Claims Examiner Resume Sample and Job Description

In a multibillion dollar business such as insurance there is the need for a specialist who verifies the clients’ claims for authenticity, policy following and file completeness. This is the job of the claims examiner, an insurance specialist who acts on behalf of the insurer and should behave like an auditor or even a detective, for the more complicated cases.

The claims examiner is required to have excellent reasoning abilities to be able to tell truth from erroneous requests and select requirements done in good faith from those looking to trick the company. To apply to this job a bachelor’s degree in a business, management or even legal field is a good starting point, completed by a few years of experience spent in an insurance office. Additional certifications might be necessary to be allowed to work in some states.

When applying and interviewing for a claims examiner job, be sure to focus on the smallest details that can really make a difference, highlight your reporting abilities and list the compliance guidelines you are able to follow, adapted to the niche you are looking to work in.

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Tips for Claims Examiners Resumes

Detail-oriented and critical thinking

Use your judgment and logical thinking to put together the argumentation behind each case. See if the facts validate the claims and the client is entitled to the amount they require. Don’t overlook any small element including the circumstances and the actions that were taken. Investigate each case, paying attention to those coming from known controversial sources or cases similar to each other. Make sure you look at each document on file and check it for authenticity and relevance.

Report generation

This is a job requiring excellent written communication skills, as the claims examiner is supposed to put together a report describing the results of the cross examination. Most companies require a mix of forms and written evaluation of the situation. The examiner is supposed to accept or deny the claims based on his investigation. In the case when there is not enough evidence to take a motivated decision, they can ask for additional documents. They are held accountable by the employer for their decisions.

Client consultancy

The claims examiner is required to keep in contact with the client throughout the evaluation process and notify them about any changes, intermediary results or obstacles. The role also implies explaining to the client what they are entitled to as a result of the policy, the evaluation process, the possible problems and an estimation of the time necessary to get the approval and get the money. Responding to any client inquiries and asking any additional questions that might solve the case faster are also on the list.

Claims Examiner’s Resume Samples

The following resume samples and templates for claims examiner can help you get a better idea of what your resume can look like.

 

A claims examiner should always adjust their resume to the specific job description and make sure they highlight their strong points.

Additional Claims Examiners Resume Tips

• Computer proficiency – As an important part of the job is to operate digital platforms like client databases, computational software, analysis programs and so on, the claims examiner is expected to feel comfortable operating a computer.
• Legal knowledge – Claim examiners are the first line of specialists evaluating clients’ requirements from the insurance company. In the case a client feels the amount received does not match the promise, they can sue the insurance company. In this situation the claim examiner will be cited in court and is required to act as an expert and support the case.

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