Claims Representative Resume Example

Summary Profile of Claims Representative

Highly analytical and dedicated professional with extensive experience leading all functions of financial crimes analysis, risk management, and project management to confirm optimal compliance with set AML legal/regulatory guidelines.

Skilled at preparing credit risk reports, analyzing/addressing potential issues, while ensuring efficient/accurate processing of corporate actions, improving operational efficiency, and developing innovative solutions to mitigate risks. Proven ability to examine claims data, investigate facts, determine liability, and adjust serious/complex nature claims. Excel at planning, designing, and deploying robust processes, policies, and road maps to detect and mitigate fraudulent activities. Expert at exercising independent judgments and decision-making abilities, while confirming high level of client confidentiality. Adept at developing and sustaining trusted relations with clients, regulators, auditors, and key stakeholders leveraging interpersonal communication skills. 

Areas of Expertise of Claims Representative

⦁ Risk Assessment & Mitigation

⦁ Stakeholders Management

⦁ Strategic Decision-Making Process

⦁ Anti-Money Laundering

⦁ Executive Level Reporting

⦁ Resource Allocation & Management

⦁ Regulatory Compliance

⦁ Compliance Monitoring Plans

⦁ Know Your Customer (KYC) Process

Claims Representative Job Description & Day-to-day Job Duties

Claims representative calculate, process, and handle insurance claims, including examining property damages and physical injuries to calculate claim liability by gathering information from various sources through interviewing claimants, witnesses, and specialists.

Gather required information of current and potential clients via Customer Identification Program (CIP) by reviewing and finalizing advanced due diligence.

Head end-to-end facets related to anti-money laundering by investigating, researching, and preparing documentation to determine level of risk associated with customer accounts by leveraging several tools, such as SAS AML/ECM, OFAC, Enigma, and Actimize. 

Assess and analyze unusual/suspicious activities and process alerts generated by BSA/SAS Anti Money Laundering (AML) systems. 

Provide exceptional administrative assistance to credit risk review managers encompassing seven team leaders and 36 credit risk officers. 

Claims Representative oversees several facets related to time, attendance, and scheduled vacations for credit risk review team members.

Ensure CRR reports are uploaded for regulators by collaborating with Enterprise Risk Management.

Confirm departments’ compliance are in line with set policies and procedures by coordinating with information security and disaster recovery efforts.

Provide routine support in development of documents, expense management through efficient ordering of supplies, and appropriate mail distribution.

Accomplishments & Achievements

⦁ Carried out Know Your Customer (KYC) investigations in line with BSA/AML regulatory compliance requirements.

⦁ Minimized Banks’ exposure to terrorist funding and reputational risk by executing screening process leveraging Bridger LexisNexis watch list and filtered Politically Exposed Persons (PEPs).

⦁ Conducted assessments of 100+ clients and delivered departments’ Service Level Agreements (SLAs), while ensuring absolute quality and accuracy.

⦁ Drafted corporate governance and internal checklist assurance report for signature and delivered to enterprise risk management team.

⦁ Ensured departments’ compliance in line with set policies and procedures by coordinating with information security and disaster recovery efforts.

⦁ Oversaw ESM category managers calendar, while ensuring zero conflicts in schedule. 

⦁ Provided Perfect Client Experience (PCE) by liaising with senior level managers, lines of business, and external clients.

⦁ Approved time and attendance, as well as scheduled sabbaticals for Enterprise Spend Management Teams. 

Core Tools of Claims Representative

Bridger Insight, ActOne, Salesforce, CLEAR, Citrix, SAS AML, SAS ECM, Actimize, OFAC, Enigma Microsoft Office Suite, Microsoft Windows OS, SAP