Claim Manager Resume Samples

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F Deckow

Fredrick

Deckow

7709 Wyman Ville

Dallas

+1 (555) 764 2973

7709 Wyman Ville

Dallas

Phone

p +1 (555) 764 2973

Experience Experience

Houston, TX

Claim Manager

Houston, TX

Eichmann-Hansen

Houston, TX

Claim Manager

Contributes to the development and enhancement of claim training/curriculum
Makes recommendations on claim policy and procedures and drives claim initiatives
Report overpayments, underpayments, and other irregularities to management
Prepare reports to be submitted to management for additional authority or coverage issues
Management and coordination of award process
Conduct detailed bill reviews to implement litigation management and expense control
Management of Owner approval process

Houston, TX

Msla-claim Manager

Houston, TX

Runte, Hayes and Glover

Houston, TX

Msla-claim Manager

Develop and monitor goals for staff and the department, providing regular on-going feedback and coaching
Provide leadership and directly supervise team members to ensure performance expectations and milestones are achieved
Conduct regular self-audits of department results, processes and workflows. Analyze the information to improve outcomes and maximize productivity
Work with business leaders and technology team to improve process and system support
Identify opportunities and implement process improvements to optimize outcomes and mitigate costs
Lead and/or participate in workgroups and committees
Assist on RFP’s

present

Phoenix, AZ

PIP Regional Claim Manager

Phoenix, AZ

Klocko-Gusikowski

present

Phoenix, AZ

PIP Regional Claim Manager

present

Coach and counsel others on strengths and areas of opportunity by providing feedback and valuing other perspectives
Monitor and manage expenses
Interview and make hiring recommendations
Collaborate with other RCMs to review and improve processes
Audit files and calibrate with front line manager audit results
Monitor and drive metric results
Listen to recorded calls for customer service and process opportunities

Education Education

Bachelor’s Degree in Technical Complexity

University of Illinois at Chicago

Bachelor’s Degree in Technical Complexity

Skills Skills

Ability to effectively identify, lead, coach, develop and retain talented claim professionals
Ability to drive for superior results in business goals and objectives
Technical expertise, claims resolution skills and knowledge of insurance and claims principles, practices and
Ability to effectively collaborate with CNA's internal and external business partners, possessing excellent
Advanced analytical and problem solving skills, with the ability to prioritize and effectively manage multiple priorities
Ability to effectively deal with ambiguous situations and business issues
Ability to embrace change and value diverse ideas and opinions
Creativity in resolving unique and challenging business problems
Knowledge of Microsoft Office Suite and other business-related software
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13 Claim Manager resume templates

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Scientific Claim Manager Resume Examples & Samples

Sets up and manages the multifunctional team that will deliver the evidence development plan in collaboration with R&D Operations (CMC, Med Experts, Research, Evaluation)
Submits the Evidence Development Plan to Global Brand Managers/ Steering committee
Defines & consolidates budget, resources according to launch marketing plans, ensure Management is in line with recommendations
Implements recommendations of the Global Brand Managers/ Steering committee and develops with the project team the operational plan for the execution of the evidence Development plan
Follows up on the execution of the operational plan with relevant Clinical Operations and coordinate actions to adapt or correct when necessary
Provides updates on project progress to management
Evaluates obtained evidence against target product profile specifications and suggests appropriate actions in case of deviations (in collaboration with MD and project team)
Obtains approvals for corrective actions (if needed) and implements actions in collaborations with project team and relevant competence pillars
Compiles the obtained evidence in a systematic way that allows for easy consultation and communication and contribute to the preparation of claim submission files as needed
Liaises with the communication department for the development of internal and external communication

Excess / High Cost Claim Manager Resume Examples & Samples

Direct technical staff of DIIT and Office of Revenue Operations (ORO) in the preparation and update of computer programs and ensure that necessary technical modifications are compatible with New York State Education Department (SED) and ORO requirements for collecting data used in the preparation and submission of excess cost and high excess cost claims of over $1.3 billion in revenue
Assess and identify metrics on critical student demographics that impact claims. Create and maintain reports for analyzing special education placement and determine the impact on state aid
Manage analytical review of State excess and high cost claims. Create or modify business rules as per the requirement by Education Law in maintaining proper claim data
Utilizing advanced computer tools such as pivots and macros, manage the preparation and submission of thousands of student-specific claim reports as mandated by the State
With support from the Director, represent the Department in response to the State Education Department review of the year end data. Research, analyze, and report on supporting backup documentation. Coordinate and report on all backup documentation as requested by State Education Department. Compile and provide backup documentation as requested by the SED
Explain variances noted on the claim as identified by the State. Recommend revisions to algorithms and business rules as necessary
Prepare modules to construct program costs related to the claim. Coordinate with various program and budget offices with the Department to compile unit cost accounting components for all special education placements
Prepare and update projections as needed for submission to the SED
Develop and maintain computer models of excess and high cost claims to generate projections and simulations that reflect changes in state aid, based on potential/projected changes in student demographics and/or State law
Research current Education Law and assess impact of changes on State excess and high cost aid
Process the Medicaid revenue per Medicaid claims and apply revenue to appropriate revenue codes
A baccalaureate degree from an accredited college and four (4) years of satisfactory full-time professional experience as described in "1" above, including the 18 months of executive, managerial, administrative or supervisory experience described in "1" above

Claim Restriction Manager Resume Examples & Samples

Fluent English　
XLS practice, knowledge necessary　
Medium database administration skills　
Communication skills in a remote team environment　
Mature behavior as communication with senior professionals and FLMs is required.　
Logical thinking and flexibility　
Basic corporate finance understanding
Preferred Technical and Professional Experience

Assistant Manager, Claim Resume Examples & Samples

Medical University Degree
Insurance or financial qualifications is an advantage
Min 3 years work experience in a life insurance or financial services environment
Fast learner and hard working
Leadership and good communication skills
Independent and has the ability to work under pressure
Customer Service Orientation,

Regional Workers Comp Claim Manager Resume Examples & Samples

Works with business units and TPA to reduce Lost Time Days due to WC injuries by providing training, coaching & motivating techniques to mitigate claim costs, i.e. optimal Return To Work
Oversees claims from injury through settlement, intervening when necessary to ensure claim follows clear strategic direction that reflects SHC business initiatives
Develops & implements loss cost reduction strategies by improving processes & financial results
Integrate negotiation piece
Confers with defense attorneys to ensure optimal outcomes. (What does this involve?)
Provides leadership to internal claims professionals, third party administrators, and vendors in the execution of claim service instructions and strategies to maximize Sears' profitability
Identifies claims ripe for settlement & develops strategy to obtain timely, cost effective resolution
Works closely with TPA to manage the Medical component, facilitating Return To Work as soon as medically feasible
Approves settlement evaluation & maintains grant authority as delegated to Director, Workers Compensation
Effective oral & written communication skills

Claim Manager Resume Examples & Samples

Developing and administering all contract documents from the tender process through to contract closeout including variations and issue resolution for design, construction and other project related contracts
Advise the Client on any potential variation to the Design Consultant / Contractor’s Scope of Work that may generate cost or time impact and present PMC assessment
Lead PMC staff in assessing variations, claims, and reports to Client’s representative the position of the proposed variation
Monitor the permanent materials procurement activities by others providing consultation when requested
Evaluate potential risks to the client and to the project and thereafter suggest measures to reduce risks to levels acceptable by the Client
Prepares Progress Report Summaries of overall claims and variations
Supervises specific contracting activities of a project
Management and coordination of award process
Development of contract documents including tender documents
Management of Owner approval process
Monitor contract correspondence
Management of claims avoidance activities/measures
Claims verification of Entitlement and responses
Coordination of contract execution
Contract administration including
Schedule administration
Variation or change administration
Risk management administration
Proper operation of the Project Execution Plan
Periodic preparation and processing of site reports
Assistance to the Coordination Engineer for project reporting requirements
Maintenance of contract documents
Processing of contractor documents

Life Claim Case Manager Resume Examples & Samples

Bachelor’s Degree and 6 or more years of experience in the Claims Area
OR High School Diploma or Equivalent and 8 or more years of experience in Group Life claims area
AND 10 or more years of direct line claims management experience
Knowledge of Life, Disability and Absence Management
Ability to collaborate effectively within a matrix environment
Demonstrate effective research skills
Strong proficiency with MS Office Products
Secures information and reviews coverages to determine liability for life claims
Applies claims and target market knowledge to identify how individually and the wider organization can meet and exceed our customer claim service
Recommend and implement changes to processes, systems
Ensure that appropriate documentation, implementation and communication of established policy, procedures and operating standards is completed for area of responsibility
Document claims file by accurately capturing and updating claims data/information in compliance with best practices
Exercise judgment to determine liability by gathering and analyzing relevant facts
Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate
Meet quality standards by following best practices
Ensure customer service by proactively communicating information, responding to inquiries and follow customer protocols
Ensure legal compliance by following state and federal laws and regulations and internal control requirements
Serve as a technical resource by mentoring lower level claims professionals and sharing technical knowledge related to specific Line of Business expertise
Protect Zurich’s reputation by keeping claims information confidential
Business Travel, as required
Model behaviors that demonstrate commitment to corporate values
Provide input into performance management discussions of project team members
Educate team members and business partners on area of technical expertise
Provide guidance and support for team members
Take action to manage own personal development and encourage others to do the same

Claim Manager Resume Examples & Samples

Manages the work activities and staff of the functional area and has full management responsibility for the performance and development of subordinate staff in accordance with corporate strategic direction. Manages team metrics by analyzing claim reports and driving for superior results
Contributes to organizational profitability by ensuring that claims are effectively managed in accordance with company guidelines and standards. Effectively manages loss costs and claim expenses
Engages with Claim leadership to identify areas of best practice execution and improvement opportunities in assigned line of business. Recommends training and process improvements and works with Field and line of business leaders to determine implementation strategy when process improvements are required. Leads implementation efforts
Builds and maintains collaborative relationships with both internal and external business, such as underwriting, risk control, quality assurance team, staff counsel and actuarial partners
Makes recommendations on claim policy and procedures and drives claim initiatives
Reviews and manages investigation of claim liability and damages, exposure identification, development of action plans for claim resolution
Manages the negotiation of claims settlement packages including setting reserves and authorizing payment or timely refers claims to appropriate location for continued claim handling
Remains current on state/territory regulations and issues, industry activity and trends. May participate in industry trade groups
Contributes to the development and enhancement of claim training/curriculum
Leads project teams and may be accountable for special projects and presentations
Works with claim leadership to assure sound and consistent approach to the investigation, evaluation, reserving and resolution of claims
Works closely with leadership to design and implement training to address identified trends
Ability to effectively identify, lead, coach, develop and retain talented claim professionals
Ability to drive for superior results in business goals and objectives
Technical expertise, claims resolution skills and knowledge of insurance and claims principles, practices and
Advanced analytical and problem solving skills, with the ability to prioritize and effectively manage multiple priorities
Ability to effectively deal with ambiguous situations and business issues
Ability to embrace change and value diverse ideas and opinions
Creativity in resolving unique and challenging business problems
Knowledge of Microsoft Office Suite and other business-related software
Management Experience preferred
Adjusting licensure with potential reciprocity and professional designations preferred
Typically a minimum eight years claims experience with extensive auto physical damage experience preferred

Msla-claim Manager Resume Examples & Samples

Responsible for overall production, performance and quality of the IME Business
Provide leadership and directly supervise team members to ensure performance expectations and milestones are achieved
Work as a point of contact to effectively understand the unique client needs; Manage new client onboarding process; Interacts with clients to strengthen/expand existing relationships and to ensure appropriate and timely resolution of service issues; Recommends solutions for meeting these needs through process mapping analysis, resource allocation, and division of labor
Identify potential new clients and new lines of business; participate in prospective and current client meetings
Work with business leaders and technology team to improve process and system support
Sets team direction, resolves problems and provides guidance to the team members
Develop and monitor goals for staff and the department, providing regular on-going feedback and coaching
Conduct regular self-audits of department results, processes and workflows. Analyze the information to improve outcomes and maximize productivity
Identify opportunities and implement process improvements to optimize outcomes and mitigate costs
Accountable for maintaining effective internal controls over the processes and transactions
Adapts departmental plans and standard operating procedures to address business needs
Influence and/or provides input into forecasting and planning activities
Responsible for managing doctor utilization to ensure they are meeting contractual expectations and timelines
Assist on RFP’s
Lead and/or participate in workgroups and committees
Perform other duties as assigned or required by operational need, or as assigned by Management
Operations Management with specific IME Industry knowledge; Knowledge and Experience working with Independent Medical Exams (IME) and Peer Reviews
Knowledge and understanding of Claim Processes and Workflows
Bachelor’s Degree in Business Administration or Healthcare Administration
5+ years of experience in managing employees
Strong Business and Operations Leader

Manager, Claim Services Resume Examples & Samples

Support account management and client needs by various levels of interaction including conference calls, emails, visits, presentations, and investigative reporting/issue resolution to ensure client retention/satisfaction
Provide timely and professional communication to clients, account managers, direct reports and senior management to effectively support team and company goals
Support the implementation of company directives and processes to meet internal/external client needs such as retention and satisfaction related to the success of the unemployment claims process
Implement and maintain process improvement initiatives as related to system and employee development through the monitoring/streamlining of current operating procedures
Provide leadership, direction and supervision to a team of Unemployment Insurance Consultants (UIC’s), Unemployment Claim Specialists (USC’s), Unemployment Hearing Consultants (UHC’s), Unemployment State Consultants (USC’s), associated Team Leads and/or other supporting claims personnel
Conduct annual evaluations of team members and provide feedback and monitor departmental performance; address performance issues
Evaluate ongoing staffing requirements by reviewing productivity reports, claims and client accounts and hiring and training new employees to meet these requirements
Coach and mentor team members including the facilitation of on-the-job training to develop job skills and effectively address client concerns and meet client needs
Ability to perform multiple tasks at the same time
Ability to respond quickly to unexpected changes
Ability to deal with people in a professional and courteous manner
Ability to communicate and motivate individuals in the department
Creativity and optimism
Ability to interact in written and oral form with clients, state agencies, and all levels of company personnel
Ability to gather, coordinate and present technical data in verbal and written form
Ability to handle high volume of work and work under deadlines
Excellent analytical skills, problem solving and decision making abilities
Ability to work well within a team
Ability to follow policies and procedures; complete administrative tasks correctly and on time
High level of organization and multi-tasking abilities
Ability to handle a high volume of work and work under deadlines
Self-motivated with high level of initiative
HS Diploma or Assoc. Degree. Bachelors Degree preferred
Preferred supervisory or lead experience with a strong emphasis on customer service preferred. Industry knowledge of the unemployment process preferred
Understanding of PC functions, including Windows-based applications and ability to learn/understand internal UCM technology/systems

Claim Manager Resume Examples & Samples

Manage the day to day operations with the Partner Support Center teams
Track and improve the performance of your agents using the daily performance report and regularly assess your agents’ skills using the QA scorecard
Ensure procedures and regulations are enforced
Provide regular, transparent feedback and reporting on team performance to your agents as well as to your manager
Manage and make decision on or escalated complicated case for your team members
Continuously improve the key performance indicators (KPIs) of your team on productivity, quality, service level, and seller satisfaction
Review and improve internal claim and returns processes
Meeting with sellers when necessary to discuss claims and dispute topics and complaints
Thai Nationality only
Bachelor’s Degree or higher in related fields
Team management skills
Results and KPI driven, highly detailed oriented
Ability to prioritize tasks and manage multiple tasks under pressure
Fluent in EN and in TH (speaking, writing and reading skills)
Good technical skills and proficiency in Excel

Msla-claim Manager Resume Examples & Samples

Operations Management with specific IME Industry knowledge; Knowledge and Experience working with Independent Medical Exams (IME)
Bachelor’s Degree in Business Administration or Healthcare Administration or equivalent work experience
3+ years of experience in managing employees

Eso-casualty Claim Manager Resume Examples & Samples

Applications will be accepted for this position through midnight on (internally3/29 and externally 4/5 )
Offer to selected candidate will be made contingent on the results of applicable background checks
Demonstrated experience handling complex casualty claims
Solid knowledge and understanding of each phase of the claim handling processes
Solid knowledge and understanding of casualty policy language, coverages and underwriting intent

Claim Manager Resume Examples & Samples

Builds and maintains collaborative relationships with both internal and external business, such as underwriting, risk control, staff counsel and actuarial partners
Reviews and manages investigations of claims, liability and damages, and works with senior management to determine if major claims should be settled or litigated
Manages the negotiation of claims settlement packages including setting reserves and authorizing payment or refers claims to appropriate location for adjudication
Technical expertise, claims resolution skills and knowledge of insurance and claims principles, practices and procedures
Ability to effectively collaborate with CNA's internal and external business partners, possessing excellent communications, negotiations and presentations skills
Bachelor's degree or equivalent experience. Professional designations preferred
Typically a minimum eight years claims experience

Claim Manager Resume Examples & Samples

Manages the work activities and staff of the functional area and has full management responsibility for the performance and development of subordinate staff in accordance with corporate strategic direction. Manages team and metrics by analyzing recovery/claim reports and delivering desired results
Manages the negotiation of claims settlement, including setting reserves and authorizing payment
Ability to effectively identify, lead, coach, develop and retain talented recovery/claim professionals
Ability to effectively collaborate with CNA's internal and external business partners, possessing excellent communication, negotiation and presentations skills
Typically a minimum eight years commercial claims/recovery experience

OPC Claim Manager Resume Examples & Samples

Provide supervision, leadership, direction and coordination of operational day-to-day activities within the Employees Compensation Claims Team
Manage the claims function to ensure operational efficiency, efficient claims settlement and equitable solution to claims dispute in accordance with company claims philosophy
Support the implementation of claims management strategies and objectives for the region/branch
Initiate new ideas and recommend changes to department policy and procedures as needed
Contribute to the refinement of processes and procedures to improve Claims systems and procedures
Approve substantial claims within appropriate authority levels
Maintain current knowledge of insurance guidelines, policy changes and modifications
Work with key stakeholders/business managers to develop sustainable Claims products and services to attract and retain customers and increase profitability
Quickly respond to and resolve complaints within the agreed service standards. Take immediate corrective actions when necessary
Lead the team to respond to critical issues and exceptions appropriately
Ensure legitimate claims are paid in accordance with policy conditions by providing technical expertise and leadership
Supervise the medical, return to work management, investigation and settlement of all claims within the team
Motivate and develop the team by demonstrating good leadership behaviours and through the use of management best practice, to enable development of staff to support the achievement of business goals

Claim Manager Resume Examples & Samples

Adjust reserves and provide recommendations to ensure reserving activities are consistent with corporate policies
Communicate promptly and professionally with all parties when answering questions and gathering claim information
Conduct detailed bill reviews to implement litigation management and expense control
Confer and direct legal counsel on claims requiring litigation and attend mediations, arbitrations and/or trials when necessary
Contact and/or interview insureds, claimants, witnesses, doctors, medical specialists and/or employers to obtain additional information to mitigate claims
Enter claim payments, reserves and new claims into computer system by inputting concise yet sufficient file documentation
Examine claims investigated by outside insurance adjusters and further investigate questionable claims to determine whether to authorize payments or refer the claim to SIU
Investigate, evaluate and settle claims applying technical knowledge and human relations skills to effect fair and prompt disposal of cases which will result in a reduced loss ratio
Maintain claim files with professional notes and detailed analysis
Pay and process claims within designated authority level
Prepare reports to be submitted to management for additional authority or coverage issues
Present cases and participate in their discussion at monthly claim committee meetings
Report overpayments, underpayments, and other irregularities to management
Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
Perform other duties as assigned by management and mentor less experienced staff
A thorough technical understanding of insurance coverage and claim procedures
A strong team player with initiative and ability to effectively multi-task
Must communicate professionally with excellent verbal and written skills
Computer skills with working knowledge of company software programs
English (Reading, speaking and writing 70%)
Travelling: 40% of time (National and international) *American VISA desirable (but not a MUST requirement)
Candidate willing to relocate to Mexico City, CDMX

Crop Claim Manager Resume Examples & Samples

Manages assigned staff. Maintains proper personnel practices including hiring, performance evaluation, salary administration, promotion, transfer, and termination. Trains and develops staff
Ensures that claims are adjusted and processed correctly according to established loss adjustment guidelines. Adheres to file documentation standards, and Crop Division reserving methodologies and practices
Improves productivity through constant analysis of workflow and procedures while adhering to established L.A.E. goals
Establishes appropriate performance and productivity standards for the efficient processing of all claim-related transactions
Establishes appropriate quality measures; monitors results to ensure high quality service delivery while upholding claim integrity standards
Provides feedback to marketing, underwriting and management staff regarding the quality of business and/or policy files
Manages the field and internal claim staff to ensure timely, accurate and professional service to all agents and policyholders
Participates in the establishment of regional goals, plans, strategies and operating methodologies
Insight and monitoring of adequate reserves
Systematic evaluation of risk to accurately forecast loss ratio projections
Candidates must have a Bachelor’s degree or equivalent business/work experience
5+ years of crop claim experience and 5+ years management/supervisor experience is required

Msla-claim Manager Resume Examples & Samples

Work as a point of contact to effectively understand the unique client needs; Manage new client onboarding process; Interacts with clients to strengthen / expand existing relationships and to ensure appropriate and timely resolution of service issues; Recommends solutions for meeting these needs through process mapping analysis, resource allocation, and division of labor
Operations Management experience
Business and Operations Leader experience
Proficient in general computer use and Microsoft Office Suite
Experience / Knowledge of Peer Reviews
3rd Party Administrator or Insurance Company experience
IME Industry knowledge; Knowledge and Experience working with Independent Medical Exams (IME)
Medical Disability Exam Experience
Knowledge of relevant State and Federal Compliance Guidelines
Prior experience partnering with Sales to identify and on-board new clients

Claim Manager Resume Examples & Samples

Coach and manage the work activities and staff of the functional area and has full management responsibility for the performance and development of staff in accordance with corporate strategic direction. Utilizes team metrics to ensure that behaviors are driving superior results and identifying areas of opportunity
Ensures the team delivers industry-leading levels of service and excellent claim outcomes for our customers
Builds and maintains collaborative relationships with both internal and external business partners, such as Underwriting, Risk Control, Litigation Counsel, and Actuary
Reviews and manages reserving, investigations, liability and damages, and settlements, partnering with Legal and other business partners to achieve optimal results
Ability to effectively identify, lead, coach, develop, and retain talented claim professionals

Specialty Branch Claim Manager Resume Examples & Samples

Demonstrated experience in a leadership role
Solid knowledge and understanding of claim handling procedures
Solid knowledge and understanding of claims concepts and strategies

PIP Regional Claim Manager Resume Examples & Samples

Monitor and drive metric results
Interview and make hiring recommendations
Evaluate performance making recommendations for merit/bonus increases, promotions and performance improvement when needed
Coach and counsel others on strengths and areas of opportunity by providing feedback and valuing other perspectives
Monitor and address customer service issues as needed
Monitor workplace culture and environment, taking action when needed
Review complex files and grant authority for coverage and indemnity when needed
Audit files and calibrate with front line manager audit results
Listen to recorded calls for customer service and process opportunities
Remain aware of changes which impact claims handling in region (internal and external changes)
Collaborate with other RCMs to review and improve processes
Work with Product Managers to gain mutual understanding of what may impact products, pricing and claims handling
Ability to listen and diffuse customer concerns through explanation of our position
Monitor and manage expenses
Maintain and build agent relationships with others
Prior FL PIP claims handling and Management experience
Understanding FL PIP Litigation landscape and how it impacts claims handling
Ability to analyze and interpret data to drive improvement
Solid understanding of compliance knowledge, policy and legal, and how to apply in decision making
Understand the importance of being available and approachable as a leader
Proficient in Microsoft Office (Word, Outlook, Excel, PowerPoint)
Effective organizational and management skills with the ability to work under pressure, multi-task, adhere to project deadlines and successfully adapt to a changing environment
About National General Holdings

Claim Case Manager, SMD Resume Examples & Samples

Strong math aptitude skills
Ability to multi-task and meet turnaround times
Demonstrate independent problem solving and decision making ability
Ability to clearly communicate claim decisions and contract language verbally and in written correspondence
Excellent analytical, problem solving, and communication skills (verbal & written) essential
Ability to multi-task, balance goals and priorities a must
Ability to work independently and within a highly collaborative team environment
Group Disability claim experience or product knowledge strongly preferred
Regulatory and Compliance experience a plus
Understanding of medical terminology and medical conditions helpful
Strong math aptitude skills and PC skills (e.g., Microsoft Word & Excel)
Ability to adapt to change
Minimum 1-2 years of disability claim / case management, or other previous group insurance experience preferred