Claims Examiner Resume

Samantha Gray

North Highlands CA 95660

(916) 987-6543

[email protected]

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Job Objective

To be given the opportunity to work as a Claims Examiner for well-established company where my skills can be used to create a good working environment.

Highlights of Qualifications:

  • Remarkable experience in reviewing and making determinations regarding medical insurance claims
  • Exceptional knowledge of CPT/HCPC and ICD9 coding, procedures and guidelines
  • Ability to conduct investigative interviews
  • Ability to interpret and apply laws, rules and regulations
  • Ability to maintain records, prepare reports and conduct correspondence related to the work
  • Ability to obtain and utilize sensitive information discreetly and objectively

Professional Experience:

Claims Examiner, August 2005 – Present

Sedgwick CMS, Sugar Land, TX

  • Processed general liability claims by collecting information to determine liability exposure.
  • Assigned reserve values to claims, made claims payments as necessary and settled claims up to designated authority level.
  • Managed subrogation of claims and negotiated settlements.
  • Ensured claim files are properly documented and claims coding is correct.

Claims Examiner, May 2000 – July 2005

Sedgwick Claims Management Services, Sugar Land, TX

  • Reviewed and processed all incoming claims to verify necessary information.
  • Entered claim data and information in the computer system.
  • Maintained all required documentation of claims examined and claims on hand.
  • Preserved confidentiality of all claims files, claims reports and claims-related issues.


High School Diploma, South Fort Myers High School, Fort Myers, FL