Sample Claims Investigator Resume

Posted in Investigator Resume Examples

Robert Tillman
4340 Garrett Street
Three Rivers, MI 49093
(222)-761-3260
[email]

Objective Searching for challenging position in which to utilize my Claims Investigator skills to their fullest.

Qualifications:

  • Remarkable experience in analyzing claims with regard to negligence, proximate cause and comparative negligence
  • Sound knowledge of insurance law and accepted industry practices
  • In-depth knowledge of varied types of insurance fraud and the strategies and methods
  • Exceptional ability to read, analyze and understand common scientific and technical journals, financial reports and legal documents
  • Ability to work effectively in a high-stress environment while maintaining a professional demeanor

Professional Experience:

Claims Investigator, August 2005 – Present
Globaloptions Group, Three Rivers, MI

  • Utilized the historical approvals with same and similar payers.
  • Utilized the FDA approval letters, compared Medicare policy guidelines with the patients indications.
  • Pursued the legal action against payer.
  • Implemented any other appropriate means to gain a favorable outcome.
  • Tracked all cases in appeal for performance measurement and outcomes.

Claims Investigator, May 2000 – July 2005
JBS, Three Rivers, MI

  • Confirmed the coverage, negotiated the settlement and identified subrogation.
  • Obtained the detailed recorded statements with proven knowledge of investigative and interview techniques.
  • Assured compliance to all applicable state regulations.
  • Developed files for transfer and subrogation referral.
  • Established the reserves and claims payable within the delegated authority.

Education

Bachelor’s Degree in Accounts, Indiana University, Bloomington, IN

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