Claims Analyst Resume Guide

Enthusiastic and detail-driven claims analyst with 4+ years of experience in the insurance industry. At XYZ, successfully identified fraudulent activity on over 500 claims resulting in a savings of $1.2M annually. Skilled at analyzing complex healthcare data to assess risk and ensure accuracy while meeting tight deadlines. Adept at process improvement initiatives that reduce costs while maintaining quality service levels for policyholders.

Well-rounded claims analyst with 5+ years of experience in the insurance industry. Possesses a comprehensive understanding of policies and regulations, as well as an aptitude for problem-solving. Seeking to join ABC Insurance Company where I can apply my expertise to ensure excellent customer service and effective claims management. At XYZ, achieved 97% accuracy rate in auditing processes while reducing processing time by 28%.

Energetic and organized claims analyst with five years of experience in the insurance industry. At XYZ, managed and processed up to 1,000+ claims per month for a variety of insurance products such as auto, property damage, worker’s compensation and liability policies from inception through closure. Skilled at identifying fraudulent or inaccurate data on policy documents while ensuring customer satisfaction is met every time.

Hard-working and detail-oriented claims analyst with 5+ years of experience in reviewing and processing insurance claims. Committed to providing excellent customer service while striving for accurate resolution of complex cases. At Company X, successfully processed over 1,000 claims per month without any errors or omissions. Seeking to join ABC Insurance as a Claims Analyst to utilize my expertise in the field.

Seasoned claims analyst with 8+ years of experience in the insurance industry. At XYZ, successfully managed over 1000 customer accounts and achieved a 92% rate of successful claim resolution. Received recognition for consistently exceeding expectations on customer satisfaction surveys by 7%. Skilled at quickly assessing complex situations to determine best possible solutions while adhering to legal guidelines.

Reliable and analytical claims analyst with six years of experience in the insurance industry. Seeking to leverage expertise in data analysis, customer service, and problem-solving skills at XYZ Insurance Company. At ABC Insurance Company, handled over 2000 claims while maintaining a 98% accuracy rate on all claim payments. Successfully identified fraudulent activities that saved the company $50K per year.

Determined claims analyst with 10+ years of experience developing and implementing claims-processing policies. Expertise in insurance claim analysis, contract interpretation, dispute resolution and customer service. Seeking to leverage exceptional problem-solving skills to join ABC Insurance as a senior claims analyst, helping the company grow by providing accurate and timely services for clients.

Detail-oriented claims analyst with 5+ years of experience assessing and verifying insurance claims. Looking to join ABC Insurance as a Claims Analyst, where I can apply my keen eye for detail and passion for accuracy when investigating customer claims. In previous roles, saved company over $1 million in fraudulent payouts by identifying incorrect information on submitted documents.

• Structured and implemented a new claims process that improved accuracy of payments by 15%, while ensuring compliance with all legal and regulatory requirements.
• Optimized existing procedures to reduce the average turnaround time per claim from 10 days to 4, resulting in quicker resolution for over 500 customers monthly.
• Successfully managed a team of 5 Claims Analysts responsible for reviewing complex insurance documents and resolving disputes within 48 hours on average each month; reduced customer complaints by 25%.
• Reported discrepancies between healthcare policies and actual payments accurately, enabling proper reimbursement rates across different providers within an 8-state region; saved $50K annually from fraudulent activities identified through audits & investigations conducted quarterly.
• Negotiated settlements with medical facilities as needed to resolve disputed claims promptly, maintaining an 85% success rate in successful resolutions without involving external mediation services or court proceedings.

• Revised over 300 insurance claims per month and successfully negotiated settlements with claimants, resulting in a 20% increase in savings for the company within the last year.
• Demonstrated expertise in interpreting complex legal documents to ensure that all claims were compliant with state regulations and industry standards; lowered errors by 10%.
• Utilized specialized software systems such as ClaimVantage and Verisk Analytics to track cases, analyze data points and generate detailed reports on claim statuses.
• Introduced process improvements which streamlined workflow processes from 72 hours to 48 hours average turnaround time on property damage claims; improved customer satisfaction rating by 25%.
• Thoroughly investigated suspicious or fraudulent activities related to submitted insurance applications or processed claims; identified $45,000 worth of frauds over the past 18 months through close examination of payee statements & policy details.

• Adjudicated over 250 insurance claims valued at over $2 million, ensuring accuracy and compliance with applicable regulations.
• Resolved customer disputes in a timely manner; reduced claim resolution time by 15%.
• Actively investigated suspicious or fraudulent claims to identify errors and discrepancies to minimize payouts for false/inaccurate information provided by customers.
• Settled complex high-value cases within minutes of negotiation, helping the company save an approximate $500K in potential losses per annum due to erroneous processing fees & inaccurate documentation issues reported by claimants.
• Facilitated accurate data entry into the internal system while providing top-notch customer service throughout each step of the process; improved overall complaint ratings from clients by 25% year-on-year.

• Represented an insurance company’s claims department, handling an average of 70+ client cases and resolving disputes within a timely manner.
• Processed over 500 validations for liability coverage, personal injury protection and medical payments; achieved 98% accuracy rate in verification process.
• Spearheaded investigations into all disputed claims to determine validity and ensured that appropriate actions were taken as per the policy guidelines; reduced resolution time by 25%.
• Competently managed high-profile cases involving bodily injury or property damage, successfully negotiating settlements with clients while ensuring compliance regulations were followed at all times.
• Formulated comprehensive reports summarizing the findings of each case and provided accurate documentation to support evidence; raised data entry efficiency by 40%.

• Analyzed and processed over 1,000 claims daily in a fast-paced insurance environment; identified and resolved discrepancies to reduce processing errors by 25%.
• Reconciled accounts using various methods of reconciliation such as P&L analysis, trial balances and trend tracking; improved accuracy rate from 65% to 95% within 6 months.
• Improved customer satisfaction ratings through timely resolution of disputes arising from claims payments & policy changes with minimal supervision required.
• Independently managed the end-to-end process for 100+ complex cases focusing on fraud prevention and risk mitigation strategies; reduced fraudulent activity by 30%.
• Coordinated closely with all stakeholders involved including customers, vendors, internal departments and external agencies to ensure proper closure of cases in compliance with industry regulations.

• Researched and analyzed medical records and insurance policies to determine the validity of claims, reducing claim discrepancy by 30% in a 3-month period.
• Participated in weekly meetings with members of other departments to discuss discrepancies between denied/approved claims and resolved issues within 24 hours on average.
• Resourcefully identified trends in fraudulent or suspicious activity while conducting reviews; reported 7 cases of fraud which resulted in a total savings of $25,000 for the company over 6 months.
• Expedited payments for valid claims by verifying accuracy and completeness prior to submission, increasing data entry efficiency by 10%.
• Documented all pertinent information regarding pending or approved/denied claims into an organized database system; successfully maintained 90+ files during each shift without any errors noted.

• Proficiently investigated 100+ insurance claims per day, ensuring that all data was accurate and up-to-date.
• Reduced fraudulent claims by 25% through detailed analysis of claim files and customer background checks; saved the company $10,000 in payroll costs over 6 months.
• Achieved a 98% accuracy rate when manually entering claim information into the computer system within 2 hours of receiving it from customers or agents; reduced average processing time for each case by 7 minutes.
• Analyzed historical medical records to determine whether treatments were medically necessary or not; identified 3 cases where patients received unnecessary services resulting in savings of $15,500 for the firm’s clients annually.
• Compiled weekly reports on new and existing cases for management review using statistical methods such as regression models to identify trends & patterns across different types of claims & policies.

Bachelor of Science in Business Administration
Educational Institution XYZ
Nov 2011

Certified Professional Claims Analyst
Claims and Litigation Management Alliance (
May 2017