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Soren Mendoza
Claims Service Representative
Summary
Highly experienced and dedicated Claims Service Representative with a proven track record of providing exceptional customer service while handling over 500 insurance claims per month. Proficient in policy interpretation, insurance law and regulations, and skilled in investigating claims, analyzing coverage, and negotiating settlements. Possesses a comprehensive understanding of claim handling processes, ensuring timely and accurate claim resolutions. Committed to providing guidance and support to claimants, ensuring a seamless and stress-free experience.
Education
Bachelor’s degree
April 2016
Skills
- Claims Processing
- Policy Interpretation
- Insurance Law and Regulations
- Customer Service
- Communication
- Negotiation
Work Experience
Claims Service Representative
- Assisted claimants with completing claim forms, providing guidance and support throughout the claims process.
- Monitored claim statuses, ensuring timely processing and resolution, and provided updates to claimants and stakeholders.
- Maintained a comprehensive understanding of insurance policies, coverages, and exclusions to provide accurate claim assessments.
- Collaborated with other departments, such as underwriting and risk management, to ensure consistency and effective claim handling.
Claims Service Representative
- Processed over 500 insurance claims per month, providing prompt and efficient service to policyholders.
- Analyzed and evaluated claims to determine coverage and liability, ensuring accurate and appropriate claim settlements.
- Investigated claims by interviewing witnesses, gathering evidence, and reviewing documentation to establish facts and recommend resolution.
- Negotiated settlements with claimants and their representatives, achieving favorable outcomes while protecting the interests of the insurer.
Accomplishments
- Successfully resolved over 200 complex claims, exceeding service level agreements by an average of 10%
- Developed and implemented a new claims triage process, reducing processing time by 15%
- Managed a high volume of incoming calls, promptly resolving inquiries and providing excellent customer support
- Collaborated with adjusters and third parties to effectively investigate and settle claims
- Negotiated favorable settlements, resulting in significant cost savings for the company
Awards
- Top Claims Service Representative Award for Excellence in Customer Service
- Recognized for exceptional claims processing accuracy, maintaining a 99.5% success rate
- Team Award for Consistently Meeting Performance Goals
- Recognition for Outstanding Communication and Interpersonal Skills
Certificates
- Associate in Claims (AIC)
- Certified Claims Professional (CCP)
- Certified Insurance Service Representative (CISR)
- Certified Insurance Counselor (CIC)
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How To Write Resume For Claims Service Representative
- Highlight your skills in claims processing, policy interpretation, and insurance regulations.
- Showcase your customer service skills and ability to handle sensitive situations with empathy and professionalism.
- Quantify your accomplishments, such as the number of claims processed or the amount of money saved for the insurer.
- Tailor your resume to each specific job description, highlighting the skills and experience that are most relevant to the position.
- Proofread your resume carefully for any errors before submitting it.
Essential Experience Highlights for a Strong Claims Service Representative Resume
- Processed over 500 insurance claims per month, providing prompt and efficient service to policyholders.
- Analyzed and evaluated claims to determine coverage and liability, ensuring accurate and appropriate claim settlements.
- Investigated claims by interviewing witnesses, gathering evidence, and reviewing documentation to establish facts and recommend resolution.
- Negotiated settlements with claimants and their representatives, achieving favorable outcomes while protecting the interests of the insurer.
- Assisted claimants with completing claim forms, providing guidance and support throughout the claims process.
Frequently Asked Questions (FAQ’s) For Claims Service Representative
What is the role of a Claims Service Representative?
A Claims Service Representative is responsible for processing and investigating insurance claims, determining coverage, negotiating settlements, and providing support to policyholders throughout the claims process.
What are the key skills required for a Claims Service Representative?
Key skills include claims processing, policy interpretation, insurance law and regulations, customer service, communication, and negotiation.
What is the average salary for a Claims Service Representative?
The average salary for a Claims Service Representative in the United States is around $50,000 per year.
What is the job outlook for Claims Service Representatives?
The job outlook for Claims Service Representatives is expected to grow faster than average in the coming years due to the increasing demand for insurance services.
What are the steps to becoming a Claims Service Representative?
To become a Claims Service Representative, you typically need a high school diploma or equivalent and some experience in customer service. Some employers may also require a bachelor’s degree in a related field.
What are the benefits of being a Claims Service Representative?
Benefits of being a Claims Service Representative include job stability, career advancement opportunities, and the satisfaction of helping people in their time of need.
What are the challenges of being a Claims Service Representative?
Challenges of being a Claims Service Representative can include dealing with difficult customers, managing a high workload, and working under pressure.