Resume

Claims Specialist Resume Example & Writing Guide

Use this Claims Specialist resume example and guide to improve your career and write a powerful resume that will separate you from the competition.

Claims specialists are responsible for processing insurance claims in a timely and accurate manner, helping customers recover from an accident or illness, and getting them back on their feet again. If you’re passionate about helping people and enjoy solving complex challenges, this might be the perfect role for you.

Before you can start helping clients, you’ll need to write an excellent claims specialist resume that will get you noticed by hiring managers. Here are some tips and an example to help you do just that.

James Smith
Phoenix, AZ | (123) 456-7891 | [email protected]
Summary

Claims specialist with eight years of experience in the insurance industry. Proven ability to successfully manage and resolve claims while maintaining positive relationships with clients. Skilled in data analysis and investigation.

Education
Arizona State University Jun '10
B.S. in Business Administration
Experience
Company A, Claims Specialist Jan '17 – Current
  • Processed and reviewed medical claims for accuracy, completeness, and timeliness in accordance with company guidelines.
  • Communicated directly with customers to resolve issues related to their health care coverage or benefits.
  • Assisted the customer service representatives by providing information regarding specific insurance plans, eligibility, etc., as needed.
  • Provided support for other departments such as underwriting, marketing, sales operations and finance when required.
  • Maintained current knowledge of applicable laws and regulations pertaining to healthcare industry practices and procedures through training programs and continuing education opportunities provided by the Company.
Company B, Claims Specialist Jan '12 – Dec '16
  • Created and maintained a database of all open claims, including the status of each claim, its dollar amount, and any notes on specific cases
  • Communicated with insurance companies to obtain additional information needed for processing claims; this reduced outstanding balance by 25%
  • Resolved customer complaints regarding coverage or billing issues; resolved 95% of these issues before reaching senior management
  • Reviewed medical records to determine if there were inconsistencies between what was reported and what was actually performed
  • Maintained an average daily production rate of 15+ new claims per day
Company C, Customer Service Representative Jan '09 – Dec '11
  • Answered customer inquiries via phone, email, and chat regarding company products and services.
  • Resolved customer complaints and issues in a timely and efficient manner.
  • Created and updated customer accounts in company database.
Skills

Industry Knowledge: Car Insurance, Home Insurance, Medical Insurance, Health Insurance, Life Insurance, Disability Insurance, Medicare Insurance
Technical Skills: Microsoft Office Suite, Salesforce, SalesforceIQ
Soft Skills: Customer Service, Teamwork, Problem Solving, Communication, Leadership

How to Write a Claims Specialist Resume

Here’s how to write a claims specialist resume of your own.

Write Compelling Bullet Points

Bullet points are the most effective way to showcase your experience and qualifications. But rather than simply listing your responsibilities, you can make your resume more interesting by using bullet points to describe the results of your work.

For example, rather than saying you “conducted research for new product development,” you could say that you “conducted research for new product development, resulting in 10 new products launched in 2018 alone.”

The second bullet point is much more interesting and provides a clear sense of the scope of the project. It also provides a quantifiable result—10 new products launched in 2018 alone—which makes it easy for the reader to understand your contribution.

Related: What Is a Claims Specialist? How to Become One

Identify and Include Relevant Keywords

When you apply for a job as a claims specialist, your resume is likely to go through an applicant tracking system (ATS). This program will scan your resume for specific keywords related to the position, like “medical billing” or “insurance claims.” If your resume doesn’t include enough of the right terms, the ATS might filter out your application.

To increase your chances of getting an interview, use this list of common claims specialist keywords to help you identify the most relevant skills and experience to include on your resume:

  • Insurance
  • Claims Management
  • Property & Casualty Insurance
  • General Insurance
  • Commercial Insurance
  • Liability
  • Workers Compensation
  • Underwriting
  • Workers Compensation
  • Legal Liability
  • Auto Insurance
  • Reinsurance
  • Casualty Insurance
  • Professional Liability
  • Risk Management
  • Homeowners Insurance
  • Customer Service
  • Employee Benefits Design
  • Claims Adjusting
  • Umbrella Insurance
  • Insurance Claims
  • Medical Billing
  • Healthcare
  • Hospitals
  • Medicare
  • Electronic Medical Record (EMR)
  • Patient Advocacy
  • Medical Coding
  • Revenue Cycle
  • Medical Records

Showcase Your Technical Skills

As a claims specialist, you are responsible for handling and processing insurance claims. In order to do this effectively, you need to be proficient in the use of technology. This might include familiarity with insurance claims software, customer service software, or accounting software. Additionally, claims specialists need to be familiar with the insurance industry and the types of claims that are common in that industry.

Related: How Much Does a Claims Specialist Make?

Remember The Basics

As you draft your resume, there are a few basic rules to keep in mind.

Make Sure Your Resume Is Easy to Scan

There are a few things you can do to your resume to make it easier to read and understand. First, left-align your text and keep the font size consistent. You should also try to keep your bullets under 2 lines each and use digits for numbers. Finally, leave some white space on the page to break up the text and make it easier to scan.

Be Concise

There is no set length for a resume, but a resume should typically be one page long when you have less than 10 years of experience. When you have more experience than that, a two-page resume is more appropriate. When trimming down your resume, remove irrelevant information, filler words, and unnecessary details.

Proofread

Proofreading your resume is key to making sure it looks its best. Spelling mistakes, punctuation mistakes, and grammatical mistakes can all be easily corrected with a careful eye. Having someone else proofread your resume is also helpful, as they can catch mistakes that you may have missed.

Consider a Summary

A resume summary statement can be an extremely valuable addition to your resume, particularly if you’re hoping to make a career change. By highlighting your relevant skills and experiences, as well as your future goals, you can make it much easier for potential employers to see how you might be a valuable addition to their team. Keep your summary statement brief and to-the-point, and be sure to focus on your most highly transferable skills and experiences.

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