SENIOR CLAIMS ASSESSOR RESUME EXAMPLE
Updated: Aug 11, 2024 - The Senior Claims Assessor is responsible for ensuring precise and timely evaluations in accordance with service level agreements. This role involves scrutinizing claims for validity, detecting potential fraud, and maintaining consistent communication with all parties involved to uphold fairness and accuracy. Additionally, this position requires effective line management of the claims handling team and fostering strong, professional relationships with customers, colleagues, and external contacts.
Tips for Senior Claims Assessor Skills and Responsibilities on a Resume
1. Senior Claims Assessor, Pacific Insurance Group, Sacramento, CA
Job Summary:
- Dealing sensitively and professionally with potentially traumatic and personal customer situations and circumstances.
- Handling difficult customer situations and complaints
- Ensure understanding of customer claim requests and take personal responsibility for ensuring that all needs are understood and that all elements will be met the first time
- Deliver accurate outputs to customers.
- Respond to all written and phone customer requests compliantly, accurately, politely and efficiently, ensuring, where possible, that the customer is satisfied with the response
- Accurately update administration systems including Exclaim, ALPHA and OPUS - in order to both satisfy the customer request and to keep all policy records accurate and up to date.
- Follow the exact Exclaim and ALPHA processing requirements, including approved and documented "workaround" at all times.
- Meet productivity targets, being efficiently available to take the next call or attend to the next work item in the OPUS work queue.
- Meet the agreed Average Handling Times, promptly discussing any barriers and constraints to meeting these with Senior Claims Assessor
- Work flexibly as part of a team within the Customer Services division, where there is a need to work on different work queues and different teams to meet the changing demands of the business
- Identify potential process or practice improvements and constructively suggest to the Senior Claims Assessor recommendations to address these.
Skills on Resume:
- Customer Interaction (Soft Skills)
- Complaint Management (Soft Skills)
- Claims Understanding (Hard Skills)
- Communication Efficiency (Soft Skills)
- Database Management (Hard Skills)
- System Processing (Hard Skills)
- Productivity and Time Management (Soft Skills)
- Process Improvement Identification (Soft Skills)
2. Senior Claims Assessor, Eastern Benefit Solutions, Charlotte, NC
Job Summary:
- To be a member of a competent and efficient team of claims analysts who deliver the technical claims assessment and underwriting function for all applicable Admin Re books of business.
- Achieve the agreed service standards for underwriting and claims assessment, and actively manage own case loads and workflows to consistently meet these standards
- Provide accurate statistical and management information
- Follow underwriting and claims management protocols and procedure manuals,
- Develop and utilise own knowledge and experience of cost effective claims management techniques consistent with industry practices
- Ensure cost efficient implementation of process changes.
- Ensure adherence to Corporate Governance requirements, with particular reference to internal company authority limits, client authority limits, and reinsurers' limits.
- Liaise with the legal, complaints and media function concerning cases escalated to legal, complaint referrals and media cases.
- Control of material financial commitments, involving hundreds of thousands of pounds per month, requiring considerable knowledge and expertise.
- Maintain an understanding and awareness of Life risk policies
- Preparing cases for review and referral
- Preparing management information and reports
Skills on Resume:
- Claims Assessment (Hard Skills)
- Statistical Reporting (Hard Skills)
- Claims Management Protocols (Hard Skills)
- Cost Management Techniques (Hard Skills)
- Corporate Governance (Hard Skills)
- Financial Control (Hard Skills)
- Legal Liaison (Soft Skills)
- Case Preparation (Soft Skills)
3. Senior Claims Assessor, Gulf Coast Claims Service, Houston, TX
Job Summary:
- Providing high-quality claims assessment for a variety of new and existing insurers, proactively identifying and obtaining all information necessary
- Validate each claim and setting clear management plans
- Investigating claims for Waiver of Premium, Income Protection and Terminal/ Critical Illness benefits and other products that may be specific to a client account
- Delivering an accurate, efficient and high-quality service in line with the Capita Life and Pensions service level agreements
- Providing thorough and robust justifications of decisions and liaise appropriately with colleagues, reassurers and Clients to ensure a fair and correct outcome
- Building and maintaining strong relationships with all customers, colleagues, reassurers, client company contacts and third parties such as Chief Medical Officers
- Offering professional and empathetic communication to claimants throughout the assessment journey.
- Providing line management to the claims handling team
- Reviewing and assessing the validity of claims
- Identifying potentially fraudulent claims
- Keeping customers updated throughout the claims process
Skills on Resume:
- Claim Validation (Hard Skills)
- Fraud Detection (Hard Skills)
- Data Analysis (Hard Skills)
- Regulatory Compliance (Hard Skills)
- Stakeholder Communication (Soft Skills)
- Relationship Management (Soft Skills)
- Decision-Making (Soft Skills)
- Team Leadership (Soft Skills)