Claims Investigator Resume

Posted in Investigator Resume Examples

Robert Tillman
4340 Garrett Street
Three Rivers, MI 49093

Objective Searching for challenging position in which to utilize my Claims Investigator skills to their fullest.


  • Remarkable experience in analyzing claims with regard to negligence, proximate cause and comparative negligence
  • Sound knowledge of insurance law and accepted industry practices
  • In-depth knowledge of varied types of insurance fraud and the strategies and methods
  • Exceptional ability to read, analyze and understand common scientific and technical journals, financial reports and legal documents
  • Ability to work effectively in a high-stress environment while maintaining a professional demeanor

Professional Experience:

Claims Investigator, August 2005 – Present
Globaloptions Group, Three Rivers, MI

  • Utilized the historical approvals with same and similar payers.
  • Utilized the FDA approval letters, compared Medicare policy guidelines with the patients indications.
  • Pursued the legal action against payer.
  • Implemented any other appropriate means to gain a favorable outcome.
  • Tracked all cases in appeal for performance measurement and outcomes.

Claims Investigator, May 2000 – July 2005
JBS, Three Rivers, MI

  • Confirmed the coverage, negotiated the settlement and identified subrogation.
  • Obtained the detailed recorded statements with proven knowledge of investigative and interview techniques.
  • Assured compliance to all applicable state regulations.
  • Developed files for transfer and subrogation referral.
  • Established the reserves and claims payable within the delegated authority.


Bachelor’s Degree in Accounts, Indiana University, Bloomington, IN

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