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Claims Examiner Resume

When a client claims for the insurance amount, his/her claim is not just entertained without any scrutiny. The claim is checked for authenticity, analyzed for the amount to be given, etc. This responsibility comes under the purview of a Insurance Claims Controller or Examiner. A Claims Examiner works with an insurance company and is responsible for checking the claims submitted by the clients, doing the required authenticity check, checking the documentation, and deciding the final amount to be paid to client for settling the claim. Thus, this job role is very crucial and affects the finances of the organization to a great extent. The sample claims examiner resume given below will help an aspiring candidate to learn about the job profile and draft a resume accordingly.

Insurance Claims Controller Resume/ Claims Examiner Resume Sample

Mercy . P. Mike
2105 Cherry Lane
Hartford, CT 06113
Ph: 808-122-5390

Career Objective:

With thorough expertise, zeal to excel, and complete knowledge of functioning of the insurance industry, am looking forward to work with an organization that gives freedom to exercise control over certain things, take the right decisions, and trusts the employee's expertise , when it comes to decision-making pertaining to his job role.

Career Summary:

With a total experience of 7 years am currently working at the position of a Sr. Claims Examiner. I am thorough with regulations governing the claim approvals and acceptance, and am good at calculating the amount to be paid in claims. Till date have handled many claims and have not faced any problem with determining the amount or claim settlement.

Summary of Skills:

  • Thorough with the laws governing the insurance industry and claim settlement procedures
  • Expertise in scrutinizing the insurance claim application, and analyzing the same to determine the amount to be paid in claims
  • Good communication and observation skills that help in thorough analysis of a claim
  • Good at maintaining required public relations with legal firms, banks, hospitals, etc.
  • Good interpersonal skills
  • Good management skills

Professional Experience:

Current Employer: BSP Life Insurance Services, CT (2008-till date)
Designation: Sr. Claims Examiner
Roles and Responsibilities

  • Report to the Branch Manager
  • Responsible for studying the insurance claims
  • Responsible for ensuring that the claims application are correct with reference to application and documents required for further processing
  • Responsible for studying the claims application thoroughly and conducting an authenticity check before further processing
  • After a thorough authenticity and analysis of the application, determine the amount to be paid in the claim settlement
  • Draft a brief report on the same and submit it to the Branch Manager
  • Explain the debt settlement amount calculation to the Branch manager, discuss issues if any, rework the amount if required, and on final approval send the application for further processing
  • Responsible for effective maintenance of the project - both preventive and corrective

Previous Work Experiences:

A] ASA Insurances Ltd. (2005-2008)
Designation: Assistant Claims Examiner
Roles and Responsibilities

  • Report to the Sr. Claims Examiner
  • Assist in analyzing the claim application
  • Assist the client in filling the application form, explain about the documents required , etc.
  • Assist in conducting an authenticity check of the application
  • Assist in determining the claim amount, drafting the report, etc

B] ASA Insurance Ltd. (2004-2005)
Designation: Trainee
Roles and Responsibilities

  • Assist the client in claim application procedure
  • Visit the patient/client in the hospital to check for criticality and authenticity with doctors
  • Assist the clients in the documentation procedures and explaining them the legal regulations or procedures of the organization pertaining to claim settlement


  • Bachelors of Commerce, University of Hartford - 2004
  • Certified Insurance Claims Examiner, Institute of CCAI, Hartford - 2005

Computer Skills:

  • Well acquainted with basic computer and Internet operations, statistical tools, and regulations governing the insurance industry

Extra Curricular Activities:

  • State-level Badminton Player
  • Active participation in sports and cultural events


Looking for suitable opportunities in Connecticut, New York, and Virginia


Available on request


Mercy .P. Mike

The sample claims examiner resume given above helps us understand the job profile of a Claims Examiner. An aspiring candidate willing to work at the said position can use this resume as a template and make the required changes to draft his/her resume. Go ahead, and draft a resume that puts forth your candidature to the best.

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