Top 12 Claims Examiner Skills to Put on Your Resume
A claims examiner plays a pivotal role in the insurance world, reviewing claims with care to confirm validity and alignment with policy terms. To thrive in this demanding seat—and catch an employer’s eye—show a balanced mix of analytical, technical, and people-focused skills on your resume.
Claims Examiner Skills
- Claims Analysis
- Risk Assessment
- Negotiation
- Customer Service
- Regulatory Compliance
- Data Entry
- Microsoft Excel
- Documentation
- Time Management
- Decision Making
- Salesforce
- SQL Queries
1. Claims Analysis
Claims analysis is the structured review of claim facts, policy language, and evidence to determine coverage, liability, and a fair outcome. It blends investigation, policy interpretation, and judgment.
Why It's Important
It safeguards accuracy, reduces leakage, deters fraud, and builds trust. Done well, it protects company resources while treating claimants fairly—no small balancing act.
How to Improve Claims Analysis Skills
Sharpen analysis by strengthening your policy knowledge, investigation habits, and use of tools.
Deepen policy expertise: Study coverage forms, exclusions, endorsements, and jurisdictional nuances. Create quick-reference guides for recurring provisions.
Use technology wisely: Claims platforms, rules engines, and fraud indicators speed review and highlight anomalies.
Lean on data: Spot patterns—loss frequency, severity trends, provider outliers—to guide investigations and reserves.
Tighten communications: Ask precise questions, confirm facts, and document decisions so another examiner could follow your path.
Audit and calibrate: Peer reviews and file audits surface blind spots and standardize decision quality.
How to Display Claims Analysis Skills on Your Resume
2. Risk Assessment
Risk assessment is evaluating the likelihood, impact, and exposure tied to a claim—legitimacy, fraud potential, and financial effect—so actions and reserves match reality.
Why It's Important
It guides fair settlements, curbs overpayment, and flags outliers for deeper review. Precision here cascades through cost, cycle time, and experience ratings.
How to Improve Risk Assessment Skills
Stay current: Laws change. Medical costs shift. Repair rates jump. Refresh your knowledge frequently.
Adopt structured frameworks: Use rating matrices and triage criteria to keep decisions consistent across files.
Elevate data quality: Clean, complete inputs make better outputs. Standardize intakes and close information gaps early.
Partner broadly: Sync with underwriters, SIU, actuaries, nurses, or appraisers to validate risk signals.
Measure and refine: Track reserves-to-ultimate accuracy, dispute rates, and reopenings; adjust your approach from the feedback.
How to Display Risk Assessment Skills on Your Resume
3. Negotiation
Negotiation is the conversation that converts analysis into resolution—finding a settlement figure and terms that align with policy obligations and evidence while respecting the claimant’s position.
Why It's Important
It trims cycle time, limits litigation, and preserves relationships. A firm, fair, well-explained offer can defuse tension fast.
How to Improve Negotiation Skills
Prepare relentlessly: Know the file cold—coverage triggers, damages, comparable precedents, authority limits.
Build rapport: People deal with people. Respect, clarity, and tone matter.
Listen with intent: Uncover interests beneath positions; you’ll find levers you can move.
Anchor with objective criteria: Policy terms, estimates, medical coding, and market rates keep talks grounded.
Craft options: Payment timing, structured payouts, or documented repairs can bridge gaps.
Escalate smartly: Bring in counsel or leadership when authority or complexity demands it.
Debrief every time: Note what worked, what didn’t, and refine your playbook.
How to Display Negotiation Skills on Your Resume
4. Customer Service
Customer service means guiding claimants through a confusing moment—clear updates, realistic timelines, and empathy—while keeping the process accurate and timely.
Why It's Important
Great service takes the sting out of loss. It reduces complaints, boosts retention, and cuts back-and-forth that slows files.
How to Improve Customer Service Skills
Clarify the roadmap: Explain steps, documents needed, and how decisions are made. Fewer surprises, fewer escalations.
Communicate plainly: Drop jargon. Confirm understanding. Summarize next actions.
Practice empathy: People are stressed. Patience and respect go further than you think.
Speed with accuracy: Streamline routine tasks and set response SLAs you can meet.
Follow up: After key milestones, check satisfaction and close loose ends.
Continuous learning: Role-play tough calls, review recorded interactions, and iterate.
How to Display Customer Service Skills on Your Resume
5. Regulatory Compliance
Regulatory compliance is strict adherence to laws, regulations, and guidelines that govern claims handling, timelines, communications, privacy, and fair claim practices.
Why It's Important
It protects consumers, shields the company from penalties, and ensures defensible, consistent outcomes.
How to Improve Regulatory Compliance Skills
Monitor changes: Track updates from relevant regulators and adjust procedures promptly.
Train regularly: Short refreshers on timelines, required notices, and documentation standards prevent costly misses.
Use checklists: Standard checklists reduce omissions and bolster file defensibility.
Audit and remediate: Conduct periodic reviews; fix gaps with targeted coaching and process tweaks.
Document everything: Date-stamped, clear notes and letters are your compliance backbone.
How to Display Regulatory Compliance Skills on Your Resume
6. Data Entry
Data entry is the accurate capture of claim details into systems—loss facts, coverage fields, payments, notes—so analysis and reporting run on solid ground.
Why It's Important
Clean inputs power clean decisions. Errors ripple: wrong reserves, delayed payments, misrouted tasks.
How to Improve Data Entry Skills
Leverage validation: Required fields, dropdowns, and rules prevent bad data at the door.
Optimize your setup: Dual monitors and sane window layouts cut toggling and typos.
Boost typing accuracy: Practice touch typing; prioritize accuracy before speed.
Use shortcuts: Keyboard commands and text expanders shave minutes per file.
Batch similar work: Process like-for-like tasks together to reduce context switching.
Mind ergonomics: Short breaks and a comfortable setup keep fatigue—and mistakes—down.
Train on system updates: New fields and workflows appear; learn them early.
How to Display Data Entry Skills on Your Resume
7. Microsoft Excel
Microsoft Excel is a spreadsheet workhorse for organizing, analyzing, and visualizing claim data to support decisions and reporting.
Why It's Important
It speeds trends analysis, reserve checks, payment audits, and management dashboards—without waiting on a data team.
How to Improve Microsoft Excel Skills
Master core formulas: IF, VLOOKUP/XLOOKUP, INDEX/MATCH, SUMIFS, COUNTIFS—bread and butter for claims data.
PivotTables and charts: Summarize large datasets, slice by loss type, region, or examiner, and visualize results.
Data validation: Keep sheets clean with lists, ranges, and input rules.
Conditional formatting: Spotlight outliers—aging claims, high severities, missed SLAs—at a glance.
Macros and basic VBA: Automate repetitive reconciliations and report refreshes.
Power Query: Import, clean, and combine data from multiple sources reliably.
How to Display Microsoft Excel Skills on Your Resume
8. Documentation
Documentation is the full, orderly record of facts, decisions, communications, and payments in a claim file.
Why It's Important
It proves compliance, explains decisions, enables handoffs, and supports litigation defense when needed.
How to Improve Documentation Skills
Standardize templates: Consistent letters and note structures ensure completeness.
Write plainly: Short sentences. Concrete facts. Actionable next steps.
Be chronological: Date and time stamp notes; capture who did what and why.
Attach evidence: Photos, estimates, medicals, recorded statements—label clearly.
Review and refine: Peer spot-checks keep files audit-ready and crisp.
How to Display Documentation Skills on Your Resume
9. Time Management
Time management is prioritizing and sequencing tasks so claims move steadily—contacts, coverage, investigation, evaluation, and resolution—without bottlenecks.
Why It's Important
Better cadence means faster outcomes, fewer escalations, and less rework.
How to Improve Time Management Skills
Prioritize with intent: Use an urgency/importance matrix; tackle critical-path tasks early.
Set realistic SLAs: Chunk work with time blocks or the Pomodoro technique to preserve focus.
Trim distractions: Turn off nonessential alerts; batch email and phone time.
Lean on workflow tools: Queues, reminders, and dashboards keep the day organized.
Review weekly: Scan aging, next actions, and stalled files; clear roadblocks quickly.
How to Display Time Management Skills on Your Resume
10. Decision Making
Decision making is weighing facts, policy, and risk to approve, adjust, or deny a claim—and recording the rationale clearly.
Why It's Important
It shapes fairness, costs, and customer experience. Good choices today prevent reopenings tomorrow.
How to Improve Decision Making Skills
Strengthen domain knowledge: Know your coverages, case law signals, and market costs.
Structure your reasoning: Define criteria, compare options, and check for bias before choosing.
Quantify where possible: Use ranges, probabilities, and expected values to clarify tradeoffs.
Communicate the why: Explain decisions plainly to claimants and partners; transparency reduces disputes.
Seek feedback: Calibrate with supervisors and peers; study contested or reopened files.
Use decision support: Scoring models, guidelines, and playbooks keep outcomes consistent.
How to Display Decision Making Skills on Your Resume
11. Salesforce
Salesforce is a cloud CRM platform that can centralize claim data, communications, workflows, and reporting for examiners and their teams.
Why It's Important
It streamlines intake, triage, notes, tasks, and analytics—keeping everyone on the same page with fewer handoffs lost to email.
How to Improve Salesforce Skills
Customize for claims: Create claim-specific objects, fields, and page layouts. Align record types and paths to your process stages.
Integrate systems: Connect email, document management, estimating tools, and policy systems for a single source of truth.
Automate with Flow: Use Flow for assignments, notifications, escalations, and approvals. Migrate legacy automations from Process Builder to Flow for maintainability and performance.
Train and govern: Offer role-based training, maintain a change log, and set clear data standards to keep records clean.
Dashboards and reports: Track cycle times, workloads, closures, and leakage indicators in near real time.
Use mobile: Update notes, tasks, and statuses on the go to keep files moving.
How to Display Salesforce Skills on Your Resume
12. SQL Queries
SQL queries are instructions to pull, filter, and manipulate database records—handy when you need precise answers from a mountain of claim data.
Why It's Important
Direct access to data speeds analysis, exposes trends, and supports fraud screening and audit prep.
How to Improve SQL Queries Skills
Select only what you need: Avoid SELECT *; choose fields explicitly to cut noise and speed results.
Index smartly: Ensure frequently filtered and joined columns are indexed; revisit indexes as queries evolve.
Limit results: Use LIMIT or TOP while exploring so you iterate quickly.
Tune LIKE searches: Leading wildcards (e.g., %text) prevent index use; avoid when possible.
Prefer joins thoughtfully: Well-structured JOINs often outperform nested subqueries.
Explain your plan: Use the database’s EXPLAIN tools to spot bottlenecks and adjust.
Batch write operations: Group updates/deletes to reduce locks and churn.
Avoid functions on indexed columns: Wrapping an indexed field in a function can negate the index; refactor filters.
Normalize with care: Reduce redundancy to improve integrity and performance, but balance with reporting needs.
Refresh statistics: Keep table and index stats current so the optimizer makes good choices.
How to Display SQL Queries Skills on Your Resume
