CLAIMS OPERATIONS SPECIALIST RESUME EXAMPLE

Updated: Aug 11, 2024 - The Claims Operations Specialist initiates dispute claims and manages documentation through the Chargeback process, ensuring timely communication and customer satisfaction. This role involves resolving disputes, researching potential fraud, and supporting both email and phone-based customer inquiries. Additionally, this position collaborates with internal teams to improve dispute-resolution processes and maintains compliance with various financial regulations.

Tips for Claims Operations Specialist Skills and Responsibilities on a Resume

1. Claims Operations Specialist, Allstate Insurance, Northbrook, IL

Job Summary:

  • Support the Heads of Claims and other senior leaders in the implementation of the claims strategy and to work collaboratively with other members of the claims team.
  • Make proactive and meaningful contributions to all project work in order to drive meaningful change and ensure the contribution of the team to the projects that participate in.
  • Work with the Claims Operations team to manage fiscal controls that are required to support the claims function
  • Oversee the internal claims peer review process to ensure annual plan is met and any performance issues, including the provision of monthly status reports. 
  • Issues to be raised with the Head of Claims Operations including any recommended remedial plans.
  • Ensure effective oversight of service providers or outsource partners (offshore and nearshore), who provide services in respect of team, flagging any issues of concern and proposing a plan to remediate
  • Oversee and where appropriate enhance the operation of claims controls, ensuring they are working effectively across the team.
  • Responsible for driving initiative within the Claims Operations function, acting as a key focal point for the delivery of this service
  • Review and update all claims SOP (standard operating procedures), specifically to ensure processes are optimal and are being followed
  • Establish and develop a network of claims broker and key client contacts and will proactively look to develop these relationships with the team.


Skills on Resume: 

  • Claims Strategy Implementation (Hard Skills)
  • Project Management (Hard Skills)
  • Financial Management (Hard Skills)
  • Performance Monitoring and Reporting (Hard Skills)
  • Vendor Management (Hard Skills)
  • Process Optimization (Hard Skills)
  • Initiative and Leadership (Soft Skills)
  • Relationship Management (Soft Skills)

2. Claims Operations Specialist, Progressive Insurance, Mayfield, OH

Job Summary:

  • Capture current detailed workflows related to the various contingencies in resolving Auto Physical Damage Claims
  • Produce highly detailed process documents and guidelines that capture best practices that will be applied in all markets.
  • Document activity triggers within Claims Portal and vendor portals such as CCC and IAA.
  • Provide actionable information to claims management through analysis of data elements and relationships. 
  • Assist in developing new strategies to support department goals and optimization objectives.
  • Support department and corporate goals, complete audits, and club/claims applications user. 
  • Participate and attend meetings as liaison to other Business Units on matters concerning Finance, Underwriting, Corporate Cashiering, Insurance Accounting, and Purchasing
  • Promptly acknowledge claims submissions, and sending acknowledgments to policyholders and brokers
  • Collaborate across multiple departments to manage the processing of claims payments
  • Create and upload new claims files into database
  • Routinely running claims and spending reports


Skills on Resume: 

  • Process Documentation (Hard Skills)
  • Data Analysis (Hard Skills)
  • Strategy Development (Hard Skills)
  • Auditing (Hard Skills)
  • Cross-functional Collaboration (Soft Skills)
  • Claims Management Systems (Hard Skills)
  • Meeting Facilitation (Soft Skills)
  • Reporting and Documentation (Hard Skills)

3. Claims Operations Specialist, State Farm Insurance, Bloomington, IL

Job Summary:

  • Researching, investigating, and validating customer disputed transactions
  • Making pay or deny decisions
  • Providing excellent customer service
  • Outbound calls to Wells Fargo customers are also required to gather pertinent information regarding the customer’s dispute (Inbound calls may also be received on an exception basis)
  • Take accountability for the entire claim process from receipt of the claim to resolution
  • Team members will process claims according to Regulation E guidelines and NACHA rules
  • Selected candidates will also be required to respond to and complete all customer requests and/or questions in a timely manner.
  • Understand the current operational process for claims and explore ways to improve as we continue to grow
  • Maintain frequent interaction with Underwriting team to communicate claim developments and trends
  • Responsible for implementation, monitoring and reporting on results of assigned special projects
  • Drive employee engagement by exhibiting passion about the company, values, business and customers


Skills on Resume: 

  • Research and Investigation Skills (Hard Skills)
  • Decision-Making Ability (Hard Skills)
  • Customer Service Excellence (Soft Skills)
  • Communication Skills (Soft Skills)
  • Claim Management (Hard Skills)
  • Process Improvement (Hard Skills)
  • Team Collaboration (Soft Skills)
  • Project Management and Reporting (Hard Skills)

4. Claims Operations Specialist, LendingClub’s, Boston, MA

Job Summary:

  • Initiates dispute claims, gathers necessary information/documentation formally or informally through the Chargeback process. 
  • Ensures communication is delivered in a timely manner to the customer, and clear expectations are established to ensure customer satisfaction. 
  • Ensure appropriate credits and reversals are executed on behalf of customers.
  • Provide exceptional customer service for LendingClub’s customers across different financial products, primarily providing customer support via email, but will require secondary support via phone.
  • Research and identify suspicious activity and conduct a thorough investigation to determine if the activity is normal or constitutes fraud.
  • Dispute resolution and reviewing MasterCard Representments and arbitration cases. 
  • Analyze merchant documentation and exercise discretion in resolving cases when the merchant refuses to issue a credit and the customer is due a credit.
  • Assists in resolving problem accounts/escalations, while evaluating processes for continuous improvement to enhance productivity and quality.
  • Develop and maintain strong working relationships with frontline sales and support staff to communicate information and provide assistance related to dispute regulations, consumer rights, and dispute guidelines.
  • Responsible for managing Dispute case load and working with Sr Manager, Claim Operations to fairly distribute work and provide training, coaching, and feedback surrounding timely and proper dispute resolution to employees.
  • Complies with all regulations by law, including but not limited to the Bank Secrecy Act, OFAC, FACT Act, GLBA, Regulation CC, Regulation DD, Regulation Z, Regulation E, and other regulations by law as it relate to the position.


Skills on Resume: 

  • Dispute Resolution Expertise (Hard Skills)
  • Regulatory Compliance (Hard Skills)
  • Analytical Skills (Hard Skills)
  • Customer Communication (Soft Skills)
  • Team Collaboration and Leadership (Soft Skills)
  • Operational Management (Hard Skills)
  • Service Excellence (Soft Skills)
  • Continuous Improvement (Soft Skills)