in line with company policy.
• Identifying and reporting on referral trends seen

Skills on Resume:

• Medico-Legal Research (Hard Skills)
• Relationship Building (Soft Skills)
• Project Management (Hard Skills)
• Service Standards Compliance (Hard Skills)
• Process Improvement (Hard Skills)
• Innovation Implementation (Hard Skills)
• Error Reduction Strategies (Hard Skills)
• Trend Analysis and Reporting (Hard Skills)

Job Summary: 

• Provide assessment service for a portfolio of claims on behalf of Tower in accordance with clearly defined assessment practices and procedures.
• Manage the initial and ongoing assessment of complex new and existing Terminal Illnesses, Total and Permanent Disablement and Income Protection claims within agreed service standards
• Undertake claim notification interviews 
• Guide and support less experienced Claims assessors and Case Managers with the ongoing management of claim files.
• Instruct third party service providers (IME, Rehab, Functional, Vocational Assessments) and monitor the service provided
• Peer review cases of other team members  
• Ensure claim remediation as directed by Tower or Senior Management are actioned in accordance within agreed timeframes.
• Undertake Facilitated Case discussion with TAL to ensure claims are being assessed in accordance with agreed contracted service standards 
• Consistently apply medical, legal, claims assessment and superannuation knowledge to assess the merits of a Member’s claim
• Provide training to other assessors, trainee assessors, and administration support staff as required or directed

Skills on Resume:

• Claims Assessment (Hard Skills)
• Case Management (Hard Skills)
• Interview Techniques (Hard Skills)
• Training and Development (Hard Skills)
• Third-Party Coordination (Hard Skills)
• Peer Review Processes (Hard Skills)
• Legal and Medical Interpretation (Hard Skills)
• Mentorship and Guidance (Soft Skills)

Job Summary: 

• Validating sum insureds to ensure the correct sum has been admitted by the Insurer
• Assessing for a condition of release under the ground of permanent incapacity, death and terminal illness
• Proactively manage claims allocated 
• Ensure a high level of communication and service has been provided to all parties involved in the claim
• Reduction in claims lifecycle to provide an improved customer experience in line with Trustee Obligations
• Ensure the right decisions are made and the correct outcomes are reached for members and families
• Agree or challenge decision made by the Insurer
• Ensure that the correct outcome for members and families is made

Skills on Resume:

• Sum Validation (Hard Skills)
• Condition Assessment (Hard Skills)
• Claims Management (Hard Skills)
• Service Communication (Soft Skills)
• Lifecycle Reduction (Hard Skills)
• Decision Accuracy (Soft Skills)
• Outcome Arbitration (Soft Skills)
• Member Advocacy (Soft Skills)

Job Summary: 

• Provide a high level of customer service to all internal and external stakeholders
• End-to-end claims adjudication and processing
• Manage daily workflow and administration support to maintain client service standards/KPIs
• Interpret policy wordings and apply accurately and complete large loss reports  
• Identify claims issues and make recommendations 
• Settle claims within company guidelines and delegated authority
• Establish adequate and accurate claims reserves
• Comply with the Insurance Code of Practice
• Comply with privacy and confidentiality principles in all work practices
• Collaborating with other departments: Complaints, Vet line, Service, Operational Underwriting and Technical Underwriting departments.

Skills on Resume:

• Claims Adjudication (Hard Skills)
• Workflow Management (Hard Skills)
• Policy Interpretation (Hard Skills)
• Large Loss Reporting (Hard Skills)
• Claims Settlement (Hard Skills)
• Reserves Estimation (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Interdepartmental Collaboration (Soft Skills)

Job Summary: 

• Deliver superior customer service.
• Operate within the company's policies and guidelines.
• Delivers agreed Key Performance Indicators (KPIs) to achieve business objectives
• Call answer rate, productivity & quality targets to ensure defined Service Level Agreements (SLAs) are met
• Proactively handle escalated calls and ensure complaints are resolved, where possible, and logged in accordance with business policy and meet FCA guidelines.
• Evaluate and enforce claim benefits and limitations based on a comprehensive understanding of the applicable policy wording or client direction.
• Qualify claims/ bills for payment
• Contribute to cost containment efforts by validating bills for services rendered, authenticity and reasonable and customary charges
• Direct bills to the appropriate internal financial process
• Ensure action and tasks are properly registered and updated in the system.

Skills on Resume:

• KPI Analysis (Hard Skills)
• SLA Management (Hard Skills)
• Claims Evaluation (Hard Skills)
• Financial Processing (Hard Skills)
• Customer Service (Soft Skills)
• Proactive Communication (Soft Skills)
• Complaint Resolution (Soft Skills)
• Decision Making (Soft Skills)

Job Summary: 

• Partner with policyholders on achieving the best outcome to minimize overdue and losses.
• Work with policyholders on rescheduling, cease shipment, debt recovery and legal action for buyers that have defaulted.
• Provide sound collection strategy and litigation advice.
• Analyze, initiate, monitor and decide on orientation of a case in amicable, legal and insolvency stages domestic or international.
• Prompt follow-up action on all the scheduled repayment dates and file progress.
• Perform the initial document checks when policyholders file a formal claim.
• Perform an initial review of the claims.
• Liaise with Account Management, Broker, and Policyholders on any outstanding documents and clarification on any discrepancies.
• Work with the claims team on the transfer of file for claim approval and payment.
• Ensure all the necessary reporting is prepared and submitted in accordance with the deadlines.

Skills on Resume:

• Case Management (Hard Skills)
• Debt Recovery Techniques (Hard Skills)
• Litigation Strategy (Hard Skills)
• Analytical Review (Hard Skills)
• Document Verification (Hard Skills)
• Reporting Compliance (Hard Skills)
• Communication (Soft Skills)
• Collaboration with Stakeholders (Soft Skills)