Claims Examiner Resume Example (Free Guide)

Are you an experienced Claims Examiner looking for a new job? Our Claims Examiner Resume Example will help you create an effective resume that will catch the eye of potential employers. Our guide will walk you through the process of creating a resume, from writing a compelling summary to showcasing your skills and work experience. With our help you will be able to create a resume that will make you stand out in the job market and get the job you want.

We will cover:

How to write a resume, no matter your industry or job title.
What to put on a resume to stand out.
The top skills employers from every industry want to see.
How to build a resume fast with our professional Resume Builder.
What a resume template is, and why you should use it.

Plus, we will provide expert resume writing tips and professional examples to inspire you.

What does a Claims Examiner do?

A Claims Examiner's job is to review insurance claims to ensure that they meet criteria and are accurate. They are responsible for determining if a claim is valid and if so, what coverage and benefits the policyholder is entitled to. They also analyze policy language to determine coverage and investigate the facts of the claim to make sure that the claim is properly documented. Claims Examiners may also make recommendations for settlement amounts and review medical records for accuracy.

We’re about to begin, but first, here are some other Claims Examiner related resume examples:

What are some responsibilities of a Claims Examiner?

Examine and evaluate insurance claims to determine coverage and liability
Investigate and analyze claims to determine validity and potential liability
Review evidence such as police reports, witness statements and medical records
Correspond with claimants and insurance companies to obtain additional information and clarification
Make decisions regarding coverage and liability on behalf of the insurance company
Negotiate settlements with claimants
Prepare written reports and documentations
Maintain updated knowledge of insurance laws and regulations

Sample Claims Examiner Resume for Inspiration

Name: John Doe

Address: 123 Main St, Anytown, CA 12345

Phone: (123)456-7890

Email: john.doe@example.com

Highly experienced Claims Examiner with 10+ years of experience in the insurance industry. Adept at analyzing and evaluating insurance claims, identifying discrepancies and investigating potential fraudulent claims. A team-player who is committed to excellent customer service and creating a positive work environment.

Work Experience

Claims Examiner, ABC Insurance, Anytown, CA - June 2016 - Present
- Review and process insurance claims for accuracy and compliance with policy coverage
- Conduct investigations to verify claims and determine the extent and appropriateness of coverage
- Contact claimants, physicians and other health care providers to obtain additional information and documents
Claims Adjuster, XYZ Insurance, Anytown, CA - April 2014 - June 2016
- Investigated and processed health and disability insurance claims
- Researched and interpreted policies and contracts to determine coverage and liability
- Provided excellent customer service to claimants

Education

Bachelor’s Degree in Business Administration, ABC University, Anytown, CA - May 2013

Skills

Claims Processing
Medical Terminology
Contract Analysis
Investigation
Customer Service

Certifications

Claims Adjuster – State of California - June 2016

Languages

English (native)
Spanish (conversational)

Resume tips for Claims Examiner

Creating a perfect, career-launching resume is no easy task. Following general writing rules can help, but it is also smart to get advice tailored to your specific job search. When you’re new to the employment world, you need Claims Examiner resume tips.
We collected the best tips from seasoned Claims Examiner - Check out their advice to not only make your writing process easier but also increase your chances of creating a resume that piques the interest of prospective employers.

Highlight any experience you have gained in customer service.
Include any special certifications or licenses you have obtained.
Mention any claims or appeals experience you have.
List any technical skills you possess, such as working with claim software.
Include any previous claim investigation experience you have.

Claims Examiner Resume Summary Examples

A claims examiner resume summary or resume objective is important to include in your resume because it allows employers to quickly identify your qualifications, experience and skills. It is a concise overview of your background and qualifications as they relate to the position you are applying for. It should be tailored to the specific job you are seeking and should highlight your strongest attributes and experiences. This will help employers identify you as a potential candidate and determine if you are the right fit for their organization.

For Example:

Experienced Claims Examiner with 10+ years of experience in reviewing insurance claims for accuracy and completeness. Demonstrated ability to quickly evaluate claim requests and minimize loss for the company.
Highly organized Claims Examiner with expertise in analyzing claims data and identifying risks. Proven track record of achieving favorable outcomes for clients while meeting all required regulations.
Knowledgeable Claims Examiner with a strong background in customer relations and dispute resolution. Skilled in providing timely and accurate information to ensure optimal customer satisfaction.
Accomplished Claims Examiner with 8 years of experience in managing, researching and resolving complex claims. Exceptional communication, problem-solving and negotiation skills.
Compassionate Claims Examiner with 5+ years of experience in managing and resolving insurance claims. Adept in preparing claims and resolving disputes with customers in a timely manner.

Build a Strong Experience Section for Your Claims Examiner Resume

A strong experience section on a claims examiner resume is important to highlight your expertise and achievements in the claims industry. This section will show potential employers your qualifications and professional experience, which could help your chances of getting an interview. An effective experience section should include your job titles, dates of employment, and a list of your key responsibilities and accomplishments. Additionally, it should demonstrate your technical skills, analytical abilities, and problem-solving skills, which are essential for a successful career in claims examining. Having a strong experience section on your resume will help you stand out from other applicants and demonstrate to employers that you are the right fit for the job.

For Example:

Provided exemplary claims services in a high-volume environment.
Evaluated submitted claims to ensure compliance with state and federal laws.
Reviewed claims information to determine the validity and accuracy of submissions.
Investigated and resolved discrepancies in claims data.
Examined documents such as medical records, police reports, and court records to support claims.
Assisted with the development and implementation of claims processes and procedures.
Developed and maintained effective relationships with claimants and other stakeholders.
Compiled and analyzed claims data to identify trends and uncover areas of improvement.
Completed all required paperwork in a timely and accurate manner.
Provided timely and accurate responses to claimants’ inquiries and requests.

Claims Examiner resume education example

A claims examiner typically needs at least a high school diploma and some experience working in customer service and/or insurance. More advanced positions may require additional education, such as an associate's or bachelor's degree in an area such as finance, business administration, or insurance. Insurance-related certifications may also be required.

Here is an example of an experience listing suitable for a Claims Examiner resume:

Bachelor of Science in Business Administration, University of Maine – Portland, OR (2013)
Associate of Arts in Business Management, Portland Community College – Portland, OR (2011)
Certified Claims Examiner, Oregon Insurance Institute – Portland, OR (2016)
Continuing Education Courses in Insurance Claims Adjusting, Oregon Insurance Institute – Portland, OR (2018)

Claims Examiner Skills for a Resume

It is important to add skills for Claims Examiner Resume in order to demonstrate that you are qualified and have the necessary competencies to do the job. Examples of skills to include could be attention to detail, problem solving, customer service, conflict resolution, organizational skills, data entry, and communication. These skills will help employers to identify if you are a suitable candidate for the position.

Soft Skills:

Communication
Interpersonal
Organizational
Analytical
Negotiation
Decision-making
Research
Problem-solving
Time-management
Attention-to-detail

Hard Skills:

Claims Processing
Data Analysis
Risk Assessment
Customer Service
Regulatory Compliance
Document Review
Loss Adjustment
Investigation Skills
Claims Negotiation
Problem Solving

Common Mistakes to Avoid When Writing a Claims Examiner Resume

In this competitive job market, employers receive an average of 180 applications for each open position. To process these resumes, companies often rely on automated applicant tracking systems, which can sift through resumes and eliminate the least qualified applicants. If your resume is among the few that make it past these bots, it must still impress the recruiter or hiring manager. With so many applications coming in, recruiters typically give each resume only 5 seconds of their attention before deciding whether to discard it. Considering this, it's best to avoid including any distracting information on your application that could cause it to be thrown away. To help make sure your resume stands out, review the list below of what you should not include on your job application.

Not including a cover letter. A cover letter is a great way to explain why you are the best candidate for the job and why you want the position.
Using too much jargon. Hiring managers do not want to read a resume full of technical terms that they do not understand.
Omitting important details. Make sure to include your contact information, educational background, job history, and any relevant skills and experiences.
Using a generic template. Take the time to customize your resume to the job you are applying for. This will show the employer that you are serious about the position.
Spelling and grammar errors. Always double-check your resume for typos, spelling mistakes, and grammar errors.
Focusing too much on duties. Make sure to include accomplishments and successes to show the employer that you are a great candidate.
Including personal information. Avoid including any personal information such as age, marital status, or religious beliefs.

Key takeaways for a Claims Examiner resume

Highlight your technical skills related to claims processing and medical terminology.
Detail your experience in handling claims accurately and efficiently.
Include any special certifications or licenses related to claims examining.
Mention any achievements or awards related to claims processing.
Demonstrate your ability to work effectively with other team members.
Highlight your experience in utilizing various insurance databases.
Mention any additional skills such as customer service or problem solving.

It's time to begin the job search. Make sure you put your best foot forward and land your next job with the help of Resumaker.ai.