Claims Resume Samples

The Guide To Resume Tailoring

Guide the recruiter to the conclusion that you are the best candidate for the claims job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

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M Jerde

Macy

Jerde

136 Gottlieb Ramp

Chicago

+1 (555) 560 1123

136 Gottlieb Ramp

Chicago

Phone

p +1 (555) 560 1123

Experience Experience

Boston, MA

Claims Intern

Boston, MA

Frami-Nolan

Boston, MA

Claims Intern

Assisting in the processing, investigating, and resolving claims. Research, survey, and provide follow up when necessary
Assist in simple claims processing work
Provide daily support to Allstate claims employees and assist with day to day activities including process, training, and communication
Assist in workflow review and streamline projects
Assist in generating letters and other correspondences
Will be assigned to a specific claims team with duties assigned by the Team Manager/Supervisor
Work with the telephone claims unit to follow claim processing routine

Boston, MA

Claims

Boston, MA

Reichert, Franecki and Prohaska

Boston, MA

Claims

Assist SIU management in providing claims fraud awareness training to the Regional Claims Office staff
Develop, analyze, and complete reports to submit to management on team performance
Develop, analyze, and prepare reports to submit to management on team performance
Makes assignments to nurse case management when indicated, monitoring their billing and performance
Collect and analyzes data to evaluate operational processes and makes recommendations to secure improvement
Collect and analyzes data to evaluate Medicate operational processes and make recommendations to secure improvement
Works closely with underwriting and risk engineering partners to provide feedback on policy forms and claim analysis

present

Boston, MA

Director of Claims

Boston, MA

Howe, King and Trantow

present

Boston, MA

Director of Claims

present

Manage according to established expense, reserve and settlement authority levels and internal claims policies established by the VP of captive management
At the direction of Claims VP, provide coaching, set expectations and manage the performance of the team
Develop close working relationships with risk managers, defense attorneys, internal staff, and vendors who support the claims operation
Oversees the management of day to day activity of the new day and rework claims teams
Effective problem solver, who anticipates issues, seeks out and analyzes information collaboratively to propose and implement solutions. Takes ownership for a successful resolution
Oversee the operational and technical work of the claims team and implement claim handling best practices to coordinate consistent and successful handling of all claims, especially claims with potential large exposure
Collaborative mind-set and willingness to work with people outside immediate reporting hierarchy to improve processes and generate optimal departmental efficiency

Education Education

Bachelor’s Degree in Related Field Preferred

Ohio University

Bachelor’s Degree in Related Field Preferred

Skills Skills

Excellent team player capable of learning and sharing knowledge in a global team environment
Team player demonstrating strong collaborative orientation with the ability to build strong relationships across the organization
Works within highly complex assignments requiring specialized knowledge in breadth and/or depth in area of expertise
Basic knowledge and experience working within a team environment
Ability to develop high performance teams and be a strong team player
Basic knowledge of developing and managing project work
Applies highly advanced knowledge of insurance policy, coverage, and regulation
Ability to investigate, evaluate and settle highly complex claims
Applies highly advanced knowledge of training facilitation and coaching skills
Applies highly advanced ability to leverage learned technical skills in support of team objectives

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Citishare Claims & Adjustments Manager Resume Examples & Samples

Acertain advanced knowledge in various software programs and expertise on 13 different network operating rules, regulations and requirements across all networks
Analyze and provide management MIS on exception volume to facilitate exception reduction
Develop impact analysis on third party operating rule changes and deliver settlement and exception processing training to TCSeServe and Citishare client base
Analyze Claims and Adjustment Unit processes in improving controls and to facilitating quarterly self-assessment in preparation of audit review
Manage internal processes to minimize financial risk to the business and Citigroup client base and to ensure regulatory compliance and or timing guidelines set forth by all third party processors
Manage settlement exception processing relationships with Citishare businesses and third party processors to ensure open and comprehensive communication
Broker partnerships and leverage existing alliances to ensure that high customer service standards are maintained
Provide day-to-day C&A oversight Management to TCSeServe to ensure incoming exceptions are accurately processed within network guidelines in mitigating potential losses to Citishare
Review eClaims in-box daily as part of management process to ensure no holdover
Complete STR and SMR to resolve the issues when internal applications and network online systems become unavailable which would potentially have negative impacts on productivity
Review the D&F differences on the aging report weekly and Arbitration reports to ensure timely follow-up to resolve any pending issues
Review monthly exception volume variance and annotate any fluctuations/root cause to management
Represent C&A department at STR meetings relative to vendor, system, network and production issues
Collaborate with third party networks or businesses in determining root cause and work with respective acquirer to implement fixes to minimize exceptions
Interface with project managers on new projects and document project requirement implication to ensure all task are tested by preparing test scripts; perform quality assurance testing and review output test results before project is implemented
Interface with external vendors ACI and Datajump to enhance internal systems upgrade to Claims Manager and eClaims. Analyze MIS yearly exception volume to reduce exception rate and cost to forecast budget plan for the unit
Prepare Management Summary report of C&A issues monthly
Manage / Approve the eClaims and RDP user entitlement request through Market Place
Manage risk and drives productivity based on best practices
Achieve zero write-offs by providing oversight to TCS Management Team
Manage C&A eClaims system and perform UAT testing for projects and network migrations
Update Citishare Operating Rules and reviews supervisor updated PCMs network operating rules in accordance to product revisions and/or changes of practices in the industry. Notify the businesses for them to implement these changes on their internal systems if necessary. Deliver settlement and exception processing training to staff and business client base
Collaborate with external vendor Datajump on internal system upgrades such as eClaims
Act as the primary backup to update the eClaims Admin tables with new Clients and Networks
Perform Annual COB Test for South West Data Center
Provide backup support across Operational Service Units (Customer Service, Change Control, Info Center and Business Support) as required
Strong experience in EFT settlement and back office operations
Customer service investigation experience
Banking knowledge
Accounting skills
Accounting – 1 to 2 years
Banking/Operations for ATM / POS - 3 to 5 years
MS OFFICE suite: Excel, Word, Power Point
SQL Data

AVP, Ontario Claims Resume Examples & Samples

Ensure a consistent legendary customer experience at every interaction aligned with the TD Brand
Contribute to making TDI a world class organization recognized as being an exceptional place to work
Deliver, in partnership with Claims Executive team, key metrics around Customer and Employee Experience, Operational Excellence and delivering on our financial commitments
Proven operations leadership is critical, along with a solid understanding of the Customer Experience, Customer Problem Resolution and the Customer Experience Model
Identify and make recommendations for business/process improvements while working with various business partners across TDI
Possess the ability to guide others to a desired conclusion and have the ability to hold them accountable
Devote time and energy to developing Senior Managers and Managers, specifically adhering to the Performance Management Practices and Leadership Profile, by coaching and supporting direct reports in reaching their objectives and delivering business results and an exceptional employee experience

Senior Living Claims Director Chicago Resume Examples & Samples

Responsible for input on development and execution of the strategies of the practice
Monitors and improves the performance of trading partner’s services for your clients
Participates in strategic large client meetings as required
Manages the quality and appropriateness of client service agreements
Ensures appropriate program design and documentation - service scope aligns

Multinational Claims Resume Examples & Samples

· Development of annual claim service plans including reaching agreement of special handling instructions and reporting procedures with applicable claim service providers and issuing documents to clients
· Coordination of Aon claim team members assigned at the country level
Coordination, collection and presentation of claim data on behalf of client corporate risk management.Participate in on-site claim audits
Desk Based advice to client on claim matters, status and coverage interpretation
Coordination of the escalation of sensitive claims with carriers, third parties administrators and adjusters, all subject to Aon’s formal protocols
· Identification of opportunities for the introductions of Aon Claims and/or risk control consulting services, the scope of which is beyond the base service

Global Captive Claims Resume Examples & Samples

Manage time spent in the delivery of agreed client services to ensure content quality, timely delivery, and profitability
Meet or exceed assigned billable hours and utilization goals
Communicate and collaborate with manager and captive managers to identify opportunities for new business development
Establish rapport and maintain positive working relationship with clients and colleagues
Adhere to established Best Practices and make recommendations for improvement, when appropriate
Maintain knowledge/skills as an insurance professional and possess excellent written and verbal communication skills
Participate in telephonic or in-person claim reviews and audits designed to result in file resolution, inclusive of documenting claim specific outcomes and action plans
Attend and participate in periodic on-site client meetings regarding service delivery and/or stewardship

Claims Processing Specialist Resume Examples & Samples

Review source documents for completeness and accuracy. Compare information in system against source documents to ensure accuracy
Enter data into computer accurately and within established time frames
Resolve problem claims not accepted by system edits and audits as appropriate
Perform research as appropriate to resolve claims issues. Make determinations utilizing both SOPs(Standard Operation Procedures manuals) and on line help screens
Achieve and maintain established production and quality standards
Follow up on processing issues and make suggestions for system efficiencies
High School Diploma or equivalent; may hold post-high school Degree
Six to 1 year of working experience in related fields (Medical Billing or Claims processing )
Some office experience, computer experience or data entry skills,
Some healthcare related knowledge
Ability to read and interpret moderately complex documents such as procedure manuals, and government/healthcare guidelines

Motor Claims Resume Examples & Samples

Analysis of first notification of Own Damage and Third Party liability claims
Pro-active treatment and settlement of claims
Manages portfolio of claims allocated
Controls cost through identification of potentially fraudulent cases and recovery cases
Works flexibly in the Motor Claims Team to meet customer needs
Operate within Service Level Agreements and Claims compliance deadlines
Undertakes special projects or assignments as required

Claims Operational Excellence Manager Resume Examples & Samples

May lead team in addition to leading cross-functional project teams to drive process improvements within the business. Responsibilities include scheduling and facilitating project team meetings, developing project plans to include identification of key deliverables and timelines, summarizing and communicating project status, training and coaching project team in the use of Six Sigma tools. Generally accountable for projects expected to have significant client impact and/or greatest margin improvement
Employ structured methodology and analytics to problem identification and solution process; utilize data analysis techniques to identify process improvement opportunities and develop solutions for the business. Mentors and coaches other, less experienced Black Belts on the appropriate use of Six Sigma tools
Employ consultative techniques in uncovering and assessing process improvement opportunities within the organization through dialogue with operational leaders and team members. Categorize process improvement opportunity as either enhancement to client experience or margin improvement; ensure alignment with Client Service strategy and objectives. Propose improvement recommendations to the leadership team
Facilitate the adoption of a process improvement culture and practice within the business. Prepare a thorough analysis of downstream impacts of project deliverables, identifying all impacted areas and stakeholders; partner with other organizations such as finance, compliance, technology, etc
Facilitate the integration of a culture that incorporates efficiency and productivity/performance improvement to operating procedures throughout the organization by providing formal training programs or utilizing more informal communication methods
Develop key metrics of success and track accordingly. Monitor project cost and progress in project deliverables. Track project outcomes relative to financial saves; ensure documentation to project planning system and incorporation of financial saves to departmental budgets
Strong project leadership skills with demonstrated experience analyzing business processes; history must demonstrate successful project coordination
Demonstrated interpersonal and written communication skills; able to work effectively with all levels of staff and cross-organizationally
Exhibits strong affinity toward training and mentoring others to build capabilities in process improvement methodology
Previous people leadership or coaching experience
Six Sigma Black Belt or Lean Process experience

Unemployment Claims Lead Resume Examples & Samples

Serves as primary contact directing and consulting with partners, managers, partner resource generalists throughout the organization and external parties on matters related to unemployment insurance
Assists the manager with departmental staffing decisions and ensures smooth partner on-boarding Participates in departmental strategic planning
Contributes to the development and tracking of department metrics and key performance indicators to measure team and individual performance
Maintains a high level of proficiency in company unemployment insurance objectives. Performs research and analysis to maintain expertise in state unemployment policies, laws, and regulations
Supports and executes team training for new partners as well as driving ongoing learning opportunities for the team
Identifies and implements recommendations for continuous process improvements and actively supports the ideas of others
Acts as a floor coach ensuring accurate information is being communicated, answering questions and handling escalated calls and cases for timely resolution and customer satisfaction
Analyzes and resolves complex or escalated issues
Responds and ensures timely, courteous and professional follow up to all incoming case documentation and communication to completion. Manages specialized and senior level partner unemployment claims
Audits the quality of information provided to the state and prepares related reports
Assigns work and reviews work product, ensures all claim deadlines are met, determines additional resources, if needed and supports service levels by taking escalated calls
Develops partner knowledge to build a strong and knowledgeable team
Supports vendor compliance and serves as a primary contact for vendor communication
Lead or supervisory experience (1 year)
Project or program management (1 year)
Customer service experience (2 years)
General Human Resources (3 years)
Case management experience (3 years)
Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Visio, Microsoft Project)
Ability to deliver strong customer service
Ability to organize work and manage time
Ability to handle sensitive information and maintain confidentiality

Avp Claims Americas Resume Examples & Samples

Manage a team of highly skilled professionals within the global organization
Develop the strategic vision of the department and implement the necessary action plan to improve interactions and service quality optimizing resources
Motivate and inspire the Claims professionals within the Americas Region
Ensure the application of corporate guidance from the Worldwide Claims Substantiation
Participate in the development of Worldwide Claims Substantiation guidelines and processes
Liaise with Legal Department, when claims related issues are at stake, both in demand and in response
Communicate and promote Claims Substantiation for the Americas for all stakeholders
Partner with senior management on issues related to claims in terms of company responses and positions
Minimum of ten years industry experience (cosmetics, personal care products, pharmaceuticals or food). Specific experience in claims substantiation required
Juris Doctor degee is required
Must have prior leadership experience
Advanced communication, leadership and influencing skills
Participation in various technical & liaison organizations within the industry
Excellent organizational skills and the ability to handle multiple tasks
Able to interact successfully within an R&I environment
Experience working in a Global Organization
Multi-lingual - In addition to English fluency, Spanish is strongly preferred. Portuguese and/or French would also be a plus
Must be legally eligible to work in the US on an on-going basis

Initial Claims Processing Specialist Resume Examples & Samples

Proficiency in Microsoft Office Word, PowerPoint, and Excel
Ability to maintain a good attendance record and possess a desire to learn
Prior experience with initial claims processing
Experience working in a call center environment and/or customer service environment
Prior experience in the health insurance industry
College degree or some college coursework

Claims Divisional Manager Resume Examples & Samples

Maintains and controls proper technical authorities/experts throughout the division and personally handles escalated client complaint issues
Assists senior leaders in areas of development regarding system enhancements, technology enhancements, vendor selection, and departmental workflow
5+ years of auto claims handling
Strong leadership skills that includes effective coaching and collaboration
Presents issues in a highly professional manner; excellent communication skills-both verbal and written
Solid understanding of regulatory environment and state statutes that affect the insurance industry; ability to translate this knowledge to procedures

Claims Complaint Specialist Resume Examples & Samples

Formulates DOI/BBB complaint responses, addressing all concerns and gather all necessary documents to file a complete and timely response meeting all state requirements. Ensure all responses are accurate and objective. Partner with Claim Leaders on all responses
Investigate and monitor complaints to ensure compliant business practices are being followed. Work with Claim Leaders and the Training Manager to close identified gaps
Work with the AAH compliance area as well as Claims Compliance on any research needed of applicable laws and regulations
Complete reports around analysis and trending of complaints. Complete other reports requested by internal business area as needed
3-5 years of relevant claim experience
Strong verbal communication and interpersonal skills
Continuous desire to learn
Associate in Claims-designation-Am Institute of Chartered Property Casualty Underwriters

Manager, Guest Claims Resume Examples & Samples

Compliance with federal and industry guidelines
Fostering and maintaining positive relationships with key stakeholders, partners, vendors, and regulatory agencies
Oversight of department budget and forecasting
Recognizing and responding to incidents that have significant exposure
Management of claim-level and aggregate financials
Strategic business planning and implementation
Adherence to excess policy and reporting requirements
Development and oversight of a team in excess of 25 Cast Members
Florida 520 License in Good Standing
Proven accomplishment as a leader
Proactive communicator who can interface effectively at all levels in the company and can appropriately influence business results through negotiation, persuasion and personal presence
Possess unquestioned ethics and integrity
Demonstrated compassion and commitment to diversity and inclusion including inviting diverse
Demonstrated strong partnering skills that result in a positive business results
Demonstrated strong analytical skills and ability to synthesize various sources of information
Demonstrated strong organizational skills with attention to detail
Demonstrated understanding of medical and legal terminology
Bachelor’s Degree in Business, Risk Management, or associated field, or a minimum of 15 years Florida Liability Claims Management experience of which 5 years were in a leadership role

Claims Spec / Asst Resume Examples & Samples

Receive calls and emails from insured’s, beneficiaries, agents, attorneys and funeral directors who are calling to report or inquire about the status of a claims (average 150 calls per person per week)
Prepare new claim file with information for the Examiner who will pay/deny the claim
High school education needed along with 0-2 years of experience with computers and insurance background
Knowledge of claims process
Skills Advantage Work Ready Certificate, Optional. Above average telephone and customer service skills, legal terminology, dependability and strong organizational skills
Knowledge of the claims department, other departments within the company and the other offices that form Transamerica would be helpful

Claims Cost Mgmt New Opportunity Manager Resume Examples & Samples

Lead a team of highly motivated associates to uncover new cost savings concepts utilizing the latest methods and technologies that are available in the industry
Work side by side with the entire Claims Cost Management dept. to ensure all overpayments are actively pursued and every angle is researched
Network with peers within Humana and the industry to stay on top of the latest concepts, contracts, edits, etc that are put into place in the healthcare field
Work with multiple business partners to identify and pursue all opportunities where Humana and the healthcare industry are at risk
Report activities and progress towards goals and objectives within CCM and ensure that objectives stay aligned with department goals
Must be highly organized yet flexible to always adapt to the everyday changing business environment in Claims Cost Management
Always looking for ways to improve processes and improve efficiencies. Inspire team to act and improve current models and ways of doing business and look for the next new idea
Proven reporting and organization skills
Demonstrated success working in collaboration with multiple departments and disciplines
Strong computer skills including MS Office desktop applications (Word, Excel, PowerPoint)
Demonstrated competency in both oral and written communication skills
Solid understanding of process / work flow concepts
Excellent interpersonal and teamwork skills
Master’s Degree in Business, Finance or related fields
Humana Claims experience (CAS or Metavance)
Previous experience successfully identifying fraud, waste, abuse or overpayment situations/concepts
Healthcare claims processing experience

Senior Systems Manager, Medicaid Claims Resume Examples & Samples

Has very strong domain working expertise with Medicaid
Must have strong functional expertise and understanding of Medicaid claims and its end to end lifecycle
Has working knowledge of healthcare EDI transactions
Has working knowledge of healthcare administration, preferably within the government environment
Must be able to conduct in-depth functional discussion with client’s IT and Operational SMEs
Must know end to end Medicaid system and business operations to be able to help steer client, IT and Operations team to implement policy related system changes
Constantly look for federal and state level regulatory compliance needs and work with account manager to make proposal for system enhancements/process upgrade to keep system and business process compliant with changing needs
Four (4) year degree from accredited college or university
Bachelor’s / Master’s degree in computer science or related area of studies are a plus
Minimum of 8 years of hands on project management experience with direct responsibility and ownership of the project
Minimum of at least 5 years in a leadership role for a government or private sector health care organization
Previous, recent, and successful experience with MMIS (or equivalent) or MMIS claims expertise is required
Proficient with Microsoft Office and MS Project like tools
Experience on .net architecture and technology is a plus
Has working experience of managing multiple vendor based delivery teams
Has working experience of writing contract to outsource work

Claims Processing Specialist Resume Examples & Samples

Proficiency in all Microsoft Office Programs, including Word, PowerPoint, Excel
Related work experience
College degree or some college coursework preferred
Fluency in Spanish

Claims Processing Specialist Resume Examples & Samples

Read and understand insurance benefits to estimate coverage and patient out of pocket responsibility
Ability to meet quality and efficiency metrics in a production environment
Some customer service duties with the majority of your work on the computer
Documenting case files with complete notes on work
Complete special projects as needed
Organized and attentive to details
Proactive, positive attitude
Ability to work the hours stated below
Previous Medical Insurance experience

Team Member, Claims Contact Centre Resume Examples & Samples

Responsible for the assessment, management and administration of a portfolio of risk product claims within delegated authority to achieve profitability targets
Ensure claims are actively managed to by ensuring appropriate investigations are undertaken such as medical, financial and factual
Manage FOS, SCT and Litigated Claims (in conjunction with relevant stakeholders), including drafting of written responses
Meet specified quality and service standards
Effectively and pro-actively communicate with both internal and external stakeholders to build strong relationships
Provide technical training and assistance to new members of staff
Act as a point of reference for technical queries including assistance with documentation of guidelines and procedures where required
Contribute to presentations where required
Assist with reporting and internal/external audits where required
Support management direction and change processes – acting as an advocate within the team as necessary, and participation in projects as directed by Team Leaders
Actively participate in Projects including system enhancements and UAT testing where required
Encourage innovation and problem solving
You will have come from a contact centre environment
Experience in AWD and Eclipse would be an advantage
Knowledge of claims processes, definitions under policies, techniques in claims investigation

Team Lead, Claims Resume Examples & Samples

Bachelors Degree preferred but not required
Prior experience with Claim Management processes preferred
Proficiency in MS Word and Excel required
Strong critical thinking, mathematical, problem solving, decision making & analytical skills are desired
Detail oriented with solid interpersonal skills
Demonstrated strong Customer Service skills
Willing to consider someone with a strong retail or operations management background that is interested in gaining a knowledge of Group Insurance products.**

Common Depositary Claims Resume Examples & Samples

Provide respective ICSD’s with timely and accurate responses to daily queries
Review and reconcile any data discrepancies with Euroclear and Clearstream in advance of upcoming scheduled payments
Provide Euroclear and Clearstream with timely feedback on a daily basis for all data discrepancies
Provide a central point of contact for Euroclear and Clearstream Income teams
Participation in weekly / monthly client service conference call’s
Accurate logging of all queries/responsible area and closure date leading to provision of daily metrics with sound analysis of fluctuations
Assistance in completion of all daily processes/deliverables across Depositary team
Provision of weekly metrics with sound analysis of fluctuations
Working closely with team leader to identify areas of operational risk and co-writing system of checklist to minimise risk; reviewing and signing checklists daily
Provision/submission of Monthly Management Control Assessment (MCA) paperwork
Leads and/or participates in projects as directed by the Team Leader/Section Manager and provide feedback on project related activities
Provide progress reports and support to Team Leader as required
Participate in any root cause analysis on a daily basis
Initiative is essential
Strong organisational skills and an ability to work accurately under pressure
Ability to work within a team dealing with high volumes
Ability to work under pressure and meet strict deadlines
Highly productive with good organisational/time management skills
Ideally from an Operations background with sound understanding of securities
Good understanding of general MS software packages (Excel, Word, and Outlook)
Knowledge of Euroclear and Clearstream would be advantageous
Knowledge of Product type / structures, documentation, swift formats would be advantageous

Claims Case Manager Resume Examples & Samples

Answer the 1-800 ITVERP Resource Line, responding to and assisting victims of international terrorism
Process victim applications for reimbursement, including but not limited to, drafting and mailing claimant, collateral source and provider correspondence
Enter and track all claims activity into Excel based tracking systems
Interact regularly with victims of international terrorism
Draft expense summary sheets in Excel for claim recommendations
Draft meeting minutes, after action minutes, and weekly reports for Program Manager review
Participate in and contribute to weekly case management meetings
Maintain daily operations of the claims management process
Respond to data requests in a timely matter
Interact professionally with diverse government officials, including but not limited to, the Department of State, the Federal Bureau of Investigation, and the National Security Division within the Department of Justice
Bachelor’s degree in Social Work, Psychology, Sociology, Counseling, Mental Health, Anthropology, Education, or other Social Science related discipline required
2+ years of government based, client, or customer facing experience in the social sciences field
Experience interacting professionally with a wide variety of stakeholders
Experience drafting diverse documents (i.e. letters, reports, correspondence, and claim recommendations)
Proficiency with Microsoft Office (Word, Excel, and PowerPoint)
Ability to obtain a Department of Justice security clearance, which involves a criminal background and credit check
Previous experience with client management highly preferred
Experience working in a consulting environment and with government programs preferred
Demonstrate immaculate attention to detail
Ability to produce high quality work required
Ability to be flexible, multi-task, prioritize, detail-oriented, and manage multiple activities simultaneously in a fast-paced, changing environment
Experience working directly with victims of crime
Ability to speak another language fluently
Experience processing claims
Experience working in the field of international terrorism
Demonstrate commitment to client satisfaction
Ability to exercise good judgment, discretion, tact, and diplomacy
Solid customer service skills
Strong team player with the ability to take initiative and work well independently
Strong outreach abilities and interpersonal skills

Director, Claims Oversight Resume Examples & Samples

Motivate management staff and subcontractors to effectively manage their departments to consistently meet quality and production goals
Promote total quality management by challenging staff and subcontractors to evaluate processes and modify as business needs changes while staying within budget
Evaluate system technology and develop strategic plans to determine changes which meet the customer’s needs and work with other departments to implement
Develop and maintain relationships with other departments within Humana Government Business, Inc., subcontractors, markets, DHA and TRO Staff
Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and role essentials
Perform special projects and other duties as assigned by management
Maintain trend performance data to identify adverse outcomes and root causes
Meet with government representatives, beneficiary or provider groups to address claims and operational issues and provide a pro-active communication plan
8-10 years management experience in medical insurance industry with direct claims and/or systems
Goal and result oriented with proven track record
Project management and decision making skills
5-10 Years of health care industry knowledge in Medicare or TRICARE
5 Years of Claims Operations knowledge
Mater's degree

Claims Case Manager Resume Examples & Samples

Completes follow-ups with Claimants (Claimant Feedback Tool)
Provides ongoing updates to the ITVERP Operation Manual and ITVERP Policy Manual
Drafts revisions/updates to ITVERP standardized forms/templates or memos as needed, and submits to PM review

Claims Resume Examples & Samples

Minimum of Bachelor’s degree and 10 years’ experience in ski resort industry. Prior hospitality and amusement industry experience a plus
Must be an advanced level skier/rider
Written and verbal skills paramount. Must be a polished public speaker and comfortable addressing crowds large and small
Must be familiar with Microsoft suite of products and comfortable using/exploring new software programs
Must be able to work independently, take initiative, develop relationships and execute plans with clients, carrier partners, and industry associations
Strong decision-making skills essential

Claims Director Resume Examples & Samples

Ensure the team to meet business goals, specifically financial targets, with a long-term focus on sustainability and strategic objectives
Proactively engage with and influence stakeholders internally and externally to gather insights and facilitate alignment of deliverables and utilize available resources
Enhance the technical skills of claim assessors by compiling the claims guidelines and provision of training programs
Participate in new product development by reviewing policy provisions, product brochure and product materials, setting claim administrative guidelines, training to assessors and reviewing claim forms
Assist in reviewing claims procedures and guidelines and ensuring regulatory changes are adopted
Provide training on claims guidelines and procedures to distribution channels
Keep updated of market information and share the best practice with the team
Lead any ad hoc project as assigned
Minimum of 12 years solid individual life or medical claim assessment experience with at least 6 years in leading assessment teams
Degree from a recognized University
Professional qualification in life insurance including FLMI (Fellow, Life Management Institute), ALHC (Associate, Life and Health Claims), ACS (Associate, Customer Service) would be an advantage
Proven leadership, people management and problem solving skills
Attentive to details with strong analytical and presentation skills
Strong communication skills, able to communicate well in both business and technical aspects with people from at different levels
Proficiency in written and spoken English and Chinese
Good PC knowledge in MS Excel, Word and PowerPoint

FCD Claims Resume Examples & Samples

Responsible for the overall management, coordination and maintenance of one of the major segment of the Bank's operations activities
Assist in the formulation, recommendation and implementation of operations policies
Direct the study and establishment of new and revised systems, procedures, methods, and forms
Accountable for budget management
May be responsible for cross-site / function project leadership
May serve as center manager for site
Has the ability to influence across department / site
Have impact on the Bank's earnings, operation or image and a major impact on the functional area
Ensure assigned area(s) are adequately staffed and all personnel are trained and developed
Work with peers throughout the Bank to develop, enhance and implement business strategies
Build external relationships in functional area
8+ years of operational management experience with at least 5 years in call center environment (virtual network/call routing environment)
Exceptional leadership skills in creating an environment where employees are excited, engaged and capable of delivering optimum performance
Proven communication and diplomacy skills to work cross-functionally to influence others, drive results/change, and implement projects/processes
Experience in credit/debit card investigation and chargeback processing with knowledge of Visa/MasterCard rules and regulations
Extensive fraud knowledge and background preferred
Strong PC skills in Microsoft Office and specific knowledge of systems and applications used to support a call center environment

Claims Professional Resume Examples & Samples

Preparation for and participation at claims reviews
Analysis of claims data and reserve exposures
Identifying and promoting action on opportunities for claim cost mitigation
Participation in client / carrier meetings
Ongoing communication with internal clients to best support the renewal process, program close out process and other duties as needed
Travel required (25-30%)
7 -10 years of experience with a carrier or third-party administrator adjusting worker’s
Broker, construction claim experience, and experience working with multi-state worker’s compensation jurisdictions would be a plus

Claims Professional Resume Examples & Samples

Position is currently located in Jericho, NY and will be relocated to Garden City, NY – Fall 2016
Proficiency with MS Office suite products (Word and Excel)
5 -10 years of experience with a carrier or third-party administrator adjusting worker’s

Claims Specialists Resume Examples & Samples

Has intermediate computer skills including: word processing, spreadsheet and powerpoint software
System savvy, attention to detail and action orientated person
Possesses strong written and verbal communication skills in both English and Mandarin

Manager, Casualty Claims Resume Examples & Samples

Oversight of claim activities for operations in all 50 states and Canada, representing over 2,300 open claims with $134 million incurred costs
Serve as point of contact to OPCO and TPA for claims management responsibility
Manage, maintain and enhance the partnership with Third Party Admistrators (TPA)
Monitor claim files for exectuation of appropriate claim handling and reserving practices while providing technical support and oversight
Collaborate on action plans for claim settlements within specific financial thresholds
Communicate and coordinate new policies and procedures & implementation between Sysco and TPA
Provide support with Corporate Safety Services and Enterprise Risk Management team to align strategies and goals to minimize incidents and costs
Generate and analyze claims loss runs and reports to identify and communicate trends
Communicate status of claims, claims cost and reserve information to OPCO as necessary
Serve as Corporate claims representative on all initial serious claims calls and telephonic claim reviews
Attend trials, mediations, arbitrations, hearings and other forums as needed
Partner with OPCO HR managers to ensure timely and appropriate Return to Work (RTW) for associates with or without restrictions
Determines actual time missed from work due to work related injuries and illnesses and provides accurate information to both the OPCO and TPA to ensure accurate DART tracking
Bachelor’s Business Administration Degree required and or equivalent combination of education and experience
Ongoing continuing education courses required
5 years’ claim adjusting experience with an insurance company or TPA dealing with high volume multi-jurisdictional workers’ compensation, general liability and auto liability claims and two years of experience with a large employer
Excellent analytical and interpersonal communication skills
Ability to interact effectively all levels
Excellent presentation and team building skills
Thorough understanding of the casualty claim process
Strong understanding of medical and legal terminology
Strong critical thinking ability, attention to detail and ability to multi-task in a fast paced environment
Promote teamwork and quality service through daily comunication and coordination with other departments

Claims Senior Service Specialist Resume Examples & Samples

Provides back-up for any support functions in the office
Investigate prior losses and other information on file and orders reports as needed at the direction of adjusters and managementReceives, screens and routes incoming telephone calls and other electronic correspondence
Prior experience providing excellent customer service experience in an office environment preferred
Ability to perform routine tasks of basic complexity under general supervision
Fluency in both Spanish and English is especially desirable

Claims Intern Resume Examples & Samples

Gain exposure to the overall Claims operation
Provide daily support to Allstate claims employees and assist with day to day activities including process, training, and communication
Currently in good academic standing, pursuing a Bachelors degree graduating in December 2016 or Spring 2017

Claims Liability Intern Resume Examples & Samples

Candidates should possess the following skills, experience, and attributes
Demonstrates strong verbal and written communication skills
Ability to work both on a team and independently and with integrity

Expense Claims Solutions Team Lead Resume Examples & Samples

Manage and coordinate a team of business analysts
Handle the operating budget and planning of the team (allocation of resources, recruiting, reporting)
Ensure proper functional analysis and process definition in line with Expense Claims Core Model
Manage deployment projects, tools enhancements and major incidents (Project Management and roadmap, release management and major incident reporting)
Prepare and participate to governance committees with IT, Group Finance, the Businesses and Concur Third-Party
Master’s degree in Finance or Business
Professional experience: Minimum 3 years of experience as a manager of small teams in the field of Cost Accounting or Finance
Experience in managing and maintaining Finance or Accounting tools
Experience using Concur Expense software or equivalent tools a plus
Experience using ERP or other similar general ledgers is a plus
Fluent in French (minimum B2 Level, CECRL certificate)
Leadership & Coaching skills
Quick self-starter, pro-active attitude with ability to work in a fast changing environment and with international locations
Strong communication skills (spoken & written)
Strong analytical mind, problem solving, planning & organisation skills
Ability to work under tight deadlines

Senior Director / Director, IFP Claims Resume Examples & Samples

Ensures that the Underwriting and Claims Management Policy and the Claims Standards set out in the Product Risk Management Manual are implemented within the business unit, where applicable. The implementation includes developing more detailed claims guidelines that are appropriate for the business unit’s specific business. Also, ensures claims staffs’ compliance with the detailed claims guidelines
Oversees Claims participation in product development to ensure that any claims concerns are raised and that Claims practices are appropriate to the product’s target markets and pricing assumptions
Ensures that the department’s claims practices and procedures align with the International Claims Association’s Statement of Principles
Participates in the selection of reinsurer(s) and in reinsurance treaty negotiation
Ensures treaty documentation reflects Manulife’s standards for claims and ensures compliance with treaties
Maintains excellent relationship with reinsurers
Provides leadership and direction in the hiring, professional development and training of the claims staff in order to maintain Manulife’s reputation as a recognized and experienced leader in insurance industry
Responsible for determining appropriate levels of claims approval limits for all lines of business. This includes recommending changes to the maximum approval limits for any level of claims staff to Underwriting & Claims Risk Management. Also, responsible for ensuring that delegation of approval limits to each claims staff are based on established criteria that is clearly communicated ad monitored
Responsible for the internal audit process of the Claims Department, ensuring that the audits are conducted in accordance with standards agreed upon with Underwriting & Claims Risk Management and the Underwriting & Claims Risk Committee. Ensures that audits finding and trends are reported to Underwriting & Claims Risk Management semiannually
Oversees that the risk(s) is understood from the outsourcing of claims business functions, activities or services to affiliates or third parties. Ensures that there is effective identification, mitigation, management and monitoring of all inherent risks associated with outsourcing and that they are managed in a manner consistent with all applicable policies
Oversees ongoing monitoring of claims trends sharing any changes, e.g. increases in incidence, increase in contestable claims, etc, with management within the BU, including Underwriting and Pricing
Active in industry committees, forums, meetings, etc. representing the Company to industry peers and distributors. Keeps abreast of emerging issues/trends, including litigation and arbitration trends, and regulatory changes that impact claims revising detailed claims guidelines as necessary. Ensures that claims staff is made aware of such changes and comply with them. Advises Underwriting & Claims Risk Management of any emerging issue/trend, including litigation and arbitration trends, or regulatory changes that could have implication for other Manulife business units
Shares with Underwriting & Claims Risk Management and the Underwriting & Claims Risk Committee claims fraud situations and where available and applicable, will share findings such as the operations and financial impact of them, the lessons learned from them and the actions taken within the business unit, division, globally
Reviews and signs the completed annual Claims Self-Assessment Questionnaire prior to submitting it to Underwriting & Claims Risk Management on a timely basis
Develops and maintains excellent relationships with all affiliates, third parties and business partners in order to build confidence in and promote Manulife’s strengths including claims as a core competency
Proven track record for strategic planning, tactical management and results driven successes
Strong operational management background
Strong relationship management skills, internal and external
Sound decision making skills
Excellent negotiating and influencing skills
Ability to interact with all levels of senior management
Excellent presentations skills. Able to present concepts and knowledge in an effective manner to Claims Professionals, Industry Leaders, and business partners who may or may not have an understanding of Claims
Post-secondary education required
Generally, need 10+ years of claims experience; however, this may vary based on education, training and business unit’s market

Senior Manager Group Life Claims Resume Examples & Samples

Manage work flows, processes and plan resources to achieve superior service -Handle escalated claims in a professional and empathic manner
Responsible for improving service through analysis of performance and implementation of continuous improvement initiatives
Build strong relationships with the sales force, customers and other business partners
Work in partnership with members of leadership team to ensure priorities are clear and are in line with business strategies
Participates in projects as a representative for their team. Competencies
Excellent leadership skills with the ability to influence others
In depth knowledge and experience of insurance business and claims
Strong decision making skills and customer service focus
Ability to motivate and develop staff to achieve high quality and service standards
Strong problem resolution skills
Experience and proven capability in initiating process improvements and implementing change
University degree or equivalent work experience
Minimum of 5 years in a leadership role
Experience in dealing with customers/advisors
Insurance knowledge

Claims Liaison Resume Examples & Samples

Document, track and resolve all plan providers’ billing and payment issues
Research verbal and written providers’ claims inquiries
Collaborate with various business units to resolve claims issues and provide instruction to providers’ billing staff and services regarding claims submission policies and procedures to ensure prompt and accurate claims adjudication
Identify authorization issues and trends
Direct and educate Provider Services and Relations with the claims reprocessing notification, utilizing knowledge of provider billing and claims processing
Analyze trends in claims processing issues and assist in identifying and quantifying issues and reviewing work processes
Identify providers experiencing a large number of claims issues or with the potential to develop claims issues and proactively work to eliminate barriers for accurate and timely claims processing
Identify potential and documented eligibility issues and notify applicable departments to resolve
Meet with providers to discuss claims payment policies and procedures and resolve claims issues
Handle provider additions, changes and terminations as identified
Run claims reports regularly through provider information systems

Claims Senior Manager Resume Examples & Samples

*Please note that this position is located at Banner Corporate Center Mesa off Country Club & Brown. It is not located in Phoenix, AZ
Supervises the operations of all reimbursement services for third party, ERISA, commercial risk, capitation, and third party administrator contracts. Develops, manages and maintains work processes and procedures for the companys benefits plan eligibility, capitation payments, claims adjudication, processing and reimbursement services
Selects, trains, coaches, motivates, conducts performance evaluations, and directs the workflow for the assigned Reimbursement Services staff. Develops goals and performance expectations for staff and manages staff performance
Maintains all required records. Supervises and coordinates the maintenance of all aspects of internal records associated with the departments management information and claims payment system. Responsible for maintaining department reporting obligations to internal and external constituents
Maintains a current and thorough knowledge of the Summary Plans Descriptions for each health plan serviced, and provides training, resources and information to the claims staff to enable the correct and timely adjudication of all provider and member claims
Meets organization criterion related to claims turn-around, quality, and provider payment requirements. Accountable for ensuring high performance outcomes through an integrated process of operational, quality, medical cost and resource management
Supervises human and material resources needed to maintain or exceed department standards. Participates in the development of the department budget in conjunction with established goals and objectives. Plays a key role in ensuring budgetary goals are met on an annual basis
Manages monthly capitation payment determination and payment distribution for all providers with current capitation contracts
Manages daily payment and check processing and distribution for all claims and capitation payments for the companys reimbursement services

Claims Team Member Resume Examples & Samples

Demonstrates experience and a proven track record in Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims in a facility of significant size and complexity, hospital business operations, information systems, and patient accounting applications, as typically acquired in 0-2 years of acute hospital patient accounting positions
Experience participating in Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims standards, processes, policies, procedures and service level agreements
Experience in complex regional/ shared service environment with multiple/ matrix reporting relationships desired
In-depth knowledge of various insurance documentation requirements, the patient accounting system, and various data entry codes to ensure proper service documentation and billing of the patient's account
In-depth knowledge of Revenue Cycle applications, including Hospital Patient Accounting
Data entry skills (minimum 50-60 accurate keystrokes per minute)
Ability to communicate and work with patients, physicians, associates, Sutter Health leadership, multiple direct patient care providers and others in order to expedite the patient accounting process. Strong communication skills (verbal and written) in dealing with trainees, associates, and internal/external customers
Excellent ability to identify, prioritize, resolve and / or escalate complex problems promptly
Ability to learn new applications/software systems effectively and efficiently

Claims Team Lead-sutter Shared Services Resume Examples & Samples

Demonstrated leadership experience and a proven track record in Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims management in a facility of significant size and complexity, hospital business operations, information systems, and patient accounting applications, as typically acquired in 3-6 years of acute hospital CBO management positions
Experience developing Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claim standards, processes, policies, procedures and service level agreements
Experience participating in planning new or expanded services and managing projects desired
Deep familiarity with general hospital management principles, practices, and procedures
In-depth knowledge/ awareness of all areas related to Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims and how they interrelate
In-depth knowledge of advanced principles, methods, and techniques related to compliant healthcare billing/collections
A comprehensive knowledge of Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims management functions in acute and non-acute settings
Familiarity with work standards and productivity measures, quality control mechanisms, and workload distribution
Knowledge of technological advancements, labor savings procedures/ processes/ equipment and other state-of-the art department-specific systems
Knowledge of Patient Management information system applications, preferably EPIC
Ability to execute strategy and communicate knowledge of business processes and enabling technologies, specifically in a Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims function
Ability to serve as a reference and coach others on key Payer-specific (Medicare, MediCal, Medicaid, and/or Private) Claims processes, policies, and procedures
Ability to independently set and organize own work priorities for self and for the assigned team, and successfully adapt to new priorities as part of a changing environment. Must be able to work concurrently on a variety of tasks/projects while leading a high volume, high accuracy work team composed of individuals having diverse personalities and work styles
Ability to handle heavy workloads and short deadlines in a positive manner. Adapts quickly to changing conditions, assimilating new processes into job functions and taking ownership
Excellent ability to establish, develop and manage customer relationships
Demonstrated leadership skills and the ability to provide supervision, direction, and constructive feedback to team members to support continuous improvement
Ability to effectively detect, surface and resolve conflicts among individuals and/or work groups
Ability to communicate ideas both verbally and in writing to influence others using on-on-one contact and group discussions
Ability to positively influence others in a desired direction to achieve identified outcomes
Ability to develop effective working relationships/ networks within and outside the organization

Senior Manager, Casualty Claims Resume Examples & Samples

Manage EPL claims brought against Marriott, including attorney letters, administrative agency charges, arbitrations, mediations and judicial actions
Administer Marriott’s global Fidelity insurance policy and manage claims brought under this policy
Receive, review and make insurance coverage decisions for EPL and Fidelity claims
Conduct initial and follow-up investigations on EPL claims, including attorney demand letters, arbitrations and third-party guest claims
Assign EPL claims to outside counsel and negotiate staffing and bill rates
Oversee outside counsel through every stage of the litigation process to ensure compliance with Marriott policy, appropriate defense tactics and cost containment
Monitor, review and pay invoices and expenses submitted by defense counsel
Collaborate with Marriott associates in other departments, including Human Resources, Employee and Labor Relations, Loss Prevention, Internal Investigations, Legal and Internal Audit, in the resolution of EPLI and Fidelity claims
Advise the Director of Specialty Claims of any high exposure claims and trends and collaborate on resolution strategy
Attend deposition preparation sessions, depositions, arbitrations, mediations and trials
Provide knowledge and insight to Human Resource representatives, General Managers and Directors of Finance about Marriott’s EPLI and Fidelity insurance policies
Act as a liaison between the field, Corporate and outside counsel to insure that all of Marriott’s policies and practices are applied uniformly and consistently
Draft and assist with the review of internal EPL team practices and procedures
Attend meetings, conferences and training sessions on topics pertinent to EPL/Fidelity claims handling and resolution
Minimum of at least 5 years EPL claims handling experience or related work experience
Good communication skills (verbal, listening, writing), including the ability to deliver difficult messages to internal and external customers, outside defense counsel and/or claimants
Keen ability to grasp and apply technical knowledge, including litigation case management and disposition oriented claims handling
Ability to handle an active list of EPL and Fidelity claims and prioritize work
Zealous negotiation and claims resolution skills
Strong organization skills and ability to meet deadlines
Ability to work well in a team and provide assistance to fellow associates
Willingness to accept and respond positively to constructive criticism
Ability to present oneself with a positive, professional demeanor
Trustworthy with strong business integrity and ability to hold sensitive information in confidence
Highly organized and able to handle multiple priorities at any given point in time

Ads-gap Claims Processing Resume Examples & Samples

Receives incoming calls to open new claims and obtain documentation and information for claim processing
Maintains positive customer relationships in a courteous and professional demeanor in all dealings with the public and fellow employees
Accurately identifies and indexes separate documents
Accurately inputs data and information in a timely manner
Provides consumers, lenders and other partners status of claim and required information and documentation to complete claim processing, including deadlines
Ensures consumer understanding of claim process and required documentation including deadlines
Provides advanced knowledge of the product and claims processing system which requires specific actions and abilities to communicate effectively with consumers, lenders and other partners
Communicates verbally and in written form with our customers, lenders and other parties regarding the adjudication of claims
Acts as SME regarding all functionality within the specific AOR
Builds and maintains strong working relationships with peers; both internal and external to the AOR
Supports Commitment to Communication by participating and advocating any needs or changes
Ability to adapt to a constantly changing extremely fast paced environment
Intermediate written and verbal communication skills
Abilities with Word
Ability to learn new computer programs and department processes
Strong communication and conflict resolution skills

Claims Adjudicator Resume Examples & Samples

Perform claim adjudication for participants of The Major League Baseball Players Benefit Plan in accordance with plan provisions, regulatory requirements, procedural requirements, and quality requirements
Review and adjudicate complex claims requiring research, additional information requests, tracking, and written responses. Process and resolve claims which require rework. Submit information to vendor for medical necessity review
Provide customer service to plan participants via incoming phone calls. Researches inquiries and responds to callers within required turnaround times
Compile information for stoploss and subrogation claims
Assist with additional plan administration functions as needed
2-3 years experience adjudicating health claims preferred
Medical terminology and coding familiarity
Demonstrated experience with Internet, Outlook, word processing, spreadsheets, and databases utilizing multiple screens
Superior customer service, written, and verbal communication skills

Claims Intern Resume Examples & Samples

Pursuing a Bachelor’s Degree, Associate’s Degree or Technical Diploma in insurance, business, or a medical-related field
Availability to work part time during the school year
Strong customer orientation and excellent communication skills; verbal, written, and interpersonal
Demonstrated analytical and critical thinking skills
Proficiency with Windows, MS Office, and web applications
Coursework in medical terminology or human anatomy is a plus
Prior work experience in medical/health insurance industry is a plus

Claims Team Lead Resume Examples & Samples

Proficient understanding of medical terminology, health conditions, company policy provisions, state-specific regulations regarding licensures and benefits, and time requirements and examination procedures
Good general insurance knowledge
Knowledge of provider care and billing practices
Ability to review and interpret policy contracts, provisions, riders and endorsements
Ability to make decisions and easily adapt to change and sell them to others
Friendly, professional and empathetic telephone manner in order to effectively resolve problems with policyholders, agents, providers or internal customers
Familiarity with PC and software programs
Ability to meet departmental audit quality standards
Ability to work well with others (team player)
Strong sense of customer relations
Senior examiner/supervisory experience preferred
College degree or some college preferred, or comparable experience
CPT, HCPCS, and ICD-9 knowledge
Strong understanding of hospital contracts

Claims Advisors Resume Examples & Samples

Minimum of 5 GCSE’s or equivalent at grade A-C, including Maths and English
The ability to manage a demanding and busy workload
Strong communication and rapport building skills with the ability to disseminate technical information in a concise and professional manner
Quick to take on-board new information which is technical in nature
Analytically minded with the ability to resolve complex queries
Excellent numeracy skills and comfortable working with large volumes of data
Impeccable attention to detail with a methodical and conscientious approach
Able to promote continuous improvement and respond positively to change
Previous experience of managing complex claims advantageous (although not essential)

Mgr-liability Claims Resume Examples & Samples

Plan, select, train, develop, motivate, lead and manage claims staff
Manage litigated claims. Coordinate and consult with Legal counsel in lawsuits against the company
Develop, implement and manage effective and efficient processes and procedures for the administration and reporting of claims, associated litigation and related escheatment liability
Analyze liability claims data to identify trends; conduct strategic planning to control costs associated with claims
Develop, implement and monitor the effectiveness of cost containment programs designed to control costs related to liability claims,
Manage and control activities associated with the handling of vehicle liability, general liability and property recovery claims and lawsuits to include investigation, evaluation, reserving, litigation, negotiation, resolution, payment and recovery
Ensure all claims and related matters are handled in accordance with legal obligations and in compliance with applicable laws, rules and regulations
Evaluate coverage, liability, damages, financial exposure; develop defense and settle strategies; identify sources of indemnification, contribution and/or recovery; approve or negotiate settlements in serious claims and litigation with settlement authority up to $350,000
Select, negotiate and contract with and manage the performance of all liability claims administration and cost containment vendors
Develop, implement, manage and monitor the effectiveness of controls over reporting, audit tools, administration and payment of claims; respond to various internal and external audits of processes, procedures and controls
Perform other assignments (or duties) as required
Bachelor’s Degree or four (4) years directly related work experience
Five (5) years experience managing bodily injury liability and property damage liability claims and litigation of significant exposure and complexity involving serious injuries
Comprehensive knowledge of casualty claims, contract, tort, damages, subrogation, contribution/indemnity and other applicable / related law
Comprehensive knowledge of insurance policy provisions, practices, laws and regulations
Ability to interpret and apply laws and regulations, determine appropriate courses of action, present solutions and resolve claims
Excellent leadership and interpersonal skills
Strong verbal and written communication skills including presentation skills and public speaking
Excellent analytical, problem solving, negotiation, vendor selection, contracting and organization skills
Strong knowledge of statistical claims data and reporting
Successful completion of required training programs and all licenses as required
Professional designation in claims and/or insurance preferred
Experience and ability to use Microsoft Office Software, including but not limited to; Word, Excel, and E-mail

IT Claims Interface Development Intern Resume Examples & Samples

Eligibility to work in the US
Able to commute daily to Lake Oswego, OR
Currently pursuing degree in CS, MIS, CIS, AIS, BIS, IT
0 GPA or above at an accredited 4-year University
Working knowledge of MS Word, Excel, PowerPoint
Must be able to function with minimal supervision
Completed courses: Data Structures, Algorithms, distributed computing, Data management, mobile technologies, Java, Math
Basic understanding of any Software Development Life Cycle Methodologies (ex. Waterfall and/or Agile)
Unix, UI frameworks, SQL knowledge
Candidate is interested in working alongside Health Care IT developers and Project Managers in the Information Technology profession
Effective presentation and Group discussion Skills

Claims Processing Manager Resume Examples & Samples

Works on issues of diverse scope
Receives assignments as objectives and determines how to use resources to meet these goals and schedules
Requires significant planning and direction setting to coordinate with other divisions or resources
Recommends changes to policies and establishes procedures that affect the immediate function
Monitors projects to ensure completion on schedule and within budget
Minimum three (3) years of lead or supervisory experience in a claims processing environment
Experience in LMP environment managing large groups of employees in a collaborative work team environment required
Five (5) years of management experience

Claims Adjudicator, Grade Resume Examples & Samples

Reviews claims and makes payment determination with authorization limit to a specific dollar limit (ie. $19,999/claim.)
Checks with Lead and Supervisor for any claim exceeding specific dollar threshold (ie. $19,999)
Reviews and evaluates claims for proper and correct information including, correct member, provider, authorization, and billing information on which to base payment determination
Refers to eligibility, authorization, benefit, and pricing information to determine appropriate course of action (i.e. claim reject / denial, request for additional information, etc.)
Conducts research regarding coordination of benefits issues, fraud and abuse, and third party liability
Utilizes knowledge of government regulatory policies and procedures to ensure compliance with government regulations including but not limited to CMS, DMHC, DOC, DHS and requirements of accrediting agencies such as NCQA
Prepares material for audits and provides assistance to Lead and Supervisor during audit
Assists with the preparation of materials for audits (including Quality, Compliance, and Regulatory audits) and provides assistance to Lead and Supervisor during audit
Review member/provider claims by checking provider service contracts and other supporting claims documentation in accordance with service agreements
Coordinates payment agreements with providers, working with appropriate MSA and Regional Contracts Department staff
Proactively works to ensure claim review is resolved appropriately
Three (3) years medical claims adjudication experience
Experience in processing multiple types of medical claims and lines of business required (inpatient / outpatient, third party billing, hospital, and professional.)
Four (4) years medical claims adjudication experience preferred in processing multiple types of medical claims and lines of business (inpatient / outpatient, third party billing, hospital, and professional
Experience with SNF, DME, or Home Care/Hospice Claims processing preferred
Excellent skills in communication preferred
Medical Terminology Certificate preferred

Claims Benefit Specialist Resume Examples & Samples

Evaluate and determine if services are covered under the policy
Interpret policy provisions by state and determine benefits payable
Determine riders on policy , activate and reimburse
Confirm clinical reviews are up-to-date prior to reimbursement
Apply and determine elimination period days appropriately
Coordinate and apply Medicare and other governmental agency benefits
Determine initiation of waiver of premium
Proficiency in all Citrix-based applications
Candidate must have intermediate knowledge of RLTC claims adjudication processes and procedures
Knowledge of inter and intra departmental work flows and procedures
Candidate must have working knowledge of company claims transaction
Candidate must have working knowledge of company plans, riders and benefits including sound knowledge of LTC contract language
Candidate must have the ability to identify complex and non-complex payment transaction
Candidate should have working knowledge of CSPP and LifePro payment processing in addition to Promise and Beacon

Specialist, Absence Claims Resume Examples & Samples

1 – 3 yrs of experience in insurance claims that directly aligns with the specific responsibilities for this position
1 – 3 yrs of absence management claims experience including familiarity with US Federal and State Leave of Abscense Laws
Ability to read, analyze and interpret Short Term Disability documents required
Completion of FML certification course required
Demonstrated knowledge of medical terminology

Damage Claims Team Lead Resume Examples & Samples

Create a claim to track the status
Contact parties involved to acquire information about the vehicle’s condition at each point
Work with all parties involved to reach a resolution
Assist insurance adjuster in settling claim
Communicate with parties involved on status and what is needed to proceed with claim
Make payment arrangements once settlement is reached
Assist others in department as needed
Make arrangements for payment to customer and collect payment from vendor
Train new employees
Track daily emails and faxes received for the team
Oversee claims process when manager is out
Handle claims for large clients-Toyota, NMAC, Ally, OMSC
Provide weekly updates to national accounts on open claims
Assist other departments with questions and escalations
Resource for team members to seek advice
Manage claim rotation spreadsheet
Create and maintain documents for departmental training and on-the-job guides
Participate in leadership training
Distribute new processes to the team and train as needed
Perform other duties as directed by department supervisor

Internal Claims Proc Resume Examples & Samples

Processes all internal claims or encounters with the exception of DHMO
Makes all necessary adjustments associated with the Internal claims or encounter processing
Reviews all encounter errors, researches, and tracks required information to resolve errors for submission
Reviews and resolves rejected or held internal claims or encounters, taking appropriate actions which may include but are not limited to adjusting, denying, and resubmitting the internal claims or encounters with corrected information
Reviews various reports and information to determine the causes of the holds and other issues and resolves by taking appropriate actions
Research, proactively work with other departments, and respond to inquiries from internal and /or external customers as appropriate to compile all information gathered to resolve issues promptly and answer any questions in reference to status of internal claims or encounters
Applies knowledge of various product types where applicable to help resolve issues
Communicate problems and/or trends to management
Perform other department duties and special projects as assigned
Follows established Code of Conduct for claims processing procedures in compliance with all applicable State and Federal regulations and demonstrates the ability to exercise diligence, care, and integrity in performance of duties
Consistently supports Compliance and the KP Principles of Responsibility by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal, State, and local regulations, accreditation and licensure requirements (if applicable) and Kaiser Permanente's policies and procedures
Minimum one (1) year of medical claims processing experience

Group Claims Policy Manager Resume Examples & Samples

Demonstrated experience in financial services
Demonstrated experience in research and innovation and development of new solutions
Extensive technical expertise in group and life insurance claims management demonstrated through previous technical and/or leadership roles
Development of claims management philosophy and policy
Experience in leading change across Customer, Product, Underwriting or Claims
Experience in prior leadership positions in Group Claims management will be highly regarded
Relevant tertiary qualifications supplemented by relevant work experience

French Claims Resume Examples & Samples

Fluent in French and English (spoken, written)
Willingness to work at least 1 weekend day and outside of the "standard" work day as needed to support customers, this may include mandatory overtime during peak volume periods
Ability to compose a grammatically correct, concise and accurate written response
Demonstrate flexibility to work overtime hours as per business requirement
Previous data analystical experience including use of SQL, OBIEE or ETL
Experience working in a fraud/risk based environment
Prior knowledge of the anti-money laundering risk mitigations procedures

Japanese Claims Resume Examples & Samples

Fluent in Japanese and English (spoken, written)
Willingness to work on weekends, and outside of the "standard" work day
Experience with Microsoft Office, including Outlook, Word, and Excel
Experience with customer service and/or finance related work
Data analysis using SQL, OBIEE or ETL
Interpersonal skills, with the ability to communicate complex transactional issues correctly and clearly to both internal and external customers
Self-disciplined, diligent, proactive and detail oriented
Demonstrated analytical and problem solving skills, including the ability to recognize non-obvious patterns

French Claims Investigation Specialist Resume Examples & Samples

Fluent in French (reading and writing)
Willingness to work on weekends and outside of the "standard" work day
Experience with Microsoft Office, including Outlook, Word and Excel
Clear, crisp and proactive documentation of operational procedures required to tackle known risk related patterns
Demonstrated ability to analyze problems logically
Demonstrated positive, results oriented attitude
Ability to effectively manage time, and individually prioritize multiple tasks of competing priority
Ability to maintain high levels of confidentiality and data security standards

Director of Claims Resume Examples & Samples

Oversee daily claims operations of multiple levels of staff & multiple function across one or more business units
Lead project management & implementation & Goal initiatives
Oversees Health Plan Audits by providing direction & oversight of scheduling, communication, research, results and any corrective actions responses
Oversight & Direction on regulatory Audits in addition to any Regulatory Reporting requirements
Assists in Regulatory Audits in addition to any Regulatory reporting requirements
5 years of managerial experience in medical claims adjudication or medical claims processing
2 years of experience managing budgets, process improvements & quality assurance
Certified Professional Coder (CPC)
2 years of experience developing presentations to include charting
2 years of experience managing relationships with clients / vendors

Manager of Claims Liability Resume Examples & Samples

Current state licensure (RN), baccalaureate degree (preferably in health care)
CPHQ preferred
5 years experience in health care and 2 years experience in clinical risk management preferred
The capacity and interpersonal skills to successfully interact with hospital personnel and physicians
Analytical and statistical skills and broad range of knowledge in healthcare regulatory and accreditation requirements

Senior Claims Developer Resume Examples & Samples

Implement claim payment processes that meet regulatory requirements and claim business rules
Conduct claims systems utilization, capacity analysis/planning and reporting, and claims-related business and systems analysis
Ensure data integrity, data security and process optimization
Serve as our internal Regulatory Affairs' point of contact
Partner with functional area leaders and SMEs to determine impact and solutions
Implement Claim ops solutions to meet regulatory requirements
Lead Claim Ops market conduct or financial exam activity, corrective action plans responses and restitution projects
Remediate gaps in existing production processes that do not meet regulatory requirements
To be considered for a telecommuting role, you must live within 50 miles of a UHG office
1+ year of Visual Basic (VBA) Programming experience
1+ year of VB.NET Programming experience
C# programming experience
2+ years of strong Microsoft Excel experience
Macro Express Programming experience
UNET and /or COSMOS Claims experience
Development Planning experience
1+ year of UHC or Optum Claims experience

Claims Policy Resume Examples & Samples

Interprets AHCCCS policies, rules and regulations, research changes and additions, identify potential issues, communicate impact of changes to division/agency management, and write/update policies regarding claims payment. Represents Claims Department on committees and in meetings when these concerns arise
Provides professional and technical assistance to, and consult with providers, agencies, contractors, other State agencies, CMS representatives, other divisions and staff regarding AHCCCS benefits and reimbursement policy and procedures. Responsible for development, interpretation, communication, writing and updating of claims policy for internal and external customers
Works closely with the Claims subsystem issues when identified on audit and training
Conducts audits on fee for service providers and is responsible to recoup dollars when claims billed are out of compliance with existing policy and/or billing guidelines
Oversight of the staff who develop technical assistance training for AHCCCS Division of Fee For Service (DFSM) Providers. Data research and surveys are used to identify issues affecting providers, which are then addressed through technical training. Oversees the proactive development of education and training to simplify and clarify the technical aspects of claims processing for providers and internal staff
This position is also responsible for representing DFSM at administrative hearings and the payment of DFSM claims grieved through the AHCCCS Office of Administrative Legal Services
Excellent written and oral communication/presentation skills, business and technical writing techniques, as well as effective interpersonal and group skills
Leadership, management, and supervisory experience
Principles and practices of claims auditing, as well as Claims and coding submission practices
Research, analysis and project management techniques, as well as instruction and evaluation methodologies
Analytical and comprehension skills to interpret and apply federal and State statutes and regulations
Experience in writing issue papers, interpreting laws and rules, writing decisions and policies
Experience in project management and supervision
Experience in medical claims and health care delivery systems

Claims Adjudicator Resume Examples & Samples

Processing of high priority Claims Financial transactions involving identification and closing of policies, freezing of assets and notification to Beneficiaries of settlement requirements
Processing settlements and disbursement of assets according to beneficiaries’ options
Identification of transactions that need to be forwarded back to the Business Unit and/or to other departments/teams
Referring transactions to Business Unit Support for clarification of handling
Reporting processes that need to be included in the team’s online manual to ensure complete process documentation
Manage Rush inbox for rush request
Investigate, evaluate and settle claims, applying technical knowledge and analytical skills which in effect does have
Fair and prompt disposal of cases and to contribute to a reduced loss ratio
Payment of claims once all IGO paperwork is received
Perform work coordination task for priority task assignments
Perform call task (inbound and/or outbound) in order to facilitate completion of death claims processing
Computer literate - ability to use the desktop computer system. Advance knowledge on MS application like Word and Excel
Ability to use the phone system
Follows simple instructions on how to log in to the phone system
Basic telephony skills
Excellent written and verbal communication skills. Ability to converse effectively using the English language
Ability to compose a grammatically correct, clear and concise paragraph/ essay
Exhibits good navigation skills
Ability to use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems
Ability to recommend means of obtaining and analyzing transactional data, as well as evaluate the accuracy of business transactions in accordance with company procedures and contracts
Ability to work independently and remain self-motivated with minimal direct supervision
Strong organization skills and close attention to detail
Good interpersonal skills with ability to interview individuals associated with audit subject matter, as well as communicate findings to management
Superior understanding of claims functions
Ability to identify business process improvements and report existing deficiencies to management
Ability to analyze and manipulate large volumes of transaction-level detail

Claims Go-to-market & Change Navigation Expert Resume Examples & Samples

Bachelor’s degree in communications, business or related field
MBA and/or other advanced degree a plus
5-7 years business experience, including experience in medium to high complexity change management activities
Extensive knowledge of product delivery and adoption tactics
Extensive knowledge of change management principles, methods, tools and templates
Significant experience delivering new products/services/capabilities and owning benefit realization
Significant experience implementing and developing communications and change management plans
Highly advanced written communications, verbal communications and interpersonal skills
Advanced project management and organizational skills
Stakeholder management, including experience interviewing stakeholders and conducting focus groups

REO Claims Senior Rep Resume Examples & Samples

Minimum two years mortgage or banking industry experience required
Real Estate Owned claims experience preferred
Knowledge of Servicing Systems LPS / MSP preferred
Proficient with Microsoft Office Products, including Word, Excel, Powerpoint, etc

Claims Director Resume Examples & Samples

Provide strategic leadership and technical expertise to the claim organization to achieve profitable growth and customer service goals
Effectively lead and drive initiatives to achieve operational excellence and a Best in Class claim organization
Bachelor's degree or equivalent required and 10+ years of relevant work experience
This position requires proven leadership experience (direct leadership/management experience with formal direct reports strongly preferred)
Broad knowledge of Disability products, philosophies, processes and markets, as well as product marketing and distribution is strongly preferred
Requires strong team building skills and the ability to build/maintain effective working relationships
Must be results oriented with strong financial accumen and the ability to think strategically
Excellent management, analytical, problem solving and negotiation skills required
Must be flexible and demonstrate good judgement
Minimal travel is required

Claims Generation Team Lead Resume Examples & Samples

Experience managing a small team of 15 employees
Medical claims billing experience
Familiar with payer requirements of claims, such as insurance guidelines, modifiers and HCPC codes
Payroll Experience
DME Industry Experience

Claims Senior Service Specialist Resume Examples & Samples

Activities are of moderate complexity, requiring some independent judgment, performed under general supervision, using procedures standard to the organization
Demonstrates knowledge of internal operations and develops relationships to facilitate workflow
Knowledge of Excel, Word and PowerPoint, a plus
Experience in working independently in a face paced environment

Claims Adjudicator Resume Examples & Samples

Analyzes data feeds from carrier commission statements to substantiate customer reimbursement requests
Evaluates customer manual claims submissions against employer plan rules and IRS 213(d) guidelines
Compiles weekly reports for TPA Leader comprised of approved and denied claims
Coordinates distribution of claims denial letters
Assists TPA Leader with internal and external audits
High School diploma required; 4 year college degree preferred
1 year experience in customer service required. 2-3 preferred. Experience in retiree HRA industry highly preferred
Demonstrated mathematics skills
Must understand reimbursement rules for qualified health expenses
Able to provide the highest level of attention to detail to ensure accuracy

Total Loss Claims Senior Service Specialist Resume Examples & Samples

Performing support functions including email, calendar management, and word processing with a strong emphasis in excel
Processing total loss claim files and payments
Receiving, screens and routing incoming telephone calls and other electronic correspondence
Generating and sending appropriate forms to insured/claimant for completion
Completing all necessary forms, logging documents into the system, and route documents to the appropriate parties

Debit Card Claims Reg E Specialist Resume Examples & Samples

Carries out specialized research to resolve problems
Helps train personnel in the department
Monitors laws and regulations to ensure compliance
Maintains forecasted production to meet departmental goals
Investigate a minimum of 80 Checkcard claims per day
Review Dispute Forms and Regions systems to identify fraudulent activity and validity of customer's claims
Adhere to Regulations - E time frames in completing investigations
Communicate with customers regarding claim resolution per regulatory requirements
Review claims for chargeback rights based on transaction type and provide appropriate documentation to Chargeback Dispute Analyst for initiation of funds recovery

Senior Ba-claims Resume Examples & Samples

Senior Business Analyst
Business Focused Role
6 Month contract with a view to extend!
Claims

Director of Claims & Appeals Resume Examples & Samples

Develops and executes strategies for a function or discipline that span a large business unit or multiple markets / sites
Directs others to resolve business problems that affect multiple functions or disciplines
Product, service or process decisions are most likely to impact multiple functions and/or customer accounts (internal or external)
Ensure that proper benefits are applied to every claim
Identify and apply knowledge of new plans / customers to process their claims appropriately
Identify and resolve claims processing errors / issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider)
Resolve or address new or unusual claims errors / issues as they arise, applying appropriate knowledge or prior experience
Communicate and collaborate with external stakeholders (e.g., members, family members, providers, vendors) to resolve claims, errors / issues, using clear, simple language to ensure understanding
Collaborate with internal business partners to resolve claims errors/issues (e.g., Subject Matter Experts, Network Management, IT / systems staff, Compliance, vendor management teams, contract teams)
Document and communicate status of claims / investigations to stakeholders as needed, adhering to reporting requirements (e.g.,status letters / reports)
Communicate the value of our products and services to applicable audiences, using clear, simple language to ensure understanding
Identify and communicate opportunities to improve claims processing efficiency and reduce rework (e.g., workflows, knowledge / process gaps, customer needs, claims volumes / submissions, issues related to quality / resources / systems, automation opportunities)
Provide advice / consulting / direction / support to colleagues as needed to enhance their ability to process claims accurately
Identify training opportunities among peers and / or staff members
10+ years of Leadership Experience
5+ years of experience in Claims, Grievances and Appeals

Claims Adjudicator Resume Examples & Samples

Claims Processing
Reviews claim requests to determine eligibility for processing and escalate to management as necessary
Makes appropriate system entries and verifies accuracy
Ensures utilization of most up to date processes and procedures to update claims
Identifies process improvements, offers solutions to claim problems, and communicates recommendations to management
Manages tasks according to company guidelines
Client Inquiries
Responds within company standards to inquiries by telephone and written communication
Works with colleagues across the organization to research inquiries in a prompt, courteous, and accurate manner
Claims processing and/or medical office experience preferred. No claims experience required
Excellent written and verbal communication skills to effectively interact with customers on the telephone
Excellent organizational and time-management skills to handle multiple tasks
Basic computer skills and the ability to navigate through multiple systems without assistance

Claims Approver Resume Examples & Samples

Reviews, processes and pays claims on death, cancer, ordinary/industrial accident and health, and total and permanent disability according to Company procedures and appropriate state regulations
Determines proper payees for payment to assure that the Company is fully discharged from liabilities associated with claims
Identifies claims that meet qualifications for payment via Life Accounts, and completes processing necessary to set up the accounts
Enters claims into systems, maintains pending files, matches output to the appropriate file and distributes new mail
Handles incoming calls from policyholders, insureds and other external or internal customers promptly and professionally
Audits paid claims for accuracy and completeness. Verifies that all needed information was received and codes statistical data regarding cause of death as required
Experience in maintaining a high degree of accuracy associated with high volumes of work and/or multiple duties. Ability to continuously make repetitive motions of the wrists, hands and/or fingers
Demonstrated experience maintaining the confidentiality of information handled in the course of completing work
Proven experience working in a customer-oriented field and effectively articulating information to clients in a patient and understanding manner while managing multiple tasks
Proven strong analytical skills, including demonstrated experience identifying and quantifying problems and providing effective resolutions when dealing with multiple alternatives
Demonstrated experience working effectively within a team. Must provide examples from work experience of going above and beyond the call of duty to assist team members
Must provide examples of working under multiple deadlines and minimal supervision. Must be able to cite examples of self-motivation and effectively completing work when given little or no direction
Demonstrated excellent verbal and written communication skills with the ability to successfully interpret and communicate business needs to internal or external customers in a clear, focused and concise manner while following proper rules of punctuation, dictation and style. This would include strong telephone communication and etiquette skills
Proven experience adapting and demonstrating flexibility associated with changes to policies/procedures
Demonstrated experience acquiring and assimilating new knowledge and skills. Must be able to cite examples of work experience wherein new skills were applied to successfully complete assigned tasks
Working knowledge of word processing, spreadsheet and Microsoft office applications

Claims Resume Examples & Samples

Willingness to work on weekends, and outside of the "standard" work day, work overtime during peak periods as needed
Ability to write clear, crisp and proactive documentation of operational procedures required to tackle known risk related patterns
Proven ability to work in fast paced dynamic environments where decisions are made without compromising on customer experience and financial losses
Contribute to or lead other special projects which support reducing risk related losses while maintaining focus on positive customer experience
Maintain individual accountability for performance metrics, ensuring ever-increasing levels of productivity and accuracy against established benchmarks
Identify, communicate, and champion process improvement opportunities that will benefit internal and external customers
Demonstrated ability to work independently and make complex investigation decisions with little to no guidance
Self-disciplined, diligent, proactive, and detail-oriented
Proven ability to work in fast-paced dynamic environments where decisions are made without compromising on customer experience and financial losses and maintain high levels of confidentiality with data security standards
Excellent team player capable of learning and sharing knowledge in a global team environment
Experience with service launches / system testing / program management
Experience with ticketing system, deep dives or escalations work in customer service
Demonstrated ability to analyze problems logically utilizing data queries pulled from SQL, OBIEE and ETL
Experience in e-commerce fraud operations
Previous experience leading others, coaching, recruiting and training employees

Claims Adjustor Resume Examples & Samples

Daily receipt, review and coding of new claims for entry/update in the internal claims software system and from Customer Service call center. Initial telephone contact to be completed within 24 hours of receipt of new claims
Management of non-litigated claims to include investigation, management of chargeback process, determination of Medicare eligibility, resolution of any conditional payments and investigation into the need for an MSA, liability evaluation and settlement in accordance with General Liability Claims Handling Guidelines. Routine communication with store and regional team members, customers and/or legal representative via routine phone calls and written correspondence. Obtain, review and evaluate medical bills, records and/or damage estimates
Maintain routine diary with minimum goal of 90% compliance at each diary review (30 – 45 days) per adjustor guidelines, to include but not limited to
Documentation of initial 24 hour telephone contact
Documentation of all conversations and evaluations in notes
Documentation of reserves and rationale for amount
Documentation of Medicare eligibility and Conditional Payment research
Documentation of reserve/settlement authority
Daily documentation of all contacts/required actions /status related to claim
Contracts/invoices/leases related to claim
Work with insurance carriers and third party contractors for acceptance to tender based upon contractual liability and obtain written acceptance, or subrogate claims that we settled on behalf of a vendor or other third party contractor
Responsible for managing chargeback program for assigned claims including updates in system documenting charges to stores for incidents and making timely reversals per Asset Protection’s chargeback SOPs. This includes monthly review of all charged and non-charged claims reporting changes which will appear in the store’s monthly P&L statements
3-5 years of GENERAL LIABILITY claims handling and/or customer service experience
Bachelor degree in Business or Risk Management preferred
Ability to work independently within reserve authority and provide recommendations for claims over authority to present to Litigation Specialist or GL Claims Supervisor
Knowledge of civil torts to provide liability and damage evaluations (to negotiate claims with customers and/or their attorneys)
Ability to review contracts and understand insurance obligations for risk transfer
Experience working with multiple jurisdictions
Proficient in the use of a claims software system and Microsoft Office applications
Ability to work 9am to 6pm

IT Lead-claims & Toxicology Resume Examples & Samples

Partner with the business partners to manage the overall IT demand & continously manage business partner expectations
Prepare and deliver regular updates and communications (verbal and written) to the Business and IT Leadership teams, and extended business partners
Understand and define business drivers, requirements definition, design gap analysis, prototyping, execution and deployment activities
Function as a technical application owner (TAO) for the existing technologies and applications that support this function and ensure business partners are aware of new and emerging technologies in the Open Innovation, Business Development, Business Process Management, and UX/Digital Design
Conduct research on current / future technologies, processes and best practices, benchmark with other internal J&J companies and external partners, and determine application of new technologies in the Consumer Companies R&D organization
Lead projects of medium complexity, and act as Liaison between the various IT organizations to ensure successful delivery of initiatives to the business partners
Lead efforts to standardize processes and technologies globally
Champion the change management efforts of IT initiatives with the business partner community
Interface with suppliers and vendors to evaluate software, hardware, or services and make recommendations
Ensure Service Level Agreements are established and meet expectations of the business partners
Perform analysis, design, implementation, and maintenance activities
Actively participate as core team member for key business/IT initiatives
Participate in the business planning activities by identifying future business demand and ensuring appropriate funding is in the business plan
Provide coaching/guidance to peers, junior team members, co-ops and/or consultants
Consistently demonstrate knowledge seeking and sharing behaviors across IT organizational boundaries in the performance of daily work and encourage junior associates to do the same
Apply principles, concepts, and practices of the J&J Leadership Imperatives
Ensure that J&J information assets are appropriately identified and valued, and are protected by complying with and enforcing all local and worldwide security policies
Ensure that security is considered and emphasized in all IT plans and actions
A minimum of a bachelor's degree is required
A minimum of 5 years of IT experience is required
Hands-on experience supporting R&D groups is preferred
Hands-on disciplined project management skills are required
Hands-on experience in one or more of the following Cloud / SAAS / Mobile models is preferred
Hands-on experience with one or more of the following webMethods / IMDG / BPM is preferred
Broad understanding of Design Principles (User Interface and Business Process Mapping) is preferred
A demonstrated working knowledge of core application development principles and J&J SDLC methodology is preferred
Demonstrated ability to lead a team and manage work in accordance with full system lifecycle (SDLC) from concept to production deployment is preferred
Hands-on experience supporting an application portfolio (post-launch) is required
Experience implementing global process/systems is preferred.Info Technology

Manager, LTC Claims Contact Center Resume Examples & Samples

Responsible for supervising the efficient, professional and timely processing of all claims related items as well as the opening of new claims
Take customer escalations and ensure appropriate follow up
Train staff in system and departmental procedures. Oversee the development and updating of operating procedures and training manuals. Develop and conduct individual and group training sessions
Ensure efficient organization in staff scheduling to accommodate call volume, coverage hours and unexpected absences
Participate in the creation and maintenance of individual and department metrics
Increase department productivity with continual monitoring and measuring of performance levels and QA standards
Participate in development and management of call 'scripts' and ensure they're adhered to
Maintain current department reports and work with the leadership and workforce teams to develop new ones to increase department productivity and profitability
Use Contact Center systems, including call management and recording system
Lead, coach and motivate team members
Provide regular feedback and direction to associates regarding team and personal performance. Take corrective action as necessary
Write and deliver performance evaluations and participate in salary planning
3-5 years training and coaching experience
Ability to work independently and in a matrix organization
Ability to maintain confidentiality of customer and employee information
Experience in a similar leadership role with an insurance or financial services company
Prior success in a role as a contact center team leader, trainer or supervisor
Experience developing training materials, documenting processes, and interpreting contract language and/or procedures
Medical experience, worked with the elderly or understanding of long-term care industry helpful

FCD Claims Phones Resume Examples & Samples

Minimum of 2 years of management experience strongly preferred(Internal or External)
Influence without authority: Negotiate to win/win outcomes & Influence others to work collaboratively on common goals
Risk and Controls mindset: Wears the Risk and Controls hat to ensure employees know the policies and procedures that govern their work and duly adhere to it. Is able to identify key gaps/opportunities that could potentially pose as a threat/risk to our company and help remediate these issues effectively. Abides by all applicable regulatory requirements
Do the right thing: Is able to maintain the highest standards of integrity by doing the right thing for our customers, our employees, our shareholders and all our partners

Claims Advisors Resume Examples & Samples

Previous claims handling experience advantageous, although not essential
Sound numeracy skills and comfortable working with large volumes of data
5 GCSE’s at A-C grade (including Maths and English) desirable (or equivalent experience)

Cres REO / Claims Proc Senior Resume Examples & Samples

Reviews and analyzes more complex claims and takes appropriate action
Evaluates, processes, and monitors mortgage loan foreclosure/workout claims from the date of filing to the date funds are received when a foreclosure or loss mitigation action has been completed
Reviews Consumer Finance Department foreclosure, First Hawaiian Bank and SBO foreclosure requests. Communicates with the requestor marketing views and/or opinions for the approval or denial of the requests
Communicates directly with the claims outsource vendor, the real estate management company and SBO companies to ensure timely filing, monitors file during eviction, discusses marketing strategies, resolves outstanding problems, and facilitates the sale of each property
Approves initial and subsequent repair requests and negotiates purchase offers within guidelines
Ensures that each OREO loan carries a proper book balance and adjusts the balance accordingly by processing appropriate accounting entries
Controls losses by resolving problems, analyzing timelines, providing reasons for delays, and documenting unusual circumstances to obtain maximum claim reimbursement
Makes recommendations to management outside of guidelines
Completes functions within established policies, procedures and regulations for four different types of insurers and any investors, if applicable
Completes monthly OREO status report with current updates of each property along with reconciliations of accounting entries made, adjusting OREO book balances to the total general ledger amount. Also provides monthly reporting on foreclosure, marketing and sold status of SBO loans
Prepares all final OREO dispositions and journals when properties are sold. Closes out claim file by auditing claim for any supplemental claim filings and closing claim loans when final funds are received
Provides customers and other departments with information for OREO properties
Assists with the training of other department employees
Years of functional/professional experience: One+ years of experience in mortgage loan servicing
One+ year of experience in real estate/property management
Good knowledge of mortgage documents and mortgage servicing procedures
Good knowledge of collections/foreclosure/bankruptcy procedures
Thorough understanding of all mortgage loan claim requirements
Knowledge of MS Office software, including Word, Excel, Outlook and Windows
Ability to meet deadlines and time parameters
Customer service and interpersonal skills

Group STD Claims Case Manager Resume Examples & Samples

Communication (Verbal and Written)
Strong math aptitude skills
Regulatory and Compliance experience a plus
Minimum 2 years of disability claim management experience (STD preferred), or other previous Group insurance experience

FML Claims Case Manager Resume Examples & Samples

FMLA and Group Disability claim experience or group benefit product knowledge strongly preferred
Strong interpersonal and PC skills (e.g., Microsoft Word & Excel)
Minimum 1-2 years experience working with group disability or absence management, medical disability services or similar preferred; knowledgeable of governing regulations and medical terminology
Previous case management, customer service or call center experience desired

Director of Claims Resume Examples & Samples

Investigate, evaluate and dispose of high exposure, complex medical malpractice and general liability claims
Oversee the operational and technical work of the claims team and implement claim handling best practices to coordinate consistent and successful handling of all claims, especially claims with potential large exposure
Develop and oversee the execution of the litigation management and strategy
Direct outside counsel to most efficiently manage litigation and process
Monitor and control expenses related to claim handling activities, including legal expenses
Manage according to established expense, reserve and settlement authority levels and internal claims policies established by the VP of captive management
Develop close working relationships with risk managers, defense attorneys, internal staff, and vendors who support the claims operation
Daily oversight of resources, workflow and processes
Develop, recommend and implement continuous improvement initiatives which result in cost effective enhancements in quality and service
Build positive relationships with internal/external clients and clinicians to accomplish organizational goals
Work closely with hospital and physician risk management teams to identify trends and coordinate risk management efforts, as directed by the VP of captive management

Senior Director Claims Resume Examples & Samples

Provides leadership and direction to ensure cost effective and successful management of liability claims and litigation, including the handling of claim files, creating reports, database entries, establishing and following standardized claims management procedures and other claims management responsibilities. Creates, monitors and updates policies and procedures. Serves as a role-model for the organizations mission, vision, values, and behaviors
Manages caseload of higher exposure cases, and provides direction and legal advice to Claim Directors and Specialists on other claims and litigated matters. Establishes and implements standardized excess reporting guidelines and reviews and responds to queries regarding excess carrier reports and loss runs. Oversees trial preparation for major claims. Within delegated authority limits, independently negotiates or directs the negotiation of the claims/lawsuits to resolution. Represents facility, physician, and/or organization at case evaluations, pre-mediation meetings with families and mediators, mediations and trial
Provides legal advice and counsel to employees, leadership, and captive insurer relating to risk management issues, risk mitigation issues, and settlement and litigation strategies. Provides legal advice and direction to the organization with respect to incidents, potentially compensable events, claims or suits. Directs privileged investigations
Develops, participates in and coordinates internal and external claims audits, and leads claims team roundtable and reserve review processes. Monitors for and identifies system claim trends, as well as industry benchmarks. Prepares claims data reports and prepares case review materials. Presents comprehensive information at internal claim reviews and status reports to facility leadership, risk managers, facility administrators, medical staffs, various committees, executives and other as requested
Participates in the attorney selection and re-evaluation process. Retains approved defense counsel on a per claim basis and directs and supervises the work of outside defense counsel pursuant to litigation protocol. Partners with defense counsel to establish a claim resolution strategy, facilitates and communicates same. Provides guidance and clarity to other team members relating to litigated matters
Identifies loss control issues and makes recommendations on process improvements and risk mitigation efforts. Documents risk modification and risk reduction strategies. Works collaboratively with the risk management team and leaders across the organization to identify risk management trends, issues and opportunities for improvement
Responsible for cultivation of and assistance with Banners Insurance Program. Participates and presents at meetings with insureds and potential insureds; prepares clear and comprehensive written evaluations, data reports, dashboards, presentations and other materials, participates in and presents at insurance underwriter meetings, facility meetings, physician practice meetings, corporate committees, governance committees and other organizational structures and at other medical staff and physician program meetings. Provides education throughout the system relative to the program

National Claims Administration Resume Examples & Samples

Building relationships with key HPSA department leaders in region and partner with them to understand initiatives, service request needs, strategies and challenges
Partner with NCA leaders to provide the voice of the region during issue management, planning and performance review sessions
Provide transparency to the NCA leaders re: issues and areas for improvement
Assist with operational readiness activities with regional leaders for system/process deployments
Participate in regional meetings with customers/vendors as needed to represent the NCA, when in-person is required
Provide command center support during releases/upgrades as needed
Provide hands-on support to the regional departments regarding system challenges, engaging NCA team members when required for assistance
Bachelor’s degree or equivalent experience required. Demonstrated experience is required in the following areas
Client Services
Project Management experience in achieving results through others in a complex matrix organization
Industry knowledge of standard health plan operation processes and infrastructure
Ability to see and understand end-to-end processes, cross boundary dependencies and “down-stream” effects
Ability to influence and persuade at all levels of the organization through large group presentations as well as small group communications. Ability to gain confidence and support of customers
Success in managing complex projects, affecting multiple stakeholders and applications, preferably in a multi-regional or multi-business unit organization
Collaborative style with ability to engage multiple diverse stakeholders with differing views
Ability to successfully work in a Labor-Management Partnership environment

Claims Appeals & Grievances Processors Resume Examples & Samples

Should have exposure to MS Office
Ability to work with limited supervision
Quick Learner
Flexibility to work in shifts
Research and resolve queries
Knowledge on HealthCare basics and Claims terminologies

Claims A&G Processors Resume Examples & Samples

Eye for Details
Ability to multi-task and manage time efficiently under the pressure of deadlines
Resolving claim level edits and warning messages
Knowledge on HealthCare RCM basics and Claims terminologies
Analysis and problem solving skills
Writing communication skills

Senior Manager, Casualty Claims, Asia Pacific Resume Examples & Samples

Develop relationships with local carrier and broker representatives within the Continent
Serve as claim consultant to hotels, providing advice regarding guest claims or customer service requests
Seek assistance and/or direction from HQ Claims regarding high risk claims or any claims involving negligent security practices, serious vehicle accidents, bodily injury, death or liquor liability claims
Evaluate and perform loss-trend analysis of insurer loss reports in order to: a) identify newly reported cases, b) ensure claim reserves are consistent with company and insurer based guidelines and philosophy, c) direct any TPA participation on applicable claims and d) properly determine when aged case reviews or inquiries may be advisable
Develop country “practice manuals” that capture claims best practices and serve as reference for future risk mitigation and loss prevention within each country
Obtain periodic updates from claim handlers on high-exposure or complex cases and provide direction, reserve recommendations and resolution strategies as appropriate
Refer correspondence, e-mails or lawsuits to relevant carrier
Use Riskonnect to develop dashboards to analyze and quantify claims trends
Provide HQ Claims senior management with a summary and plan of action on high exposure or high profile cases
Notify relevant excess carrier of any claims that have potential to exceed primary limits
Interface with Global Safety & Security to identify and define risk mitigation or loss trend strategies
Act as a liaison between carrier and operations as needed
Assist in obtaining needed records such as vendor contracts and corporate or internal documents
Establish a schedule for formal claim reviews with the carrier
Conduct claim audits of carrier’s files and prepare a written report of findings
Notify designated individuals and coordinate appropriate responses to emergency events
Analyze Reservation of Rights letters or coverage denials for accuracy and compose written responses, if warranted
Assist hotels in handling Innkeeper’s claims that fall below the $2,500 USD deductible. Provide recommendations for release or denial language
Identify favorable claim outcomes or lessons from losses to share via meetings, seminars or newsletters
Participate in annual policy renewal activities as warranted
Review and make recommendations for edits to carrier’s and broker’s program summary documents
At least 6 years’ experience handling casualty claims, with direct adjusting and first party property experience preferred, along with corporate risk management experience in lodging or related industry is highly desirable
Four-year degree from an accredited college or university required
Applicable industry licensing
Chinese language proficiency (Mandarin and/or Cantonese) required
Demonstrate strong leadership/teamwork skills
Strong interpersonal skills to influence and communicate effectively with others, both inside and outside the organization and insurance profession
Ability to grasp and apply technical knowledge including litigation case management and adjusting skills
Effective reasoning and decision making skills
Possess very sound coaching, counseling and development planning skills
Advanced knowledge of claims process
Good communication skills (verbal, listening, writing), including the ability to deliver difficult messages to customers and /or claimants
Ability to meet deadlines and follow up in a timely manner
Strong computer skills, including proficiency in Microsoft Office Suite
Working knowledge of Risk Management information systems

Director, Claims Resume Examples & Samples

Ensure strategic alignment, appropriate policies and defined objectives for claims operational services across multiple product lines
Provide senior level decision making authority on claims operations, including sign-off authority, considering contractual requirements, appropriate risk management and key controls
Remain abreast of competitive and industry developments including best practice operating models
Accountable for leading and directing continuous improvement and/or transformation efforts in a way that delivers continuous value add and cost effective service for the customer resulting in a positive customer experience. Identify, prioritize and direct all business activities considering the business process, customer impact, information system impact, business impact, change management and other efficiencies
Develop and manage to quantitative goals, objectives, standards and metrics for the claims organization including but not limited to; quality, production and time service results. Resolves inquiries through the development or interpretation of policies, procedures and directives. Evaluates and reports effectiveness of service efforts to ensure established goals and objectives are met or exceeded. Performs cost/benefit analysis of services and programs (to include ROI) and directs compilation of historical data and future projections
Oversee analyses of all legislation, mandates, legal requirements and area results. Direct the preparation and reporting of such results and the dissemination of information to the appropriate functional areas. Directs the identification of areas of noncompliance, the development of procedures to modify and/or enhance existing processes and assures appropriate corrective actions occur
Maintain compliance with policy, procedure, and generally accepted insurance industry standards. Represent the Company in negotiations, litigation, and/or depositions. Effectively collaborate with internal and external business partners within the operation and throughout the Companies to ensure support and attainment of Division and Corporate goals and objectives and ensures effectiveness of service delivery to meet business needs
Lead, manage, and develop staff, ensuring top talent selection, development, placement, and succession. Develop and maintain an engaged and accountable workforce and a fair and equitable working environment
This position may require frequent standing or walking for extended periods of time
Excellent planning and leadership skills - with proven experience managing managers, supervisors, as well as, individual contributors
Must possess a proven leadersh presence
Ability to effectively communicate and make effective presentations to corporate officials, clients, brokers, community leaders and government officials
Ability to develop and operate within budget
Ability to analyze, interpret, and utilize significant data to make sound business decisions
Strong organizational awareness as observed through an ability to understand the influential relationships in the organization
Ability to build strategic alliances internally and across business lines to ensure business needs are well understood and being met
Ability to develop a collaborative and cohesive work team
Ability to understand the mission of the business, market dynamics, key business drivers, financial indicators, and customer base
5-7 years of demonstrated Claims leadership experience
Experience in best practices and process improvement implementation
Financial acumen and analytical skills along with solid risk management practices
Bachelors degree and/or advance degree is preferred

Director, Claims Resume Examples & Samples

Approves and makes complex claim management related financial decisions consistent with company guidelines for assigned area(s) of responsibility
Develops and executes claim initiatives which have substantial impact on the success of claims handling, enhance the customer experience and successfully meet the annual business operating priorities
Develops and maintains close customer ties, articulates customer needs, keeps priorities in focus with the desires and expectations of the customer
Develops, maintains and analyzes appropriate metrics and control mechanisms for claims including using data and analysis to improve business results by targeting opportunities and process improvements within claims
Develops, manages and oversees the budget for his/her assigned area(s) of responsibility
Directs the processing and administration of all aspects of complex claims for his/her assigned area(s) of responsibility ensuring accurate and timely claim management
Ensures all assigned area(s) of responsibility claims eligible or ineligible for payment conform to quality, production standards and specifications
Ensures regular quality audits of for assigned area(s) of responsibility claim team members work
Monitors and assesses trends in claims, identifies opportunities, and implements industry leading, best practices to enhance the customer experience and improve claim management effectiveness
Monitors and implements claims policy and guidelines in compliance with claim objectives and insurance laws and regulations
Provides subject matter expertise and technical guidance to claim team members on claims adjudication for assigned area(s) of responsibility
Reviews and resolves complex escalated issues and concerns for assigned area(s) of responsibilities
7+ Years of experience years in Claims that directly aligns with the specific responsibilities for this position, including 3+ years of managerial, supervisory, and/or demonstrated leadership experience (Preferred)
4 Year/Bachelors Degree or equivalent work experience (4 years of experience in lieu of Bachelors) in Business or Finance (Minimum Required)

Claims CSR Resume Examples & Samples

Answers phone calls and addresses issues from providers regarding the status of medical claims submitted
Provides claim billing instruction
Clarifies claims policies and procedures
Documents responses to provider inquiries/issues
Demonstrated professional interactions with internal and external customers in a health insurance call center
Demonstrated experience with medical claims payment processes and ICD-9/10 coding
Proficient level of keyboard skills (40 WPM) and the ability to navigate within a computer/systems
Demonstrated experience with research, analysis techniques, independent decision making and knowing when to evaluate the decision
Experience with AHCCCS Rules, Regulations, Policies, Procedures
Specialized knowledge of AHCCCS Fee For Service Programs
One year of experience in medical claims processing in an insurance/managed care environment

Latin Region Claims Management Resume Examples & Samples

Latin America Region Partner Program claims management including validation to ensure compliance and eligibility for proper payment within defined SLA (service level agreement)
Collaborate with Program Manager, Program Lead, and key program stakeholders
Executes processes such as configuration & quote, pricing analysis, bid support, revenue recognition, invoicing, or organizational sales reporting
Compiles work and presents final deliverables
Produces analyses and reports using business applications
Contributes to continuous process refinement and improvement
Evaluates a variety of common business issues and recommends course of action
First level university degree or equivalent experience
0-2 years of experience in a business related function, preferably finance, accounting, or compensation in a transnational environment
Advance Portuguese highly preferred
Good communication skills (e.g. written, verbal, presentation) in English 85%
Intermediate Excel
Ability to work as active member of a team
Basic understanding of internal business processes and policies

Warranty Claims Validator With Chinese & English Resume Examples & Samples

Have good command of Chinese and English
Have high school diploma
Possess good communication skills (be able to build, maintain and enhance professional relationships with clients and others)
Have Data processing accuracy, be detail oriented, and able to evaluate/research a warranty claim
Have knowledge of warranty processes or mechanical knowledge of machinery

Director Claims Quality Resume Examples & Samples

Provides leadership to and is accountable for the performance of managers and/or senior level professional staff
Executes functional, market-level, and/or site strategy, plans, production and/or organizational priorities for Quality Initiatives
Identifies and resolves technical, operational, and organizational problems
This position is responsible for quality reporting, analysis, control audits and for developing plans and programs to support continuous quality improvement using applicable tools. May assist in the creation, implementation, and evaluation of Total Quality Management (TQM) programs
Leads the Optum Claims Operations, Quality Control/Audit organizations. Responsible for the staff performance and development of the quality control programs, including
6+ years prior experience in a transactions based operation
6+ years of experience within a matrix and/or shared service model or organization
5 years prior experience in leading and managing people (direct reports)
Demonstrates understanding of basic process management and total quality management principles and methodologies (e.g., Six Sigma; Lean, BPQM, Project Management)
Audit and/or healthcare claims experience preferred
Preferred training / certification in Six Sigma, Lean, Project Management, etc
Interpersonal Skills - ability to deal and work with people with different backgrounds. Demonstrated ability to build and maintain long term internal business relationships
Decision-Making Skills - capable of arriving at the appropriate decisions after weighing the pros and cons of all the options
Communication Skills - excellent verbal and written communication skills in addition be a good listener to give value to the opinion and suggestion of others
Accountability – Takes ownership of tasks, performance standard and quality results. Maintains necessary attention to detail to achieve high level performance
Problem Solving - Solution Driven Approach Skills - demonstrate ability to review problem, troubleshoot root cause issues and determine path to resolution
Flexible - Able to work effectively in a changing environment and contribute innovative ideas
Accuracy and Efficiency - Excellent time management and organizational skills balancing multiple priorities. Accurate when processing detailed tasks while meeting deadlines
Self-starter, able to independently, drive work and prioritize work with minimal oversight

Warranty Claims Management Team Lead Resume Examples & Samples

Manages the process of Warranty Claims Management team operations, its analysis and review calls (internal/external)
Communicates and cooperates with the other Warranty Claims Management teams share the best practices
Develops high quality client relationship and shares experience
Takes responsibility for professional development and growth of the team
Experience/Proficiency in team management
Strong ability to build and enhance professional relationships with client and the team
Good analytical and process oriented thinking
Proficient English skills - high command of both written and spoken language
Very good communication and presentation skills
Good knowledge of MS Office suite

100

Casualty Claims Trainee Internship Resume Examples & Samples

Working well with others in a fast-paced, collaborative environment that is also intellectually challenging
Achieving targeted performance goals to manage costs and support Allstate’s industry-leading operational standards
Excellent customer service skills and a passion to help others

101

ITS Claims Processing Team Lead Resume Examples & Samples

Interacts with the customer and other internal departments to resolve escalated or unusual issues
Acts as first level support for Claims Processing teams when complex cases arise or processing clarifications are needed
Apprises the Claims Supervisor and Operations Manager of inventory, aging, quality, and escalated member cases
Participate in weekly internal quality calls and monthly calibration calls with the customer
May act as the Leader-On-Duty in the absence of the Claims Supervisor/Manager

102

Claims Service Leader Resume Examples & Samples

Bachelors degree in related field preferred or equivalent experience
Applies highly advanced knowledge of insurance policy, coverage, and regulation
Applies highly advanced knowledge of problem solving and preparation of complex reports for analysis
Applies highly advanced ability to leverage learned technical skills in support of team objectives
Advanced negotiation and/or arbitration skills
Applies highly advanced knowledge of training facilitation and coaching skills
Ability to investigate, evaluate and settle highly complex claims
Applies advanced skill in motivation, organization, training, coaching and facilitation of teamwork

103

Director, Claims Qual-lynx Resume Examples & Samples

Effectively supervise, lead, motivate, and provide direction to managers, supervisors and related staff
Construct content for Claims Best Practices and Claim Standards documents, and related Guidelines, with ongoing responsibility to update
Develop and implement Best Practices to drive optimum outcomes on behalf of the organization, with ongoing responsibility to improve and update
Develop and implement processes for customer-centric, efficient and effective casualty claim management
Develop staff performance measurement tools and standards to ensure responsibilities are clearly defined and Best Practices are achieved
Develop, implement and monitor metrics to ensure staff is providing high quality, accurate and efficient claim handling and complying with Best Practices. Provide training to staff related to same
Develop and implement Management Exception Reports to assist management with staff oversight
Perform periodic claim file and program reviews with appropriate feedback to staff and upper management
Monitor legislative changes within each state, and assures compliance with all state claim handling requirements
Assist with claims operations department expense and revenue budget preparation and variance analysis
Assist with ongoing claims operations staff and other resource needs analysis and recommendations to upper management
Lead projects for claim department and other company initiatives
Prepare periodic reports for VP of Account Management and Claim Operations and others
Maintain a thorough knowledge of the litigation process and litigation management, an understanding of relevant jurisdictional laws and regulations, statutes and related revisions or changes in the law and apply to policies and procedures appropriately
Maintain a thorough knowledge and application of insurance contracts and policies, at all levels including primary, excess and reinsurance, and related laws
Identify training needs and develop effective training program across coverage lines
Working with the Director of Account Management, assist in the management of clients in the areas of claims administration and litigation through development of benchmarking, loss analysis and general performance measurement reports to ensure adherence to Best Practices, as well as company client specific claim program goals, directives, initiatives, policies and procedures
Develop claim handling recommendations guidelines as part of improved Best Practices
Provide guidance to staff on coverage, liability and damage analysis, especially on severe and complex claims
Conduct and oversee all internal claim reviews and audits to ensure effective claims handling by adjusters
Attend external client meetings to and conduct claim and program reviews
Complete monthly SCORE audits on supervisor and unit managers
Conduct monthly meetings with managerial staff
Assist in hiring and training of new employees and ensure ongoing training in relevant areas
Review time tracking and approve time off requests to ensure adequate staffing at all times
Evaluate staff performance on an ongoing basis; responsible for performance reviews, goal setting and progressive discipline procedures to ensure a non-discriminatory and consistent work force
Conduct or participate in client training and education externally as needed
In a leadership role, initiate company projects/endeavors over and above routine department/director functions
Complete annual performance evaluations on all direct reports
Travel on behalf of client or company, where needed to diverse geographical locations
Attend state and national insurance and risk management conferences when requested or required by upper management
Able to work flexible work hours, including nights and weekends consistent with company needs
Strong analytical and strategizing skills
Exceptional technical skills and legal knowledge
Exceptional leadership skills; Ability to work collaboratively with other leaders and across business units
Ability to generate innovative solutions to difficult situations
Strong financial acumen and understanding of fiduciary responsibilities
Ability to lead staff located in diverse geographical areas
Proficient with MS Office programs including Excel and Word
Proficient with claims management and RMIS systems
Proven interpersonal skills capable of dealing with all levels of personnel
Exceptional ability to multi-task
Superior organizational and decision making skills
Expertise in Workers’ Compensation and related claims handling practices and ability to apply same
Thorough understanding of managed care practices and ability to effectively apply same to obtain excellent claim results
Deep knowledge of client and carrier claims procedures
Strong coverage interpretation skills across diverse coverage areas
Significant understanding of self-insured retention, excess and reinsurance reporting
Deep understanding of claims evaluations and exposure potential
Fluent in medical terminology and medical/injury treatments
Customer-focused orientation with outstanding customer service skills to interact effectively with clients, carriers, brokers, risk managers, defense counsel, vendors, management and staff
Expertise in principles of workers’ compensation laws and applicable state and federal laws, including CMS and Medicare laws
Deep understanding of defense principles, multi-state jurisdictions and proven expertise in litigation management
Experience in managing high exposure, complex claims
Experience in managing catastrophic claim events

104

Damage Claims Team Lead Resume Examples & Samples

High school diploma/equivalent
1+ years of directly related transportation experience
Automotive, transportation logistics industry, insurance and/or auto repair knowledge is preferred
Skilled at managing multiple tasks in a fast-paced environment
Strong interpersonal communication skills
Detail oriented with good judgment and problem-solving skills
Self-motivated, reliable and dependable
Intermediate knowledge of Microsoft Word, Excel, and Outlook
Possess superior knowledge of navigating the Internet
Strong knowledge of Microsoft Excel, Word, and Outlook
Experience with high volume of inbound/outbound calls and emails
Accurate typing and data entry skills

105

Claims Trainee Resume Examples & Samples

Have a Bachelor’s degree or above with a minimum 3.0 cumulative GPA
Be legally eligible to work in the U.S. indefinitely
Have the ability to travel to Schaumburg, IL for 5 weeks of classroom training
Be flexible to relocate within a 5 year period to a location within the assigned line of business to one of Zurich’s metro office locations

106

Claims Internship Resume Examples & Samples

Assist in managing an inventory of claims
This is your chance to explore Liberty Mutual as a potential employer. We will provide you with a meaningful experience, along with the management support, tools, and resources you need to be successful. You will have the opportunity to participate in educational and social programs that will accelerate your development, as well as an online community of interns that will provide a collegial environment to help with your transition from school to work
Must be currently pursuing a Bachelor’s degree (graduating in 2018 or 2019)

107

Water Claims Restoration Specialist Resume Examples & Samples

Accurately assess mitigation handling on a claim-by-claim basis
Interact with program vendors within designated timeframes throughout span of mitigation, ensuring proper mitigation
Create alignment regarding policy and procedures within unit and across vendors for handling losses
Identify trends and share best-practices across group
Monitor mitigation estimates and final bills to ensure they are correct
Use Xactimate estimating software to adjust and reconcile mitigation estimates
Rotational schedule will include two shift cycles to include 8:00AM - 4:30PM and 10:30AM – 7PM EST with every other weekend rotation
Water Claims Restoration Specialist will be based out of the Lake Mary, FL office
At least 3-5 years of prior work experience in insurance and/or dealing with specialty mitigation, restoration, and/or mitigation companies dealing directly with the identification, oversight and mitigation of water damage claims, including the estimation and monitoring of these losses is a plus but not required
Possess excellent interpersonal, written and verbal skills, strong analytical skills, as well as superior customer service and negotiation skills
Strong ability to work in a team environment
Ability to deal with and negotiate with external vendors
IICRC-WRT and/or IICRC-ASD designations highly desirable but not required
Ability to work flex-shifts between 8am-9pm with rotating weekends

108

Claims Internship Resume Examples & Samples

You will participate in job shadowing, working with claims information systems, and assisting your team with day-to-day job functions
You may also spend time out of the office observing and/or assisting with field assignments to learn how to provide professional customer service, perform inspections of loss sites, assist with itemization of damages, work with contractors, participate in court appearances and assist with damage appraisals
You will be assigned additional training or project work including an end of summer presentation to management
Working towards Bachelor's degree, with a competitive academic standing
Minimum 3.0 cumulative GPA. Additional requirements might apply
Strong interpersonal skills, both written and verbal
Demonstrated customer service and negotiation skills
Attention to detail in a fast-paced work environment

109

Claims Special Projects Manager Resume Examples & Samples

Conceptualizes immediate and long-range needs of LMB Claims with respect to project mission. Must understand business objectives as they relate to project goals
Translates LMB Claims needs into a comprehensive project plan which ensures successful project completion
Negotiates projects objectives and direction with Integration Program Managers, Program Coordinator, and VP of Integration. Will interact with, and provide updates to, LMB heads, Division Senior Vice Presidents and Managers of such departments as Information Systems, Corporate Research, Actuarial, Underwriting, Claims, Sales, Legal, and Human Resources
Negotiates with external agencies/organizations such as law firms, State insurance departments regarding sensitive and/or complex issues
Prepares periodic written reports for Integration Program Managers, Program Coordinator, VP of Integration, and other Senior Managers regarding project status and keeps appropriate parties informed of project direction and renegotiates direction as necessary
Makes presentations regarding project direction and recommendations to Integration Program Managers, Program Coordinator, VP of Integration, and other Senior Managers
Identifies sources and relationships of corporate data and makes recommendations/decisions regarding consolidation and storage of data for access by Integration Program Managers, Program Coordinator, VP of Integration, and other Senior Managers
Bachelor’s degree or equivalent experience, advanced degree or professional designation preferred
Minimum of 7-9 years progressively more responsible experience in a financial and/or project management environment with exposure to project planning, simulation, modeling, capital budgeting, cost benefit analysis and information systems development required
Strong negotiation skills also required

110

Claims WC Spec Rep Resume Examples & Samples

Ascertains and verifies employment, and determines if injury arose out of (and during course of) employment
Completes workers compensation status and reserve evaluation on all assigned cases. Secures evidence and information by office conference, telephone, correspondence, and by assigning necessary field investigations
Contacts employee by telephone, correspondence or in person, and explains workers' compensation benefits
Determines nature, extent, and duration of disability; reviews with doctors; authorizes medical care and examinations; and maintains medical coordination of all claims
Determines monetary value of disabilities, and authorizes weekly indemnity
Negotiates settlements within extent of authority, and issues claims drafts or checks in payment of claims
Contacts, investigates, and negotiates subrogation settlements on assigned cases
Establishes and controls diary for file control
Assists in training Workers' Compensation Claims Representatives
Maintains adjuster license in states where required

111

Y-claims Internship Resume Examples & Samples

Develop the knowledge and skills needed to conduct thorough investigations
Negotiate settlements
Knowledge of legal liability, insurance coverage and medical terminology helpful but not mandatory
Minimum 3.0 cumulative GPA; additional requirements may apply

112

Director of Total Loss Claims Handling Resume Examples & Samples

Define and manage the value stream for Total Loss and Salvage
Align Personal Lines and Safeco Total Loss and Salvage processes
Lead Continuous Improvement efforts of investigation standards through Root Cause Problem Solving
Drive process adherence and use of consistent tools, methodologies, and documentation in decisions
Maintain open communication with Field, Analytics and end users in multiple groups across the company
Maintain a high pace of progress, starting with consistent improvements that will deliver customer experience improvement benefits
Incorporate and utilize Lean Principles in implementation of standard work and improvements
Makes presentations regarding project direction and recommendations to Senior Department/Division Managers
Coordinates with other project owners and stakeholders process changes that have impacts across various points of the claims value stream
Ensure Personal Insurance branded Common Purpose and Quality standards adhered to in the development and execution of projects
Conceptualizes immediate and long-range needs of Department/Division with respect to project mission. Must understand business objectives as they relate to project goals
Bachelor's degree or equivalent training required and MBA and CPCU preferred
Strong quantitative, analytical, teamwork, written and oral communication, and leadership skills to aid in peer-like interactions with other departments and senior management is required
Minimum of 5 years' experience in roles requiring problem solving/analytic skills, project management and presentation skills required
Claims management experience preferred
Lean exposure and experiences preferred
Ability to collaborate across multiple stakeholders
Proven track record of results delivery and attention to detail

113

Claims Unit Manager Resume Examples & Samples

Oversee and manage the entire claims handling process working independently and through special projects to direct the branch's activities in this area
Summarizes results, identifies opportunities for efficiencies and improvements in order to make recommendations and communicate key messages to branch team and senior management
Bachelor's degree plus 7-10 years of relevant and progressively more responsible claims work experience required
MBA and/or advanced insurance related designations / CPCU preferred

114

Claims Denials Specialist PRN Resume Examples & Samples

Coordinates denials management process with the field
Organizes systems and processes to ensure timely notification and communication with customers related to the denials management process
Participates in the development of rehab clinical programs promoting standardization and best practice exchange
Develops and provides education to RehabCare teams and customers using distance learning and on-site programs
Investigates compliance with federal, state and local regulations in collaboration with leadership and coordinates an appropriate response
Develops and provides comprehensive orientation to RehabCare appeal practices
Four years of clinical experience
Knowledge of all payer regulations and standards across the continuum of care
Frequent use of computer systems
Ability to travel occasionally
Skilled in developing and conducting training programs
Knowledgeable of current regulatory environment and ability to process and train new regulations
Ability to teach and train new information
Maintains up to date knowledge of new clinical developments
Working knowledge of each of the three rehab disciplines
Knowledge of Policies & Procedures related to providing therapy services
Approximate percent of time required to travel

115

Mgr, Claims Resume Examples & Samples

In consultation with superior and subordinate supervisory personnel as a appropriate, develops short- and long- term goals and plans for area(s) of responsibility
Develops, secures approval of, and administers an operating budget for attainment of agreed upon goals in accordance with approved plans
Formulates policy for area(s) of responsibility and secures appropriate approvals. Develops and administers procedures necessary to implement approved policy and provides the overall direction necessary to ensure the delivery of efficient and effective area services
Hires, develops, evaluates, and (when necessary) disciplines and discharges subordinates personnel or makes authoritative recommendations in such matter. Develops function-specific orientation and training programs for area personnel. Establishes standards for effective job performance and evaluates subordinates according to such standards. Delegates these responsibilities to supervisory personnel as appropriate
Responsible for the provision of services in the area(s) of claim services and benefit adjudication, and claims handling
Responsible for the development, implementation, documentation, and monitoring of an ongoing quality assurance program for area(s) of responsibility. Ensures compliance with regulatory agency guidelines and standards
Provides both claim specific representation and corporate representation in relation to claim litigation
Participates in catastrophe operation duties as assigned
Reviews and approves claims over supervisor’s limit
Resolves all non-routine and contestable claims decision. Provides guidance to Claims Associates & Supervisors and assist them with questions
Responsible for consistency in claims handling procedures and compliance with regulatory agencies guidelines and standards
Participates on committees and in programs for safety, fire prevention, disaster recovery and so forth. Ensures the development of specific plans for inclusion in these programs
Serves as liaison with other organizational components; establishes and maintains the working rapport necessary to develop cooperation and effectively integrate area services into the company’s overall business fulfillment system
Receives and investigates all complaints concerning his or her area(s) of responsibility and its personnel; determines veracity of such and (as necessary) takes corrective or disciplinary action and/or prepares reply
Remains abreast of developments in the field(s) of claim/benefit delivery, compliance issues and legal issues by pursuing a program of self-development, participating in professional organizations, interacting with peers, reviewing pertinent literature, and so forth. Incorporates advancements when practicable and cost effective
Directs the preparation of records as well as recurring and special reports and analyses for area(s) of responsibility ensuring that they are complete, accurate and prepared on time. Reviews and interprets these in order to ascertain the extent to which goals are being attained Takes corrective action as necessary

116

Director, Claims Management Resume Examples & Samples

Develop and manage cost-effective, efficient, compliant, and accurate processing and/or service strategies and procedures, to deliver a high-quality level of service for advisors and clients. Take primary responsibility for implementation of these strategies and process improvements among teams of on-site and virtual employees. Define and establish efficiency, accuracy, and service quality metrics for all employees. Drive teams to meet or exceed these metrics, by effective communication of goals, monitoring progress, motivating performance, and managing expectations within all teams, as well as with internal partners
Provide effective leadership to direct reports incorporating performance management practices through individual performance plans, periodic reviews and feedback sessions, coaching and development, as well as oversee and advise direct reports on the performance management process for associate level employees within their group
Manage relationships with a variety of partners working on similar product lines or transactions, including both on-site client service teams, product management and development, and sales force groups, in addition to offshore partners to effectively manage costs and ensure a seamless and cohesive client experience
Identifying potential risk/issues and collaboratively work with key business partners, driving to a solution while mitigating risk
Provide project management and subject matter expertise on large scale process improvements or other projects related to products and transactions handled by their teams. This would include project leadership where appropriate as well as managing the involvement of direct and indirect reports on project teams
Work directly with clients and beneficiaries as necessary to resolve high urgency or highly complex service issues as necessary when escalated by leaders or coaches, including coordinating involvement of technology, sales force, or other service teams and internal partners in issue resolution and service recovery efforts
Consult with workforce planning and service forecasting team to provide high-level leadership of staffing plans and scheduling to ensure an appropriately-trained workforce is available to meet service volume expectations. Partner with other service teams to facilitate cross-functional resource sharing as necessary. Approve service transactions when required by company or regulatory policy or procedure as necessary
10+ years relevant experience
In-depth knowledge of key Insurance & annuity service functions and regulations
Ability to provide strategic direction and professional development to a team
Excellent written/verbal communication and presentation skills and demonstrated ability working with internal partners at all levels
Excellent analytical, problem solving and organizational skills
Experience in project management, e.g., budget management, deliverables
Ability to plan and manage multiple priorities
Previous experience managing offshore partner relationships
FINRA Series 6 or 7 or ability to obtain within 90 days of start date
Leadership or Ameriprise-specific knowledge
Knowledge of Ameriprise client and advisor account servicing procedures and policies or financial services regulations and service
FINRA Series 26 or 24

117

VP Claims Resume Examples & Samples

Develop and implement a strategic vision intended to provide a focused, actively managed approach to claim quality and customer service
Develop, implement, and leverage data and analytics to measure effectiveness of claim initiatives
Manage talent development and acquisition from both internal and external sources
Lead a complex, high volume business with an atmosphere devoted to continuous improvement, a disciplined approach to process that leverages technology and automation
Effectively interact with all levels of the organization including reporting responsibilities to CNA executive management
Effectively collaborate with internal and external business partners including our key vendor partner
Leads strategic initiatives as part of the LTC transformation and build out of the Claim function
Leads, directs and has full management accountability for LTC claim staff in accordance with strategic direction
Builds a high performance LTC claim team through effective recruiting, hiring and developing LTC claim talent
Provides direct oversight of CNA claim team and integration with administrator responsible for claim support and payment. Responsible for assuring the administrator operates within company’s guidelines and upholds high standards of quality service and customer experience
Works with administrator on proactively identifying issues to ensure a high level of service. Partners in developing and monitoring mitigation plans on risk items
Develops, monitors and implements claims policy and guidelines in compliance with LTC claim objectives and insurance laws and regulations
Drives continuous improvement within scope of responsibility through initiatives involving people, processes and technology. Includes identifying and owning emerging issues and trends
Develops, maintains and analyzes appropriate metrics, governance and control mechanisms. Uses data and analytics to improve business results by targeting opportunities for process improvement
Interacts regularly with internal stakeholders such as Vendor Management, Quality Assurance, Compliance, Strategy & Delivery, Finance, and Actuarial
Key participant on LTC Leadership team
May participate in corporate initiatives or projects on behalf of LTC as needed
May provide expert testimony in LTC litigations or regulatory proceedings
May represent company in industry trade groups
Strong business acumen and ability to conceptualize and execute on strategy
In-depth technical knowledge of concepts and practices within claims management, ideally in with LTC or disability domain, fundamental understanding of insurance operations, working knowledge of finance and accounting concepts
Leadership and management skills demonstrating integrity and professionalism
Ability to effectively interact and communicate with all levels of external and/or internal business partners within scope of responsibility, team and/or matrix environment
Ability to drive results by identifying, and resolving problems within scope of responsibility
Excellent analytical and problem solving skills, with the ability to manage multiple projects
Ability to achieve results by taking a proactive long-term view of business goals and objectives
Bachelor’s degree or equivalent in Business, advanced degree preferred
Typically a minimum of 15 years claims-related experience, with 10 years of leadership experience
LI-WM1
TMJ-WM1

118

Agent, Claims Resume Examples & Samples

Data entry and monitor of submitted traces for customer inquiries
Coordinate claims and assign to international teams when necessary
Investigate, dispute and resolve lost claims inquiries and coordinate status with internal departments
Resolve customer problems, investigate issues, and utilize supervisors for resolution when necessary
Other duties as assigned - Transportation Duty

119

Claims Team Leader Resume Examples & Samples

Ensure that clients (internal and external) are regularly updated as to the progress of their claims/query
Manage the client’s expectations (internal and external)
Overall responsibility for the implementation and delivery of, Compliance/Audit/Complaints/Regulatory Issues
Act as insurer claims market liaison, escalation and support
Responsible for central MI & Report production
Ensure that claims related data and statistics, when required by the regional or national teams, are accurate and produced in a timely fashion
Where within our control, ensure the integrity of data held within the relevant internal data systems is 100% accurate at all times
Manage own, and teams, workload in order to support the Divisional Directors promptly and efficiently
Ensure that the Claims Division’s strategic approach and procedures are clearly communicated as required and that adherence within the Regions is appropriately monitored and reported on
Conduct performance reviews in accordance with company procedures
Take responsibility for own and team’s continual professional development
Comply with the AJG Professional Standards Manual in accordance with statutory requirements for role with specific attention, but not limited to Managing Client information, Whistle Blowing, Treating Customers Fairly
Cert CII/ Dip CII (Chartered Insurance Institute qualifications) desirable
Practical knowledge of claims processing
Good knowledge of claims insurance (London Market / Lloyd’s and Industry) products, services, and good understanding of underlying legal principles and practices relating to risk within own role capacity
Robust knowledge and understanding of Insurance Claims division or Insurance Industry
Strong people management/coaching experience
Confidently manages and sustains a key relationship network
Leverages technical knowledge to handle claim queries ensuring a connected service
An ability to extract and piece together required learning from a range of different opportunities and sources
Excellent interpersonal skills, including listening, verbal and written communication with the ability to communicate effectively with all levels of the Company, including senior level management
Excellent personal organisation and prioritisation skills are required along with the ability to adapt to changing demands and priorities
Problem-solving mind-set
Ability to lead and motivate others through good people management skills
High level of empathy and engagement to gain trust
MS office expertise

120

Claims / Change Manager Resume Examples & Samples

Strong writing skills (specifically in persuasive writing)
An understanding of financial statements and construction estimating
An ability to comprehend Construction Documents including but not limited to Contract Drawings and Specifications
An understanding of construction scheduling, working knowledge of P6 is a plus
Keen understanding and appreciation for Contracts and strong ability and desire to manage the Prime Contract
Experience with prime contract and subcontract provisions concerning claims
Computer knowledge and efficiency, including Microsoft Office products (e.g. MS Word, MS Excel, MS PowerPoint)
Knowledge or understanding of New York law as it relates to potential recovery of claims is an added bonus
Thorough understanding and working knowledge of the construction industry and project management
An understanding of the PPP contract delivery method
Strong math/accounting skills
Ability to develop or maintain relationships with clients and subcontractors
Exhibits strong leadership qualities

121

Claims Adjudication Specialist Resume Examples & Samples

Processes claims that are pended (adjudicates); including requests medical documentation from providers, looks for consent forms, EOBs and Third Party Liability, reviews the history for duplicates or duplicate payments, identifies inappropriate billing patterns and forwards to appropriate unit, ensures medical documentation is included with submissions, supplements and links documentation, recoups and voids claims
Processes complex claim issues. Works with various divisions in AHCCCS to resolve issues; and works closely with Finance Dept. on submitted referrals
Ensures that the system is appropriately processing claims, reviews claim history to identify duplicate payments, incorrect processing, and eligibility/enrollment data in order to use decision making skills that affect whether to pay, pend, or deny a claim, and notifies the appropriate parties for resolution
Coordinates claims that have Third Party Liability
Re-processes Prior Authorization Claims
Responsible for multiple projects related to claims processing and adjudication
Knowledge of Medical terminology, principals of medical pricing (i.e. DME equipment, drugs, multiple surgical procedures), and medical claims processing
Intermediate skills with Microsoft Word and Excel, and 10-key by touch
Strong time management in order to complete special projects as assigned
Ability to maintain a pre-determined production level and to multitask in a fast pace environment
Experience in medical claims processing, specifically adjudication
Working knowledge of medical coding, CPT codes, ICD-9 codes, HCPCS codes and CPT codes
Willing to work Virtual Office

122

Head of Claims Management Resume Examples & Samples

Bachelor’s degree required, business concentration and/or advanced degree preferred
10+ years of insurance and/or reinsurance experience in claims leadership and strategy including platform assessment and analysis
Expert knowledge of insurance and reinsurance principles
Strong process improvement, performance management, and quality assurance skills and experience
Experience working with and presenting to all staff levels, up to and including senior executives
Familiarity with underwriting, claims, accounting, finance and actuarial concepts
Service-oriented mentality
Travel 30-45%

123

Claims Personal Injury Protection Specialist Resume Examples & Samples

Investigate, evaluate and conclude first party medical losses
Maintain a knowledge of the No-Fault auto insurance policy and Florida No-Fault Statute
Maintain diary, note pad and closing ratio per established goals
Ensure claim files are properly documented and claims coding is correct
Maintain a positive attitude in a fast pace environment while providing excellent telephone customer service and a low occurrence of complaints
Recognize and refer all potential Subrogation and SIU claims
Four year college degree or relevant work experience preferred
Ability to operate a computer and learn new software applications
Fast and accurate data entry skills
Good telephone manner to enhance relationships with customers and agents
Ability to understand basic insurance concepts, policy language and basic coverage issues
Ability to multi-task and maintain a high level of desk organization
Must be able to work independently and meet deadlines
Must be flexible and adaptable in a fast paced environment

124

Enterprise Claims Resume Examples & Samples

Works closely with the Claims leadership team to identify, analyze and support process improvement initiatives, business practice gaps and to ensure all claims administration procedures align to the policy language and state specific contract variations
Maintains ongoing reporting tasks as assigned by members of the Claims leadership team
Participates in new product development initiatives to help assess impacts of the current processes or systems and suggest policy language or process alternatives to support accurate and efficient claims processes
Helps to identify and establish business requirements for the claims department
Efficiently and effectively fulfill various ad hoc reporting requests being submitted to the claims department
Serves as liaison to business areas
Other tasks to be determined by management and project needs
Minimum of 3 - 5 years working experience with claims products any systems including ordering and analyzing reports, documenting business requirements, creating and implementing testing plans
Excellent verbal and written communication skills - ability to summarize findings into concise high level points geared toward the audience
Demonstrated ability to positively interface with other departments, colleagues, senior management and internal business partners is required
Strong attention to detail and accuracy - proven ability to produce quality results timely
Demonstrated experience leading projects and/or initiatives
Ability to deal with ambiguity and multi-task
Strong issue resolution skills
High school diploma required, Bachelors degree preferred

125

Genworth Claims Internship Resume Examples & Samples

Review legal documents and identify and analyze trends,
Process death reports and locate beneficiaries for claims processing,
Contact Agents to notify of pending requests and beneficiary contacts,
Manage claims workflow queries to maintain time sensitive information
Current junior or senior pursuing a Bachelor’s Degree
Ability to promote a positive work environment at all times
Results oriented, ability to meet and exceed objectives and handle multiple deadlines and priorities
Ability to work 10-20 hours per week
Flexibility to work around class schedule
Six month commitment from January 2017 to July 2017
Strong analytical and business problem solving skills

126

RA Claims Team Lead Resume Examples & Samples

A strong working knowledge of Reimbursement Account products (HRA/FSA)
Hands-on experience with claims processing
Experience in a customer oriented, client facing position, preferably supporting healthcare plans
Ability to professionally represent HealthEquity while working directly with employer groups

127

Claims Intern, Leave Services Resume Examples & Samples

Learn how to negotiate settlements
Build business and professional skills that will prepare you for leadership positions
Gain valuable real world experience with a Fortune 100 company
Efficient planning, time management and organizational skills

128

Claims CSR Resume Examples & Samples

Three or more years related experience
The Claims Assistant is responsible for providing support to an assigned team of Claims Adjusters handling property and casualty claims
Assist the Claim Adjuster in the set-up of claims assignment to vendor and retrieval of completed reports
Move documents to Image Right and index to claim file
Send a task to the adjuster that the Appraisal is attached to the file
Complete the Salvage Transmittal form and then forward titles/POA’s to Copart
Send letters as requested – POL, SOL, Denial, etc
File ISO/NMVTIS if required
Respond to emails daily, return all voicemails within 24 hours

129

Senior Director Claims Resume Examples & Samples

Leverages strategic thought leadership and operational expertise to drive operating discipline, quality and efficiency improvements throughout the end-to-end claims processing operation. Ensures a hassle free member and provider experience and industry leading Net Promoter Scores. Initiates and/or participates on cross-functional project teams to improve the quality and efficiency of end-to-end claims processing that ultimately reduce contact rate, prevent member and provider escalations and provides a consistently hassle free member and provider experience
Accountable for ensuring that all regulatory and contractual service-level agreements, performance guarantees and MBOs are achieved. Closely monitors performance and proactively identifies degradation in key performance metrics. Engages the appropriate stakeholders to drive timely root cause analysis and remediation without negatively impacting upstream and/or downstream processes / business partners
Collaborates with key stakeholders and business partners to develop and implement plans to support the annual Medicare Annual Enrollment Period and the claims volume. The scope includes workforce planning, real estate and technology resource planning, recruiting, onboarding and training plans
Develops and manages a high-performing and engaged workforce that is capable of executing on all relevant business, operational and strategic plans. Implements timely, relevant and measurable employee engagement strategies
Builds and fosters collaborative business relationships with internal and external Business Partners and key stakeholders and leverages their expertise as needed to achieve all strategic and operational plans and to advance the business
BS / BA in business or a related field with a strong preference for advanced degree
Minimum of 8+ years of progressive, professional - level operations leadership experience which includes experience managing a diverse and geographically dispersed workforce, inventory management and managing to operational MBOs and/or contractual service level agreements
Prior experience in insurance claims operations, preferably healthcare insurance claims
Experience leveraging and managing global, third-party vendors to achieve business goals
Prior experience working in a large, fast-paced, complex and matrix organization and managing multiple competing priorities
Proven track record of hiring, developing and managing a strong extended leadership team
Proven ability to collaborate and build relationships with all levels of the organization
Highly skilled at effectively managing divergent business priorities with lean resources
Exceptional communication skills with the ability to present information in a variety of different formats to all levels of the organization
Strong process and analytical skills
Strong track record of applying innovative and creative solutions to improve processes which increase quality and reduce costs
Results-orientation
Demonstrated staff development skills
Ability to travel as required by the needs of the business

130

Warranty Claims Validator With English & Portuguese Resume Examples & Samples

Verification and analysis of warranty claims based on available resources
Documenting and adding comments
Investigating Brazilian warranty claims and facilitating recovery of faulty pieces
Coaching of the rest of the team on quality aspects or new learning when required (in person via conference calls)
Implement practices to improve operational efficiencies

131

Claims Resume Examples & Samples

Monitor the Claim Service Request System
Input and distribute checks
Monitor, index, and distribute faxes
Open, date stamp, scan and index incoming mail
Process underwriting requests
Monitor the email system
Answer phones for all customers
Basic reading, writing and mathematics skills

132

Mgr, Claims Resume Examples & Samples

Establishes objectives, schedules, and cost data for the business of the function being managed
Serves as primary contact for complex issues
Assists in developing short range plans for overall area activities
May oversee the implementation of programs and strategies
May act in liaison capacity with other areas and business units

133

Claims & Hardship Case Manager Resume Examples & Samples

Proven ability to provide quality customer service
Relationship management/call centre experience
Experience in financial services (superannuation/insurance/investments and in particular financial planning/adviser commission experience)
Ability to work in a fast paced team environment where targets need to be reached and deadlines met
Displays strong capabilities in written and oral communication skills
Proven high degree of accuracy and attention to detail of output in processing

134

Claims Processing Specialist Resume Examples & Samples

Provide administrative support to the Coverage Discovery Advocate Team (including processing mail and call transfer)
Input all referrals and log sheets that are received in office the same business day to validate inventory reports
Process and input all Federal applications into the Pace database within 24 hours of arrival in office
Provide support to Healthcare Representatives regarding incomplete claims or claims that have not been received in office within the allotted timeframe
Accurately sort and prepare documents for data imaging and indexing
Prepare and send out or deliver mail to the appropriate agencies

135

Home Claims Team Leader Resume Examples & Samples

To be self motivated and accountable to ensure that business KPIs/objectives are delivered
To act as a referral point for the whole team
To play an active role in the recruitment and selection process
To effectively manage/control the Home team’s tasks and priorities
To provide coaching support and mentor the Home team
To monitor the team’s performance on a regular basis ensuring that quality, customer focus and cost control are maintained
To handle more complex customer complaints/enquiries professionally and efficiently, paying attention to cost control
To understand and interpret management information that is produced on Home, so that development trends are understood and pro-active action is taken at every opportunity
To ensure the Company’s Best Practice is followed by yourself and the team
Resolve queries raised by Customers on existing claims ensuring that the claim is progressed towards settlement at every touch
Effectively resolve any expression of dissatisfaction raised by the Customer in a caring and pragmatic way
Deputise for Home Claims Assistant Manager, as appropriate
Resolve complex complaints from customers
To ensure that deadlines set by the Home Claims Manager are met
Oversee pro-active handling process on Home Claims ensuring that they are handled accurately and efficiently
To ensure that deadlines set by the Home Claims Manager/Assistant Manager are met
Handle all enquiries as if it were the first call of the day. Be caring and professional and courteous at all times
To conduct call accreditations and file checks on team members, providing balanced and constructive feedback consistent with the Quality Management Programme
Work closely with handlers to help them to achieve the minimum Quality management benchmark score on all calls/files reviewed
Ensure the claim details are checked for possible fraudulent cases
To take the initiative and continually challenge procedures within the Department, investigating impact of issues identified and providing pragmatic suggestions for process improvement
To Lead/manage projects within the Home Claims team to identify and implement claims initiatives in line with agreed project timetables
Manage allocated Home Suppliers on a day to day basis, ensuring that a positive contribution is provided to the Home Supplier Manager in relation to operational issues and performanceahead of any meetings. Ensure KPIs are reviewed on a monthly basis and any areas of under performance are flagged and discussed with the Home Supplier Manager
Comply with internal esure policy and procedures, and comply with external best practice and legislation, e.g. equal opportunities
Coach and develop team members to improve in their own role and encourage them to move up into their chosen field
Work closely with the team to provide direction and ensure that team members are motivated and engaged to achieve targets and service levels
Ensure 1-2-1s are used as an effective tool to monitor and provide feedback, ensuring quality checks are always completed and provide constructive feedback to the team at all times. Setting stretching goals in order to achieve accuracy
To work closely with all individual team members to identify their strengths and development areas. To provide authentic support to team members helping them to understand their own capabilities and to guide them as to how to structure their development to facilitate the fulfillment of their potential
To take proactive steps to recognize underperformance and to work with individuals to overcome the issues/enhance their development
Always work to FOS/ABI rulings and service levels whilst always considering cost and economics
Utilise SAS reports ensure adherence to KPIs
Handle complaints in a sympathetic manner, moving the complaint forward to a successful conclusion. Be aware of callboards and call volumes to effectively manage call traffic to achieve the agreed service levels
Achieve an audit result at the required level
Cross reference to the policy to ensure the policyholder has the required level of cover
Any day to day issues regarding allocated suppliers are managed effectively and escalated where appropriate to the Home Supplier Manager
Extensive and thorough Home Claims knowledge built within the insurance industry in a large organisation
Forward thinking and focused, the jobholder will strive to continually improve processes, quality and performance
Evidence of coaching and developing people dedicated to frontline customer support in a targeted environment
Experience of managing a team for at least four years at a loss adjuster or other insurance company
Numeracy and literacy to GCSE level (Maths and English - Grade C and above) or equivalent
Good communicator with strong interpersonal skills
Knowledge of Legal framework (Financial Ombudsman Services rulings and recent case law)
Understanding of FCA and Regulatory Compliance
Knowledge of Claims processes and systems
Knowledge of ABI Household and Property Agreements
Awareness of fraud indicators

136

PPO Claims Team Member Resume Examples & Samples

Knowledge of insurance and governmental programs, regulations and billing processes (e.g., Medicare, MediCal, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc.), commercial third party payers, and/or managed care contracts and coordination of benefits
Familiarity with medical terminology and the medical record coding process
Familiarity with Payer-specific (Medicare, MediCal, Medicaid, Private) Claims management functions in acute and non-acute settings
Ability to independently set and organize own work priorities for self, and successfully adapt to new priorities as part of a changing environment. Must be able to work concurrently on a variety of tasks/projects in an environment that demands a high degree of accuracy and productivity in cooperation with individuals having diverse personalities and work styles
Ability to communicate ideas both verbally and in writing to interact with others using on-on-one contact and group discussions
Skills using spreadsheet, word processing, and basic statistical software applications, preferably Microsoft Suite
Well-developed process design, implementation, and improvement skills
High-level problem identification/ mitigation/ resolution and analytical skills

137

Claims Quality Reviewer Resume Examples & Samples

May participate in one or more moderately complex or occasionally complex special assignments
May lead roundtable and/or calibration discussions
Uses advanced knowledge and skill, including knowledge of policy and coverage, and property damage evaluation information systems to perform work duties and assist less senior employees
Applies general and occasionally broad knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data
Applies general and occasionally broad knowledge of problem solving and preparation of reports for analysis
Applies general and occasionally broad problem solving skills to continuously improve business outcomes
Ability to investigate, evaluate and settle moderately complex and occasionally complex claims
Provides individual decision making within authority limits

138

Large Loss Contents Claims Team Manager Resume Examples & Samples

Provides technical guidance to team members
Comprehensive knowledge of general insurance policy coverage and state regulations
Thorough knowledge of claims investigation techniques
Ability to plan, prioritize, and organize claims workload for the unit
Demonstrates good interpersonal skills including verbal and written communications
BS/BA degree plus 5+ years of claims experience

139

Claims Appeals & Grievances Resume Examples & Samples

A-Level professionals with 1-3 Years of experience in claims processing, QNXT is preferable
Good logical thinking ability
Overview of US Healthcare Industry
Good Excel Skills
Good written Communication Skills
Ability to work accurately and efficiently at all times, including those of high processing volume
Sensitivity to the confidential nature of the data and proprietary company information
Perform claim adjudication activities according to deadline
Timely processing of daily, weekly and monthly claims reports
Knowledge on Claims Adjudication

140

Approver Senior Life Claims Resume Examples & Samples

Knowledge of Ford Motor Company/UAW Life Insurance Programs and Provisions is preferred
Knowledge of ALICS claim processing system is preferred
Knowledge of Imaging Systems (scanning, indexing and retrieval) is preferred
Must possess strong PC skills to include the accurate keying of information. Past experience with Microsoft Word, Excel and Access database in preferred
Excellent communication skills, both oral and written
Demonstrated past history of dependable attendance
Team Player – willing to help others
Adept at establishing priorities and meeting deadlines
Knowledge of interpreting legal documents is preferred
Knowledge of State and Federal Laws as it pertains to the specific policies is preferred
Starting pay is $22.24 per hour

141

Claims Internship Resume Examples & Samples

Participate in real work every day, whether doing analytical work or dealing directly with customers, claimants or legal and medical professionals to help gather the critical information necessary for the resolution of a claim
Work on specific projects with defined tasks
Review medical records and evaluate losses
Learn to negotiate settlements with attorneys
Working towards a bachelor's degree (graduating in 2018 or 2019)

142

Summer Intern, Claims Resume Examples & Samples

Receive telephone calls from customers, shippers, consignees and carriers relating to cargo loss incidents
Enter Incidents, Notice of Intent to Claim and Cargo Claims into claims database
Review mail, faxes and phone information for distribution to appropriate staff member
Obtain and analyze documents to support or disprove cargo claims
Process and negotiate small claim settlements between customers and carriers
Involves phone, email and written communication with Customers, Railroads, Carriers and Hub offices
On the job training and periodic seminars to develop individual into a professional claims handler
Batch processing of accounts receivable checks and processing of accounts payable checks
Must be enrolled in an undergraduate degree program for the duration of the internship
Ability to utilize a PC
Works well within a team environment
Exceptional organization skills
Ability to type at least 40 words per minute
Experience using Lotus Notes, MS Word and MS Excel

143

Claims Work Lead Resume Examples & Samples

Facilitate and provide periodic production and coaching results to management
Updates and documents all department process changes and ensure compliance to company requirements
Develop business process models
Assist risk management with annual compliance and deliverables
Analyze KPI and other departmental data to identify and implement process improvements
Exceptional organizational, technical, analytical, and time management skills
Decisiveness: The ability to make difficult decisions in a timely manner
Managing Change: The ability to demonstrate support for innovation and for change needed to Improve effectiveness; initiating, sponsoring, and implementing change
At least 2 years related experience or equivalent combination of education and experience
6 months with Global Strategic Equities (GSE) Servicing

144

VP, SIU Claims Resume Examples & Samples

Develops and facilitates communication within the industry for identification of significant fraud-related issues
Ensures regulatory compliance through filing of fraud plans with the Department of Insurance where required; ensures the notification of the Department of Insurance on suspicious claims where required
Serves as corporate representative on industry committee associations established to combat insurance fraud. Creates lines of communication with regulatory agencies, sensitizing them to the insurance fraud problem
Monitors automated systems designed to maintain and analyze national insurance
In-depth knowledge of the insurance industry, Special Investigation Unit operations and related best practices, claims handling and payment operations, and insurance policies, coverage, and contracts
Thorough knowledge of insurance fraud schemes, indicators, elements, and appropriate legal investigative techniques, specialized resources, contracts, and evidentiary procedural, technical and operational matters associated with insurance fraud detection
Knowledge of legal issues and litigation process, Unfair Claims Practices Act and Legislative Insurance Department Regulatory requirements in regional geographic jurisdictions, state and federal civil and criminal law
Excellent customer focus to proactively identify and understand customer needs
Oral and written communication skills for frequent contact with claims representatives, claimants, policyholders, claims field management
Demonstrated decision-making skills, including the ability to recognize, analyze and improve claims performance situations such as loss control, LAE, customer satisfaction, employee development and engagement
Effective listening, oral and written communication skills necessary for customer contact, negotiation, presentations, project management, personnel management
Ability to make decisions, establish priorities, and set strategic directions
Ability to organize and deal with a variety of situations, discern problems and recommend/implement resolutions
Proven ability to operate personal computer with proficient use of claims and business software
Minimum ten years progressive work experience as an SIU Manager or 15 years combined SIU, legal, claims or law enforcement experience

145

Claims Resume Examples & Samples

Assists internal and external customers with problems or questions regarding claims by phone or through written correspondence while providing a high level of customer service
Establish initial reserves for all potential exposures and adjust as appropriate throughout the claim
Ensure timely completion of appraisals and determine accident related damages
Process correspondence related to assigned claims
Zero to one year casualty claims adjusting including bodily injury experience

146

Regional Claims Center Lead Resume Examples & Samples

Knowledge of products and product features and procedures
Familiar with FMLA regulations and requirements
Skills and knowledge in handling escalated client concerns and resolutions (strong client relationship skills)
Demonstrate commitment to client service and quality
Demonstrate initiative, strong analytical and problem solving skills
Ability to collaborate across multiple disciplines
Works effectively in a team setting
Demonstrates leadership skills
Proven decision-making skills
Excellent research and follow-up skills

147

Claims Management Specialist Resume Examples & Samples

1-2 years appraisal experience
1 year data entry experience
This position requires the attainment of at least one company-approved insurance designation. Refer to the Claims Certification Policy for a list of approved designations and policy details

148

Claims Management Specialist Resume Examples & Samples

Receive claim assignments from assigned agents, verify applicability of coverage
Determine appropriate methods and extent of needed investigation for all assigned claims and conduct investigation primarily through personal visits and also by phone, obtaining medical reports, appraisals, witness and claimant statements/interviews, scene inspections, or other necessary fact-finding methods in order to establish proper value
Ensure proper file documentation and reporting of information secured as result of claim activity. Ensure rationale for settlement that is consistent with company procedures, reporting standards and guidelines, and may also be responsible for submission of claims forms and reports as required by outside agencies
Evaluate and adjust claims within limit of assigned authority level. Consult with Claim Manager/Supervisor
Determine extent of damages, coordinate and establish repair/damage figures. Enter into final settlement negotiations up to a limit of assigned authority levels and participate in litigation process in conjunction with defense counsel when necessary
Arrange medical examinations, contractor estimates, or other specialist’s appointments when necessary
Assess recovery potential. Develop information necessary to successfully pursue recovery
Act as liaison with attorneys, public adjusters, underwriting department, rehabilitation facilities, investigators or other service vendor as necessary to manage claim including attending trials, arbitration, ADR, conducting face-to-face negotiation
Assist with monitoring quality of services rendered by appraisers, law firms, structured settlement vendors, rehabilitation vendors, etc. and make recommendations to manager/supervisor
Establish and maintain effective working relationships with corporate claims, SIU, underwriting, and other corporate personnel to assist in the timely and efficient settlement of assigned claims
Excellent presentation and public speaking skills
Ability to travel and work varying shifts
Ability to prepare own damage estimates
Ensure positive and effective relationships with all assigned agents
College degree preferred or equivalent experience of 5 -10 years experience with claims handling, preferably including field adjusting experience

149

Claims Shared Services Suppot Resume Examples & Samples

Will work frequently with Word, Excel and internal legal and claims systems
High School Diploma or Equivalent and 2 or more years of experience in the Administrative Support area
Effectively interact with technical business partners

150

Claims Intern Resume Examples & Samples

Understanding the claims process/lifecycle
Learning to read and understand title insurance policies
Conducting Legal research for claims
Investigating and recommending coverage determinations on claims as well as preparing coverage and other claims response letters
Assisting with management of litigation and outside counsel, including reviewing pleadings and motions
Attending mediations and appropriate court hearings with claims counsel
Visiting and learning about other departments within First American such as underwriting and title and escrow operations
Proficiency in MS Office Suite applications
An interest and willingness to learn about the Mortgage, Real Estate, Financial, or Title Insurance Industries
The ability to solve problems, be detailed oriented and be conscientious about all work completed
The potential to excel in the following competencies: Communication, Customer Focus, Ethics & Integrity, Teamwork & Adaptability, Productivity & Initiative
Outstanding interpersonal skills and customer service orientation

151

Motability Claims Director Resume Examples & Samples

Understanding RSA’s Motor proposition – Expert
Understanding RSA – Advanced
Understanding of the UK Motor market – Advanced
Understanding RSA’s propositions – Expert
Understanding the Marketplace - Advanced
Working Effectively – Advanced
Making Change Happen – Advanced
Planning – Expert
Using Judgement – Expert
Leading People – Expert
Communicating Effectively – Expert
Delivering Results – Expert
Operations Strategy – Expert (Ops)
Operations Strategy – Intermediate (IT)
Negotiation – Expert
Partnering with the Business - Expert

152

Claims Intern Resume Examples & Samples

Learn the claims assignment routine
Work with the telephone claims unit to follow claim processing routine
Current undergraduate student working towards degree in Business
Strong Microsoft Excel and Word skills
Ability to manage multiple priorities and the ability to meet deadlines is essential
Highly organized with acute attention to detail

153

Operation Manager Individual Claims Resume Examples & Samples

Manage work flows and recommend business process improvement opportunities that will improve the client experience and effectively and efficiently run the business
Monitor incoming volumes, staffing levels and queue inventories
Handle data, track and report on trends, then recommend solutions or courses of action
Improving services through analysis of performance and implantation of continuous improvement initiatives
Recommend strategies, priorities and action plans to close systemic operational gaps in the Claims and to maintain data integrity in the business area
Represent the Claims on projects to assist in the development of the key performance indicators and the associated tracking, to gather and document reporting business requirements, and to build, test and implement on those reporting needs
Participate and contribute to the successful implementation of projects
Remain organized and proactive under conditions with multiple tasks and tight deadlines that may change to reflect current priorities
Managing Budgets
Operational and Leadership Experience
Experience and proven capability in process improvement and implementing change
Leading complex and unique projects
Influential Communicator with the ability to negotiate
Excellent planning, organizational and time management skills
Analyze and interpreting metrics and trends

154

IT Claims Interface Development Intern Resume Examples & Samples

Learn and produce various IT documentation (design, test, process improvement etc.,)
Work and learn on application unit testing
Effective presentation and Group Discussion Skills
Candidates with excellent volunteer work in school
Desired majors: Computer Science or related

155

Reinsurance Claims Team Leader Resume Examples & Samples

Supporting and developing the team through regular communication, training, coaching and appraisals reviews
Integrating and training of new joiners / training of team in conjunction with Subject Matter Experts
Prioritizing and organizing team’s workloads, work effectively in the face of ambiguity
Ensuring Continuous Improvement initiatives are tracked and supported where necessary
Preparing reports as requested to support the claims management responsibilities
Documenting and assisting with control processes and Internal Audit
Cooperating closely with Underwriting Support and Technical Accounting Team Leaders, ensure that the teams work collaboratively
Developing and maintaining relationships with local XL Catlin teams and with stakeholders in the regions through frequent contact and being responsive to their needs
Ensuring processes, procedures and SLA’s are met and adhered to. Comply with XL Catlin claims guidelines and procedures
Working on special projects as and when required
Proven experience in (re)insurance industry preferably in claims area (ability to read and interpret insurance data) would be a strong asset
Excellent people skills; communicative, supportive, flexible and open to new challenges
Good organizational skills with ability to work under time pressure in a changing environment
Demonstrate the ability to motivate others to meet standard and achieve objectives
Be solutions focused, know how to balance short and long term goals and be able to understand the difference
High level of numeracy and excellent data processing skills with strong attention to detail
Strong analytical skills and sound judgment with the ability to take initiative intellectual curiosity: A willingness to ask questions and explore new ideas. Eager to learn and focus on continuously improving technical skills
Proficiencies with Microsoft Outlook, Word, Excel, PowerPoint and other commonly used software
Fluency in English (both spoken and written) is a must. Knowledge of second European language would be an asset (German, French, Italian, Spanish)
Continuous Improvement experience beneficial

156

Claims Services Specialist Resume Examples & Samples

Utilizes in-depth knowledge of Commercial insurance industry to identify the type of loss and make accurate determinations on what policies are involved in coverage to notify all carriers to proactively manage client experience
Manages all aspects of claims reporting process to ensure optimal client service, timely and accurate resolution, and maintain strong working relationships with carriers and other external parties
Performs special projects at the request of the Director of Claims
Establishes strong working relationship with appropriate carrier contacts and effectively follows up on all claims to ensure clients and internal staff
Identifies situations that are sensitive and escalates to Claim Consultant or Director of Claims to maximize client satisfaction and retention
Analyzes Workers Compensation Experience Modification (MOD). Performs Quick MOD reviews and ensures validity of clients Experience Modification
Ensure client claims are reported and receive priority carrier attention
Maximize the availability of the insurance carrier to ensure appropriate resources are coordinated and meet standards of performance
Provide thorough status updates and summaries to client and internal staff

157

Director, Claims Management Resume Examples & Samples

Assumes hands-on responsibility to mitigate or eliminate risk exposure and losses for our juvenile treatment facilities, correctional medical services, community corrections and electronic monitoring facilities
Manages a Claims Staff to coordinate claims through the company’s third party administrator. Performs the duties typical of a manager level
Analyzes claims to better understand the nature of injuries and provides reports to facility management in order to improve workplace safety, professional liability and property protection
Assists with due diligence activities regarding future mergers and acquisitions
Assists with writing and revising corporate policies and procedures regarding incident reporting, claims reporting and claims management
Achieves defined productivity, timeliness, and quality standards in claims administration
Develops and functions within a defined budget
Proactively work with customers (both internal and/or external) to resolve problems and to provide unsurpassed customer service and seamless benefits administration
Coordinates risk activities with other departments within the organization including Legal, Human Resources, Health Services, Operations and Proposal Development

158

Manager, Medicaid Claims Resume Examples & Samples

Manages and develops a team focused on meeting or exceeding established performance targets. Targets may be based upon plans, federal or state requirements as dictated
Acts as a technical expert in handling complaints and other escalated issues from internal and external customers
5-7 years Medicaid claims processing

159

Director, Claims Resume Examples & Samples

Advanced knowledge of Microsoft Office programs – Excel, Outlook, PowerPoint, Visio and Word
Excellent interpretation and research skills to identify problems
Able to make processing decisions in exceptional claim situations
Ability to manage multiple projects, successfully meeting deadlines while maintaining or exceeding quality/productivity standards
Knowledge of Federal and Medicaid claims regulatory requirements
Ability to abide by Molina's policies
Ability to maintain attendance to support required quality and quantity of work
Years of experience may be substituted for educational requirements
5 years claims management required, ideally with a health maintenance organization or health insurance carrier; 6 or more preferred
Experience with claims processing required; Medicaid and Medicare claims processing preferred
Experience with billing guidelines, to include various payment methodologies and fee-schedule pricing methodologies preferred
Experience with standard medical coding, including but not limited to ICD9, CPT and HCPCs required
Experience with coordination of benefits and third party liability required

160

Specialist, Claims Recovery Resume Examples & Samples

Coordinates analyzing claims overpayments and determines collection recovery strategies
Prepares written provider overpayment notification and supporting documentation such as explanation of benefits, claims and attachments
Handles collection arrangements for overpayment claimants that have not responded to overpayment requests
Maintains and reconciles department reports for outstanding payments collected, past-due overpayments, uncollectible claims, and auto-payment recoveries
Prepares and provides write-off documents that are deemed uncollectible or collections efforts are exhausted for write off approval

161

Warranty Claims Validator With Spanish & English Resume Examples & Samples

1) Warranty claim validation based on checking invoices (proof of purchase), warranty policies and available external resources (e.g. DTAC, parts catalogs, sales information)
2) Clarification with repair service providers in case of discrepancy
3) Repair service providers invoice checking (i.e. comparison with payment proposal)
4) Delivery of checked invoice to the client's accounting department
5) Documenting and adding comments (e.g. to slow pay list or to the claim)
Proficiency in Spanish language and advanced level of English
Be stress resistant

162

Supv, Claims Resume Examples & Samples

Ensures execution of claim handling strategies; including appropriate determination of coverage, processing guidelines and metrics
Coordinates work flow and staffing of day-to-day activities as well as assigns and monitors work of staff in order to adhere to productivity and quality standards
Reviews and analyzes claim reports to identify and address trends. Recommends strategies to correct adverse trends
Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow-through to closure
Reviews and documents recommendations for claim disposition; including evaluation, negotiation and settlement of claims in excess of staff authority levels
Responsible for compiling and submitting daily, weekly and monthly departmental reports to management
Serve as subject matter expert and provide feedback to team personnel and provide training as needed

163

Spec Life Claims Resume Examples & Samples

1-Responsible for new claim setup and the processing of basic claims
2-Provide support to the Benefits Analyst and Associate Manager by means
High school diploma or equilavent, post secondary education a plus
One year claims experience preferred
Intermediate Microsoft office product skills

164

Mgr-liability Claims Resume Examples & Samples

Manage and control activities associated with a large commercial automobile and general liability claims portfolio including subrogation claims, both litigated and non-litigated, to ensure appropriate investigation, evaluation of coverage, determination of liability, evaluation of damages, reserving, defense and settlement strategies, identification of indemnification sources, settlements in serious claims and litigation with settlement authority up to $350,000
Select, negotiate, facilitate contractual agreements and manage the performance of all liability claims administration and cost containment vendors
Bachelor’s Degree or equivalent work experience plus five (5) years’ experience managing a large portfolio of bodily injury and property damage liability claims, both litigated and non-litigated, of significant exposure and complexity involving serious injuries. Commercial automobile liability and general liability claims experience preferred
Leadership/managerial experience and interpersonal skills necessary to lead a team of liability claims professionals
Experience and ability to use Microsoft Office Software, including but not limited to; Word, Excel, and Outlook

165

Claims Agent Resume Examples & Samples

Investigates and reports on risks and claims resulting from accidents/incidents involving injuries, fatalities and/or property damage to the Company or third parties
Negotiates (with 3rd parties, insurance companies, independent adjusters and/or outside counsel) settlement of claims and/or recommends disposition of claims
Keeps apprised of legislation changes, case law and adjusting/insurance trends (including Insurance policies) that may affect claims handling
Keeps apprised of changes in railway operations, procedure and policy
Assist and educate Company personnel in reporting accidents in a timely manner, including the necessary information required that affect the Company
Works with Company solicitors in preparing for and during trial
Liaise with outsourced legal counsel in preparation for and during trial
Represents the Company at Small Claims Court
Liaises with insurers, and their representatives, in cases where the Company may be liable for damage caused by CN's Contractors, and for which insurance coverage may be available
A thorough knowledge of adjusting principles/standards/insurance policy interpretation through accreditation from the Autorite des Marches Financiers or related experience
CRM or CIP or working towards
Sound knowledge of relevant Federal, Provincial and Municipal statutes & by-laws (Railway Safety Act, Insurance Acts, Highway Traffic Acts, Environmental Acts, Coroners Acts, Fatal Accident Acts, Human Rights Acts etc) and AAR and other industry agreements
Working knowledge of accounting and financial reporting for analysis of complex claims
An ability to use and navigate various computer programs
Must perform various administrative duties pertinent to the job, and other duties as may be required
Candidates will require significant proficiency in both official languages both written and oral

166

Claims Unit Manager Resume Examples & Samples

Participates with Producer and Operations in planning unit goals and objectives
Ensures that work assignments delegated to staff are aligned with unit goals and objectives
Manages claims staff, including motivating/mentoring staff, providing employee training and development, conducting performance reviews and performing disciplinary action as appropriate
Recommends personnel/staffing needs to Operations
Selects candidates, conducts interviews and recommends candidate hires to Operations
Coordinates new hire on-boarding with Human Resources department
Manages unit schedule, receives and approves timecards and time off requests
Reviews and pre-approves Professional Development requests; forwards to operations for final approval
Develops strong working relationships with staff and Producers
Gathers new and lost business reports
Prepares reports including expiration and policy status reports for team
Encourages and facilitates carrier and/or brokerage relations including carrier promotions, products knowledge and systems usage and/or training
Coordinates dead file assignments
Maintains regular communication with Operations Manager
Attends company sponsored training and development programs as mandated
8 - 10 years related work experience

167

Claims Unit Manager, Complex Bodily Injury Resume Examples & Samples

Owns the development and performance of several claims teams ensuring the quality, accuracy, and timely resolution of claims of all complexities. Continuously develops talent by creating opportunities for direct reports to grow and strengthen new skills
Advocates claims customer service excellence by building empathy and passion for the customer experience that meets and exceeds customer expectations
Demonstrates a passion and vision towards a highly effective and engaged employee culture. Selects top talent, delivers continuous coaching, rewards and recognizes employees to reinforce behaviors that ensure service excellence, and holds other accountable for the development of their teams
Monitors the performance of teams and claims team managers, analyzing any problematic trends to identify root cause problems. Escalates issues or may recommend solutions to operational leadership. Advocates a culture committed to identifying process efficiencies to continuously improve how work is completed
Resolves complaints, problems, and coverage questions that are escalated from teams, escalating further if needed. Collaborates effectively with internal and external stakeholders including existing policyholders, the business community and governmental agencies, to ensure compliance with regulatory and company standards
Ability to lead and manage multiple claims teams (or Claims Reps /Specialists) and effectively communicate operational procedures
Knowledge of principles and methods pertaining to the claims field; knowledge of claims management practices, company operations and policies
Advanced insurance related designations / CPCU preferred
7-10 years of relevant and progressively more responsible claims work experience required, bachelor's degree preferred

168

LTD Claims Supp Specialist Resume Examples & Samples

Performs EA reviews on decisional and financial elements as needed
Responsible for inventory control and/or load balancing
Assists Unit Leader with control reports
Acts as team and office resource for claim related and technical issues
May provide guidance to junior staff members
Associates degree, Bachelors preferred
6+ years’ long term disability claims experience

169

Claims Senior Specialist Resume Examples & Samples

Facilitates and provide periodic production and coaching results to management
Provides input to department process changes and ensure compliance to company requirement
Assists with the development of business process models
Assists risk management with annual compliance and deliverables
Analyzes key performance indicators and other departmental data to identify and implement process improvements
Accountability: Able to take responsibility for all work activities and personal actions

170

Claims Integrity Specialist Resume Examples & Samples

Responsible for taking the lead responsibility in conducting in-depth analysis and evaluation of medical assistance issues and programs regarding activity for timely and accurate completion of all recovery projects as they pertain to provider billing utilization and SPI
Analyze and evaluate Mass adjustments to determine if the adjustments were processed according to state and federal policies and regulations. Responsible for managing the Program Integrity receipt process. Provides technical and consultative assistance to providers regarding billing utilization review
Independently makes determination of final adjustment and re-bill dispositions for complex billings. Making such determination requires thorough understanding of algorithm logic and its resulting reports pertaining to physician, dental, durable medical equipment (DME), hospital inpatient/outpatient, psychiatric and pharmacy
Serves as provider billing utilization subject matter expert in regards to provider recoveries. Monitors and pull data-driven reports from the Case Tracking system, provider billing utilization data and documents findings. Interprets medical program policy and procedural regulations in regards to recoveries and adjustments
Provides consultative services to medical providers, OPI, OPTUM, CNIS and other state employees and officials regarding recoveries and adjustments. Participates on special projects or teams related to re-procurement activities, recoveries and adjustments
Attends fact finding sessions to access and retrieve and analyze claims data for both Fee for Service and Managed Care
Develops and maintains clear, concise directions regarding payment recoveries and adjustment activities for both the medical claims and partial pharmacy claims. Utilizes relevant resources to be constantly up-to-date and trained in skills, knowledge, and usage of ProviderOne and Point of Sale systems
Three professional references

171

Bodily Injury Claims Team Manager Resume Examples & Samples

Responsible for all management related duties including performance management/evaluations, establishment of objectives, and participates in the selection of new hires
Ability to plan, prioritize and organize claims workload for the unit
BS/BA degree plus 3+ years of claims experience

172

Claims Resume Examples & Samples

Evaluate and assess damage through the submission of photos provided by vehicle owners, body shop and external appraisers
Travel a designated territory inspecting, photographing, and writing estimates when needed
Evaluate options, ratings and conditions of vehicles to determine if a vehicle is repairable or a total loss
Document estimates and claim files with the necessary detail explaining the appraisal such as parts choices, damage relation to facts of loss, unrelated prior damage, etc
Work with repair facilities on supplements to complete the repairs timely
Track and make decisions regarding rental car duration while vehicle is being repaired
Requires a candidate with a strong working knowledge of collision and comprehensive related auto repairs and estimating
Extensive experience creating auto damage appraisals with an emphasis on auto body parts repair, replacement and refinishing is required
Additional experience related to the repair or replacement of mechanical, frame, suspension and other related automotive components is necessary
ASE (Automotive Service Excellence) and/or ICAR (Interindustry Conference on Automotive Industry Repair) certifications a plus
The ideal candidate will have excellent time management and organizational skills and work successfully from a home office
Must be able to provide transparent, detailed work product that is easily comprehended by both internal and external customers
High School Diploma or Equivalent required
Analytical and human relations skills are critical
Excellent customer service skills are a must
Interpersonal skills that include effective negotiation of fair and equitable settlements that meet all recognized industry and company standards

173

Specialist Iv-hud Claims Resume Examples & Samples

The qualified administrator will be required to prepare, review, submit, and reconcile reverse mortgage deficiency claims being filed against qualified insurance with HUD
Proficiency in Microsoft Office and basic Excel proficiency
Proficient in Adobe standard edition
Ability to work well under pressure and meet daily deadlines
Must produce a high level of accuracy
Must work independently, and be able to work well under pressure
Maintain a good working relationship with other members of the department and other servicing areas
Must be able to communicate effectively and efficiently

174

Claims Approver Resume Examples & Samples

Analyze and process claims in a productive environment through our TLC claim system
Appropriately interpret a variety of plan provisions and process claims accordingly, calculating claim payments and overpayments
Review claims for receipt of all needed documentation and make outbound calls to providers for additional information
Collaborate with our Claim Support Specialists, Customer Call Center and Care Coordinators to provide a seamless claims experience
Abide by department guidelines and appropriately follow up on necessary tasks to process claims
Meet quality review standards of processed claims
Meet performance standards for financial accuracy, processing accuracy and claim timeliness
Respond to insured inquiries regarding specific claim details via telephone conversations and/or written correspondence
Gather and analyze information skillfully to identify and resolve problems in a timely manner
At least 2 years experience in a claim environment preferred
Associate level or higher degree preferred

175

Head of Claims Response Resume Examples & Samples

Collaborate with the Heads of Motor and Home Claims Resolution, Head of Third Party Capture and Credit Hire, Head of Pet, Travel and Creditor, Head of Offshore, Head of Resource planning, Head of Customer, Customer Relations and Business Partners (across COO and central functions) to embed a culture of continuous improvement, delivering an efficient end to end claims process, and ensuring a seamless customer journey from notification to claims resolution
Work with Head of Offshore to ensure that offshore operations are aligned to onshore best practice and performance deliverables
To provide significant input to business plans for claims cost control, operational efficiency and customer satisfaction
Lead the function in delivery of cost and expenditure targets through the achievement of results against key priorities and people metric accountabilities
Lead the function to ensure delivery of high levels of customer satisfaction through, speed of response and expectation management, ensuring a customer centric culture which makes insurance easier for our customers
Responsible for managing, motivating and leading the Claims Response management team, creating an environment that supports the performance and development of the team to meet business objectives, maintaining personal visibility across all locations and promote effective communication of DLG, Claims Operations and directorate objectives
Ensure that compliant claims handling policies and procedures are adopted, that controls operate effectively (incl. SOX compliance), and resolution of complaints in conjunction with central complaints area
Support the underwriting process through the consistent application of handling polices and procedures
Identify and action any legal and regulatory changes, or trends in claims handing and settlements that could impact policy coverage, pricing and/or claims settlement costs
Build and maintain effective relationships with key stakeholders (internal and external), breaking down boundaries within the organisation, ensuring meaningful engagement and the focus on customer is consistent throughout Direct Line Group

176

Claims Approver Resume Examples & Samples

At least 2 years experience in a claim environment
Associate level or higher degree
Excellent analytical and mathematical skills
Ability to comprehend and apply varied rules to multiple policies
Proven ability to meet quality and time standards
Basic knowledge of computer system, Microsoft Word, and Excel

177

Claims Unit Manager Resume Examples & Samples

Implement, communicate, and manage policies and procedures that will enable the regional claims organization to deliver successfully on the claims handling strategy
Oversee and manage the entire claims handling process working independently and through special projects to direct the region's activities in this area
Works with the organization to collect data, map critical processes, and evaluate branch initiatives
Summarizes results, identifies opportunities for efficiencies and improvements in order to make recommendations and communicate key messages to regional team and senior management
Ability to manage and direct a claims operation and to communicate operational procedures to staff effectively
Bachelor's degree plus 7-10 years of relevant and progressively more responsible claims work experience as well as proven ability as a manager required
People management skills including interviewing skills, training, performance management and communication skills
Demonstrated ability to communicate verbally and in writing at all levels of the organization and clearly and concisely express opinions, conclusions, and recommendations
MBA and/or advanced insurance related designations / CPCU or SCLA preferred

178

Claims Processing Director Resume Examples & Samples

Leads management team to establish strategic plans and objectives for the function; may assist with developing some cross-functional oriented objectives
Has overall control of planning, staffing, budgeting, managing expense priorities, performance requirements, and recommending and implementing changes to methods
Influences the development and execution of functional and KP-wide policies and long-term goals
Participates in development of methods, techniques and evaluation criteria for projects, programs, and people
Minimum ten (10) years of experience in a claims processing environment or other related environment, with seven (7) years of management experience

179

Mgr Claims Capture Unit Resume Examples & Samples

Manages Claim Capture Unit operations which includes implementing and managing all new programs associated with 800 RESPOND and 866RECOVER
Manages productivity, cross-training, and staffing levels
Compiles and analyzes call handling statistics, and maintains all franchise lead dispute process completion and statistics
Provides support and communication to Disaster Restoration team, regional management team and participating QRV franchises
Communicates with vendor – AnswerLink – to provide CCU job knowledge and productivity consistency
Serves as subject matter expert on all Claim Capture Unit processes and procedures
Coordinates software changes and additions with IT Director
Develops communication pieces related to RESPOND/866RECOVER including training material
Suggests efficiency improvements for the Claims Capture Unit
Presents RESPOND / 866RECOVER overview and training to the QRV academy
Proficiency with Microsoft Office products
Managerial experience preferably in a call center environment
Human Resource experience and/or certification (PHR) preferred to maintain positive, high level employee relations
Broad knowledge of ServiceMaster Clean and franchise operations
Ability to make sound decisions based on factual information with a mixture of experience and judgment
Ability to analyze and draw conclusions from data
Reads situations quickly to reprioritize for effective workload management
Coaching skills to develop employees for maximum performance
Meets the expectations and requirements of internal and external customers
Seeks ways to improve customer service and reduce costs
Occasionally required to
Noise level

180

Life Claims Assessors Resume Examples & Samples

Assess Group Life, AD&D, Survivor Income claims, and Compassionate Assistance Program Loans within service standards
Review of plan member or dependent coverage and eligibility
Confirmation of the contract provisions in effect for each claim
Verification of enrolment and beneficiary information
Review of proof of death (loss) documents
Review of supporting medical\police\investigative reports,
Calculation of eligible benefit and delay interest
Preparation of Navigator claims system records necessary to record and pay the claim
Communicate decisions to claimants or beneficiaries, and group clients
Assist plan sponsors with queries regarding beneficiary appointments on enrolment, and requirements for submission of claim
Provide support to beneficiaries/family members in obtaining necessary documentation
3+ years insurance industry experience specifically with Group Benefits
Previous Life Claims experience is highly preferred
Understanding of medical terminology
Interpretation of contractual wording
Excellent communication skills with the ability to influence internal and external clients at all levels
Ability to demonstrate empathy for grieving families
Strong PC Skills, including Microsoft Office (Outlook, Skype for Business, MS Word and Excel)
Solid judgment - the ability to recognize quickly what needs to be done in order to satisfy the expectations
Proven analytical, organization, time management and decision making skills
Ability to work effectively individually and with a team
Proven ability to prioritize and meet deadlines and specific turn-around times
Flexibility to adapt to change and work additional hours as business needs require

181

Manager, LTC Claims Contact Center Resume Examples & Samples

Manage a team of associates tasked with providing exceptional phone and transaction based customer service, cultivating an environment of inclusiveness within the team
Communicate effectively with employees to provide coaching and feedback, identify development opportunities pertaining to personal and professional growth, and reinforce positive results
Drive individual and team accountability, motivate and manage team to meet and exceed service goals and increase productivity, with the end result of delivering quality service efficiently
Implement activities that drive employee engagement and support the desired company culture
Collect and analyze data to maximize resource efficiency through scheduling and work allocation, monitoring past trends, applying knowledge of future events & understanding of capacity model data
Develop and maintain partnerships with training, quality, compliance, legal, and other areas to reinforce system, departmental, and administrative procedures. Promote a sense of teamwork within the team and company
Provide recognition and celebrate successes
Strong collaboration skills

182

Complex Claims Resol Spec Resume Examples & Samples

Initiate outbound calls to patients to complete accident interviews via telephone
Investigate and confirm any medical coverage related to auto, general liability, and/or worker compensation insurance available to the patient, updating the patient file in the system
Contact Auto/Work Comp insurance carriers and attorneys via telephone to identify available accident insurance coverage for the patient
Verify patient’s eligibility for coverage and obtain billing contact information for the insurance adjuster and/or attorney
Send hospital bill to no-fault, third party and workers’ compensation insurances via fax, mail and e-mail
Follow up for with insurance carriers and attorneys for expedited resolution and payment on patient’s account
Request documentation where applicable or payment and account status from insurance adjuster or attorney
Identify any patient attorney representation and confirm patient representation with the attorney office, recording the attorney information in the patient file in the system
File Hospital Liens (where applicable) and assist in settlement negotiation between the hospital and patient’s attorney/insurance adjuster
Maintain proper account documentation in CEA’s Case Management System
Send correspondence to patient, insurance adjusters and attorneys
Complete account documentation and return account to the hospital once claim has been resolved
Minimum of one year revenue cycle (ex: insurance billing, collections) experience
Property and Casualty (Auto Insurance, Workers’ Compensation) experience preferred
Health Insurance Appeals experience preferred

183

Claims Team Manager Resume Examples & Samples

Committed to developing a highly engaged workforce by motivating and inspiring employees to continuously improve the operation. Continuously develops talent by creating opportunities for direct reports to exercise and grow new skills
Ability to build a rapport with Claims management to gain an understanding of the needs of the business units. Leverages data to maximize the performance and quality of results for the Claims Support teams. Promotes a culture committed to identifying process efficiencies to continuously improve how work is completed
Promotes a culture of claims service excellence by promoting empathy and passion for the customer experience that meets or exceeds customer expectations while ensuring the teams` metrics and resolutions comply with regulatory and company standards
Ensures training needs are met and provides recommendations to manage gaps. Collects data for reports on the quality, service levels, compliance, and activities of the assigned claims operation. Adopts best practices and shares learnings with the broader team
Supports the implementation and integration of technology to enhance the Claims Support operations
Assists with planning budget objectives. Ensures expenses align with operational and company standards
Solid interpersonal and team building skills
Sound working knowledge of Claims operations, theories, applicable policies
Strong detail and quality orientation skills; effective analytical skills

184

Senior Claims Co-ordinator Resume Examples & Samples

To provide accurate technical and coaching support to ensure less experienced staff are developed appropriately, and own and others quality standards are met, queries are answered and work is completed within service
Accurately index unsolicited post, process un-applied work items (Orphan Sources) to the correct files, issue claim packs via phone or email requests and provide payment/authorisation of medical fees on a daily basis to ensure service standards are met
Complete all assigned admin work accurately (review proportionate benefits, shared liability, limitation of benefit calculations, check eligibility and checking of others work) within service standards so that business needs are met
Provide a professional call handling service in relation to the Customer Care Network and own telephone in order to provide an appropriate level of service to all customers
Process "Total and Permanent Disability" claims as allocated to ensure any changes are identified in order to meet business needs
Accurately process claims registrations, create relevant transactions and obtain the associated scheme requirements for eligibility within agreed service standards
Chase all required medical and non-medical information, within agreed time-scales, keeping the customer informed at all times to ensure all evidence is received in a timely manner
To participate in project work in order to continually improve processes and service delivery
Ensure the continued protection of Unum's information, by following all applicable Information Security policies and procedures and by reporting suspected weaknesses in information security controls to the Information Security Officer
Comply with Unum's Code of Conduct and other Company Policies and Procedures as appropriate to the role
Minimum level of 90% accuracy required
In depth product knowledge
In depth knowledge of the claims admin processes
In depth knowledge of eligibility scheme requirements
In depth knowledge of in-house systems (CMS, AWD, Alis, GPAS)
Working knowledge of Microsoft Office products (Outlook, Word, Excel)
Good level of numeracy required
Experience in an administrative role within a customer focussed claims department
A strong customer focused approach to working is essential
A good level of numeracy
Working knowledge of Microsoft Office products (e.g. Word and Excel)
Ability to train and coach others

185

Claims Agent Resume Examples & Samples

Coordinating 3rd party property damage and injury claims with NextEra Energy Resources liability carriers
Background in agricultural claims including, but not limited to, crop compensation, land damages and live stock claims
Experience in clean energy projects such as Wind & Solar a plus
Adjuster's license a plus
Investigates, evaluates and negotiates satisfactory settlements of personal injury and major property damage claims
Provides support and assistance to company attorneys throughout the claims litigation process, including court testimony
Valid Driver's License (NON CDL)
High School Grad / GED
Experience:5+ years

186

Claims Processing Specialist Resume Examples & Samples

Provide administrative support to the Coverage Discovery Advocate Team
Heavy phone work
Bi-lingual Spanish required**

187

Manager Transversal Claims Resume Examples & Samples

Several years experience in B to C industries , eg FMCG , including measurement of product performance , especially with consumers and ideally with product performance claims development experience
Experience of project and/or programme management
Good knowledge of the external context (regulatory , monitoring, bibliography, etc.)
Good knowledge product research & development : culture, organization and operating procedures
Awareness of market developments (bibliographies, benchmarking, patents and internal presentations/technologies)
Ability to supervise a portfolio and manage a budget
Proficiency in English – written and spoken
Ability to work in international networks

188

Manager of Claims Resume Examples & Samples

Bachelor’s Degree in Business Administration, Business Management, Risk Management or related field plus 5 years of experience. Additional equivalent experience may be used in lieu of the degree requirement
Relevant professional licenses and/or certifications, including a North Carolina insurance adjuster license
5+ years of experience as a Claims Examiner or equivalent
2+ years of experience working closely with senior leadership (VP and above)
5 years of experience with Juris or other claims management systems
5 years of experience with implementing best practices and efficiencies in the claims management process
Previous experience managing claims in a retail environment
2+ years of leadership experience with direct report responsibility

189

Regional Claims Advocacy Leader Resume Examples & Samples

Manage a team of Client Advocates within Region
Assume responsibility for a robust book of claims and help populate the claims database
Confer with client and broker to tailor the policy language and program design to meet the client’s needs
Provide claims advocacy on behalf of the client by providing written responses to carrier coverage positions and by negotiating favorable claim resolutions in face to face meetings
Support new business efforts by participating in sales presentations and RFPs
Monitor the performance of carrier’s claim services for your clients
Maintain direct relationships with key clients, markets and their respective outside legal counsel
Review and provide insightful commentary on new policy forms
Prepare white papers and newsletters concerning recent developments in the law and insurance marketplace
Ensure that team of Sr. Claims Specialists under your direction, perform all the above functions
Law degree required
Prefer at least 8 years of insurance or litigation experience
Broker’s license within 1 year of obtaining this position
Working knowledge of management liability coverage lines of insurance
Knowledge of claim handling and claim adjudication processes and procedures
Strong communication skills both verbal and written at executive level
Ability to analyze and provide concise conclusions
Claims advocacy skills
Proficient computer skills relevant to Microsoft Office, Outlook, and web-based applications
Data analytics and benchmarking
Knowledge of laws, legal codes, procedures and processes involving insurance

190

Claims Benefit Specialist Resume Examples & Samples

Support the claims team as the first point of referral for enquiries, as well as emails and telephone calls
Report to Senior CER / Claims Manager outstanding workloads on a daily basis via e-mail or in agreed report format
To take ownership of and responsibility for customer enquiries politely and efficiently on the telephone (inbound & outbound) and over email, within boundaries of knowledge, ensuring that the claims process is as smooth as possible and enquiries are actioned within 1 working day
Participate in regular team meetings with staff and record minutes/action points when required
Assist/deal with projects as directed by Claims Manager
Keep the Claims Manager informed of procedural barriers and suggested enhancements
To resolve any technical or contentious queries within the boundaries of medical knowledge and policy held
To ensure that all computer records are up-to date and accurate
To ensure data protection questions have been satisfied before information is provided to any caller
To identify all complaints on receipt and deal with any as the first point of contact within technical skill level
Ensure all complaints are accurately logged on internal systems
To help analyze complaints trends and assist with the implementation of subsequent remedial actions
To liaise with any internal or external contacts to discuss medical conditions. To continually strive to improve and develop medical knowledge
To log and report on all claims enquiries received and answered, providing analysis on any trends that may occur
Produce scheduled and ad-hoc claims reports when agreed by underwriting for other offices
Develop and maintain working relationships with business partners, providers, brokers and agents, to the highest level of customer service possible
To promote the best image for the company through professional appearance and behaviors
Adhere to company standards and procedures
To maintain the highest level of personal conduct

191

Claims Platform Specialist Resume Examples & Samples

Demonstrated experience with Claims lifecycle
Demonstrated experience with Catalyst program
Extensive experience with claims complex program testing
Extensive skills with process streamlining and definition
Basic knowledge of Lean process
Demonstrated computer experience including Excel, Visio, Tableau, and Business Objects
Demonstrated communication skills
Demonstrated experience with creating automation script

192

Claims Resume Examples & Samples

Offer to selected candidate will be made contingent on the results of applicable background checks
Basic knowledge and experience working within a team environment
Basic knowledge of developing and managing project work

193

Assistant, Claims Resume Examples & Samples

Provide clerical support to nationwide team of claims adjusters to facilitate timely and accurate management of workers compensation claims. This includes but is not limited to completing complex state forms, wage statement calculations
Update existing claims in claims database as needed
Electronic and paper filing as needed
Complete reimbursement requests for Second Injury funds/submit documentation to proper parties
General office machine administration
Enter stop/cancel/release checks, process cash receipts, work check exceptions
EAMS reporting
Update Subpoena Log
Utilization Review for California claims
Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argonaut’s and our customers’ ability to be profitable)
Ability to prioritize workload, handle multiple tasks, and meet deadlines
Ability to be a team player and reach out and collaborate with peers to achieve common goals in a team environment
A high sense of responsibility and pride in completing a work product of excellence
A high level of integrity and ability to earn trust of co-workers
Be a team player with a positive attitude
Polished and professional written and verbal communication skills. The ability to communicate proficiently in English is required. The ability to communicate proficiently in Spanish as well is strongly preferred, but not required

194

Claims Trainee Resume Examples & Samples

Analyzing the policy for coverage
Investigation of the claim
Oral and written communications about coverage and liability positions
Actively managing claims to ensure only expenses appropriate to the claim are paid on a timely basis
Managing a diary, completing tasks and applying creative solutions to ensure that cases are resolved timely and properly
Accuracy and timeliness in setting claim reserves
Preparing reports for file documentation
Responsible for telephone calls to all parties involved in the claim
Professional written and verbal communication skills. (Telephone skills are required)
Excellent evaluation and strategic skills required
Must possess a strong customer focus and empathy
Proficient in MS Office Suite and other business-related software
Professional written and verbal communication skills
The ability to read and write English fluently is required

195

Claims Resume Examples & Samples

In partnership with Claims Adjuster, develop medical cost projections and/or life care plans for claimant
Review medical records, question compensability and create a medical action plan/strategy for case resolution
Foster a collaborative environment and partnership with Claims Adjusters that results in claim resolution
Bachelor’s Degree & Registered Nurse designation is required
Case Management Certification, Legal Nurse Consulting Certification and/or CLCP preferred
Five years of workers’ compensation experience is strongly preferred
Previous Field Case Management Experience and/or medical–legal nurse consulting experience
Experience developing medical cost projections and/or life care plans
A natural curiosity for the medical facts of a file
Strong analytical and communication skills and medical expertise
Must work independently and demonstrate the ability to exercise sound judgment
The ability to read and write English fluently is required. The ability to also read and write Spanish is preferred, but not required
Ability to travel, sometimes overnight, approximately 5% of the time

196

Claims Internship Resume Examples & Samples

Open claims and obtain required information from insured, claimant, and other involved parties
Investigate, evaluate, negotiate and settle auto or property damage claims
Recognize and pursue subrogation opportunities with detailed investigations
Explain policy language, provide coverage information and advise insured as to proper course of action

197

Claims Team Manager Resume Examples & Samples

Supervises the day-to-day operations for the claims staff by establishing priorities, scheduling and assigning work, and coaching employees in reviewing, analyzing, investigating, negotiating and settling claims in compliance with Claims Quality Standards
Creates a high performing, results-oriented staff through candidate selection, onboarding, ongoing development, and managing individual performance with regular coaching focused on behavior and technical skill sets
Leads and actively contributes to a culture of continuous improvement and ensures utilization of tools and behaviors within the Liberty Management System to foster critical thinking and innovation around problem solving and development of standard work
Responsible for building and maintaining internal and external customer relationships. Serves as a primary point of contact for agents, brokers and policyholders. Hosts and facilitates in person and/or telephonic claim reviews on a continuous cycle and ensures Special Service Instructions are managed appropriately. Often called upon to do presentations for existing and prospective customers
Provides management oversight of claims files (non-litigated or litigated) within the unit, to include Manager Reviews on open inventory and reviews files to measure quality assurance discusses individual training and development needs. Coaches to improve technical expertise within the team
Monitors, evaluates and approves, within assigned authority limits, claims reserves, settlements and payments that exceed staff authority thresholds
Uses common reporting of data analytics to monitor claim production, inventory management, financial and quality compliance and claim volume trends and results. Data used to communicate team performance relating to production, significant achievements and areas for continuous improvement
Manages compliance within internal and external parameters, including: Oversees Liberty Mutual/Helmsman state licensing compliance and adherence to fair claims practices. Maintains awareness of existing and proposed legislation, court decisions and emerging trends in claims litigation to monitor team compliance with Unfair Claims Practices
Advanced knowledge of commercial property and/or casualty insurance claims investigation, loss assessment, reserving, insurance legal and regulatory environment, litigation and fraud awareness
Ability to get work done through others, communicate effectively (including listening, writing clearly, giving constructive feedback, etc.), get support from above, plan/organize work, analyze/solve problems, and focus on the larger picture
Knowledge and capabilities typically acquired through a BS/BA degree (or equivalent) and at least 6 years of related experience

198

Claims Specilist Resume Examples & Samples

Manage the Compensatory fee process to safeguard the servicer’s assets and comply with investor requirements
Analyze and rebut investors Compensatory Fees, MI Curtailments and Investor billing for Non-Claimable Advances and Third Party Claims
Maintain monthly billings from FNMA and FHLMC
Quality Control review for Default Claims, including supplemental claims to reduce loss exposure and provide loss analysis reports
Correspond with vendors and site employees
Act as a point of contact/liaison, ensuring that policies and procedures relating to invoicing and remittance are followed, including compliance with federal laws and regulations
Demonstrates professional behavior and teamwork, is punctual, dependable and adheres to Company policies and procedures
Ability to work necessary hours to ensure success
Attention to detail with a high level of accuracy
Analytical and Problem Solving skills
Ability to meet deadlines in a fast paced environment
Ability to manage time well and prioritize tasks
Microsoft Office experience and advanced Excel knowledge
Ability to read and write in English to effectively communicate in writing as well as verbally in person and over the phone
Ability to effectively communicate in English with customers or members of the business community
Ability to effectively present information to supervisory, etc
Ability to read, analyze and interpret documents such as technical journals, financial reports, legal documents, policies and procedures
Ability to calculate basic financial figures and amounts
Proficient in computer skills and knowledge of word processing, spreadsheet, accounting, general ledger, accounts receivable, accounts payable, e-mail and internet software
Ability to work with little supervision
Must be able to handle high volumes in a fast paced environment
Ability to meet critical departmental and federal timelines with accuracy and efficiency
Ability to build relationships with both internal and external clients/vendors

199

Claims Management Specialist Resume Examples & Samples

Determine appropriate methods and extent of needed investigation for all assigned claims and conduct investigation primarily through personal visits and ALS via phone, obtaining medical reports, appraisals, witness and claimant statements/interviews, visual evaluations or other necessary fact-finding methods in order to establish proper coverage, reserves, liability, claim value and disposition. Ensure timely contact times, evaluations, reporting, payments, etc. as outlined in the Claims department service standards
Ensure proper file documentation and reporting of information secured as result of claim activity
Ensure rationale for settlement that is consistent with company procedures, reporting standards and guidelines, and may also be responsible for submission of claims forms and reports as required by outside agencies
Arrange medical examinations, contractors estimates, or other specialists appointments when necessary
Assist with monitoring quality of services rendered by appraiser, law firms, structured settlement vendors, rehabilitation vendors, etc. and make recommendations to manager/supervisor
Establish and maintain effective working relationships with corporate claims, SIU investigations, underwriting, and other corporate personnel to assist in the timely and efficient settlement of assigned claims
High School diploma and College degree or equivalent experience required
6-10 years experience in related claims handling required
Valid driver's license in good standing with DMV is required
Ability to travel and be on-call 24 hours a day is required
Ability to prepare own damage estimates required

200

Fcd-claims IM Representment Resume Examples & Samples

Can work a flexible work schedule as work schedules vary and could include a schedule that includes working in the evening and on the weekends
Demonstrates fortitude to get things done: Is disciplined and organized. Is able to effectively prioritize and reprioritize own work. Acts with a sense of urgency, adjusts quickly to change and demonstrates the ability to delegate effectively
Work across boundaries: Is able to network effectively with colleagues. Collaborate with others to achieve common goals
Analytical skills: Manages by metrics and uses independent judgment to determine approvals related to complex business decisions. Demonstrates strong research skills and the ability to identify root cause issues and emerging patterns/trends within the business

201

Claims Initiation Team Manager Resume Examples & Samples

Contact Center experience
Strong ability to lead and coach others
Proven ability to inspire associates to achieve results
Experience driving customer and associate experience
A true team player and collaborator, able to translate knowledge and experience into strong and productive relationships
Ability to drive efficiency and manage quality
Spanish Fluency Desired
Dedicated, enthusiastic, driven and performance-oriented; possesses a strong work ethic
Working knowledge of general bank policies, programs and procedures, financial practices
Highly motivated self-starter, proactive, with intense focus on results. Conveys a sense of urgency to achieve business goals and exceed expectations

202

Claims Cost New Opportunity Manager Resume Examples & Samples

Organize and lead “Free Thinking” collaboration meetings to ensure creativity is always a central focus and not to leave any stone unturned
Bachelor's degree or 5 years of relevant healthcare industry experience
Proven leadership skills and strong experience managing teams
Experience building and utilizing SQL databases

203

Claims Group Income Protection Case Manager Resume Examples & Samples

Manage caseload of claims within turnaround standards and to required quality standards
Provide robust and sensitive technical claims management, including information gathering over the telephone with all parties, request and assessment of claims evidence, decision making and reviews
Assist with training and support for junior colleagues including coaching
Face to face visits with customers and support sales team as required
Experience of assessment of Income Protection Claims
Knowledge in depth of products processes and services
Cope with varying workloads and pressures and prioritise

204

Claims Resume Examples & Samples

Assume responsibility for complex injury claims, including soft tissue, serious fractures, fatalities, disfigurements, etc
Demonstrates a high level of investigation, analysis, evaluation and negotiation including interpretation of coverages
Complete Bodily Injury and Property Damage Evaluation Forms and make recommendations for the disposition of claims in excess of individual settlement authority
Evaluate policy coverage, contact insureds, claimants, attorneys, body shops and medical staff to determine injuries stemming from an accident while determining and establishing reserve requirements
Document computer log with results of review and intentions for handling
Plan and conduct investigations (including but not limited to interviewing parties involved, collecting and evaluating documentation and securing evidence and protecting the chain-of-custody, determine inspection needs, order police reports, scene investigation, take witness statements, review material damage photos, order medical reports, etc.) to analyze coverage, determine liability, compensability, and extent of damages
Compile information for decision making with discussion of claims committee where appropriate
Evaluate the medical injury exposure within guidelines, research & review appropriate statutes and case law for relevance to claim issues, and make appropriate and timely payments
Maintain accurate records and handle administrative responsibilities associated with processing and payment of claims. Record and update status notes, and document results of contacts, relevant medical reports and duration information per Best Practices
Determine need for independent adjusters, cause and origin experts, independent medical examiners, economists, accident re-constructionists, and engineers
Respond timely and appropriately to all settlement demands
Keep internal and external customers advised of file status and other matters as required
Evaluate claim for potential fraud and work with Special Investigations Unit as required
Assess actual damages associated with claims and conduct negotiations to settle claims
Determine if subrogation exists and take steps necessary to initiate recovery efforts
Minimum of three (3) years of bodily injury/casualty claims handling experience
Computer experience (MS Office, excel, word, etc)
Possesses strong customer service skills and behaviors
Makes decisions in an informed, confident and timely manner
Maintains constructive working relationships despite differing perspectives
Possesses strong organizational and time management skills
Ability to negotiate skillfully in difficult situations with both internal and external groups
Demonstrates strong written and verbal communication skills. Promotes and facilitates free and open communication
Understanding of applicable statutes, regulations and case law
Thinks critically and anticipates, recognizes, identifies and develops solutions to problems in a timely manner
Easily adapts to new or different changing situations, requirements or priorities
Cultivates an environment of teamwork and collaboration
Operates with latitude for un-reviewed action or decision

205

Claims Resume Examples & Samples

Proactively investigate coverage, liability, compensability and damages with all parties involved in a claim
Review and evaluate new lawsuits to determine appropriate future strategy
Review and interpret legal opinions and expert reports
Stay abreast of legal trends and case law
Review and analyze litigated claims on an ongoing basis
Work with defense counsel to develop and control strategies, in consideration of all applicable laws, venues, while controlling costs and determining settlement value versus defense at trial
Understand and apply state specific law and regulations in highly litigious venues across the country
Review each claim for coverage issues, utilize coverage attorney opinions, and work with supervisors to resolve
Assist other departments with policy and coverage questions
Establish reserve setting in accordance with company policy
Refer lawsuits to properly approved defense attorneys, and direct their handling, including the authorization of discovery actions and motions practice
Review, audit and pay invoices of independent adjusters, defense experts, attorneys, and other vendors in timely manner controlling litigation cost
Document claim file notes clearly, with all communications and activities that occur during handling of the claim, using factual and objective information
Maintain a current 30-day diary on all open claims
Though primary duties are handled inside, attendance at trials, mediations and or depositions may be required
Direct negotiation with attorneys on settlement of cases
Provide input in roundtable discussions
Other duties as assigned by the claims supervisor
A Bachelor’s Degree is preferred
Minimum of 3 to 5 years experience handling complex casualty claims including litigation
Background in nonstandard automobile claims handling is a plus
Knowledge of State specific insurance laws and regulations
Knowledge of medical terminology and human anatomy
Knowledge of civil procedures
Ability to multi-task in a time sensitive environment and handle job responsibilities with a sense of urgency
Thorough knowledge of insurance coverages, contracts and claims handling guidelines
Analytical skills necessary to make decisions and resolve complex issues inherent in handling losses
Demonstrate strong interpersonal and communication skills, both verbal and written
Ability to effectively present information and respond to questions from management, employees and customers
Strong analytical and negotiation abilities
Excellent organizational and time management skills required
Intermediate to advanced knowledge & skill in Microsoft Office products
Ability to work independently, think creatively and exercise strong, sound judgment
Ability to prioritize activities and projects while staying organized
Ability to process high volumes of work while meeting deadlines
Hard work, honesty, integrity and unwavering business ethics
Must have or secure and maintain appropriate state adjuster license(s) and continuing education credits

206

Asst VP-claims Resume Examples & Samples

Manages and monitors new and pending claim volume to ensure proper staffing levels. Monitors operations, productivity reports and staff and recommends, when necessary, changes in methods, procedures, structure, and additions or changes in personnel to secure optimum utilization of resources
Prepares and submits an annual budget, establishes an expense control program, reviews and approves expenses to assure that expenditures are within the constraints of the budget
Establishes Service Center objectives supportive of Corporate Headquarters and corporate objectives
Provides guidance to claim supervisors to ensure proper investigation and timely equitable disposition of claims. Approves reserve recommendations, establishes reserves and makes recommendations on reserves exceeding authority; analyzes and reviews, on a continual basis, the reserve adequacy of a sampling of open claim files to ensure exposure is properly reflected
Analyzes files on a periodic basis to determine accuracy and completeness and to maintain control of quality of work
Administers all policies and procedures, communicates to staff, interprets as necessary, and ensures compliance
Assures the staff adheres to our Best Practice, SOP’s, Carrier and Client specific standards and objectives. The AVP oversees the communication of the performance standards and objectives as well. The AVP also oversees and manages the performance appraisals
Selects, trains, and develops an effective and efficient department. Ensures Performance Reviews are conducted in accordance with corporate guidelines; reviews Performance results and develops actions plans to resolve identified areas of improvement. Recommends/approves salary adjustments, promotions, transfers and dismissals
Develops managers and/or supervisors, particularly in the management techniques of planning, organizing, leading and controlling through continued coaching and feedback on performance
Keeps senior claim management informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to manager for direction. Keeps department informed of current problems, changes, and new developments in the department and company by conducting periodic meetings
Provides quality service to clients and carriers and ensures that claim personnel are knowledgeable on client special handling instructions and carrier requirements. Assures all security procedures pertaining to client, carrier and company funds and property are strictly adhered to
Participates in sales presentations and meetings with current accounts in support of corporate revenue objectives
Investigates local conditions which might affect claim handling and keeps senior claim management adequately informed
Develops a thorough understanding of the claim adjudication system(s) and organizes workflow to provide for maximum productivity
Performs other related duties as required or requested
Upholds the Crawford Code of Conduct

207

Claims Exp Mgr Resume Examples & Samples

20 % - Assigns and monitors examiners' case loads
20 % - Trains and counsels examiners
20 % - Prepares weekly production reports and various management reports
20 % - Reviews and authorizes claims for payment which exceed examiners' authority
20 % - Reviews all claims denials, appeals and lawsuits for the unit

208

Complex Claims Director Resume Examples & Samples

7 years previous commercial general liability claim experience preferred
Extensive understanding of claim litigation process
Analytical with good decision making skills
Strong organizational skills and detail oriented
Ability to work independently, handle multiple tasks simultaneously and exercise good judgment
Property and Casualty licenses required. Must be obtained within 6 months of hire

209

Claims Resume Examples & Samples

Complete Bodily Injury Evaluation forms and make recommendations for the disposition of claims in excess of individual settlement authority
Evaluate the medical injury exposure within guidelines, obtain authority when appropriate and make proper and timely payments
Demonstrates proficiency in the investigation, analysis, evaluation and negotiation including interpretation of coverages
Minimum of two (2) years of bodily injury/casualty claims handling experience

210

STD Team Leader Claims GBC Resume Examples & Samples

This position will supervise a team of Short Term Disability Analysts
Provide technical and/or systems training and develop and maintain a staff capable of achieving unit objectives
They will also perform Human Resource Management activities consistent with corporate personnel policies including performance appraisals, salary administration, career development, and productivity measurement including standards of performance and methods of monitoring and reporting
Conduct monthly one-on-one meetings with staff utilizing Monthly Performance Results (MPR), provide team status reports to management and participate in office projects and business improvement initiatives
Effectively provides supervision, motivation, coaching, training, and counseling of Analysts
Assigns, distributes and coordinates work of the team with other teams in the area ensuring consistent, efficient and timely delivery of internal/external service
Recognize and analyze reasons for trends and recommend solutions
Develops and uses work management tools to facilitate efficient processes
Preferred but not required: College degree with 2 years + experience in a supervisory position
Must have at least 6 months STD experience
Must possess the ability to communicate complex information in a mentoring/training situation
Ability to develop and use work management tools to facilitate efficient processes
Solid organizational skills with ability to ensure consistent performance of team to unit objectives
Strong analytical skills with ability to interpret and use data to develop effective solutions

211

Claims Service Rep Resume Examples & Samples

Answering a high volume of inbound calls. Input information received into a database to support claims processing and handling. Determine type of insurance policy that applies to the claim the caller is making
Reach and maintain a preset call volume and achieve service level performance requirements as established by management
Assist customers in a professional and courteous manner. Advise customers on how to proceed with the basic steps following their loss
Promptly report possible fraudulent claims to Supervisor or management that could impact claim handling procedure. Maintain confidentiality of information received when processing a claim
This is a fast paced environment; hours vary from 5:00am to 6:00pm
Repwest Insurance is an equal opportunity employer and a drug free environment

212

Director, Bodily Injury Claims Resume Examples & Samples

Identifies, develops, and promotes high impact strategic initiatives for Bodily Injury Claims, aligned with key business priorities including loss cost management, operational efficiency, employee engagement, and customer experience
Directs planning and execution of multiple projects, ensuring accurate forecasting and appropriate use of time, personnel, expenses, and other resources
Manages team of individual contributors with varying levels of experience, responsible for their performance, coaching, and development
Identifies and interprets internal performance and external market data in partnership with Strategy & Analytics resources and relevant subject matter experts to highlight trends, formulate business cases, assess impacts of key projects, and identify improvement opportunities. Combines broad perspective with deep business acumen to promote best practices and improve processes for channeling, investigating, evaluating, and negotiating bodily injury claims
Engages with leaders and peers across Strategy, Analytics, Product & Technology; Claims; U.S. Consumer Markets; and other Liberty business units to solve problems and deliver results. Understands and addresses other stakeholders’ needs, builds relationships, and influences cross-organizationally
Identifies and partners with internal enabler resources in planning and execution of strategic projects, including Training, Technology Legal, Compliance, and Audit. Engages, negotiates, and manages relationships with external parties including vendors, law firms, and regulatory agencies
Prepares and delivers presentations to senior executive leadership regarding strategic initiatives, recommendations, and direction / progress of projects. Identifies appropriate messages for different audiences, and communicates them clearly and concisely
Bachelor’s degree in relevant field; Master’s degree, CPCU preferred
Minimum 7-10 years relevant work experience with progressively more responsibility in a financial and/or project management environment
Previous management experience strongly preferred
Proven track record of effective project management and execution. Consistently able to identify & solve business problems and deliver results
Casualty insurance and/or claims operations experience a plus
Strong communication skills, written and verbal. Executive presence
Outstanding interpersonal and collaborative skills

213

Claims & Perfomance Manager Resume Examples & Samples

5-8+ years experience in engineering / product development background for consumer goods industry or international testing / accreditation companies
Bachelor's Degree / Masters in Engineering or Science related subject or equivalent
Well versed with product performance certification in U.S., specifically: ASTM standards, AHAM standards or equivalent, and/or Energy Star
Experience in product performance testing according to applicable U.S., Canada, Americas & International Standards (IEC & UL)
Previous experience in dealing with product certification, related agencies & 3rd party test laboratories
Fluent in English (verbal and written)
Excellent ability to understand and discuss a high volume of content related to international standards
Attention to detail with a good working knowledge of applicable technical vocabulary
Highly motivated, internally driven, team layer with excellent communication, planning and organizational capabilities
A self-starter and a problem solver
Persistent, confident and skilled to challenge current working assumptions of others
Able to constructively question, present arguments and evidence and influence others to revise their views
Computer literate with good working knowledge of Microsoft Office
Must be able to travel extensively (50%) within US, with occasional travel to Dyson Malaysia JB, Singapore and UK offices

214

Claims Processing Team Lead Resume Examples & Samples

Assess daily inventory and assign work items to 2-3 small teams based on skill sets, volume, and timeliness requirements
Apprises the Claims Supervisor and Claims Operations Manager of inventory, aging, quality, and escalated member cases
Routinely reviews the work of team members and provide coaching and best practice solutions

215

Resolutions Claims Adjustment Lead Resume Examples & Samples

Ensure claim payments are made within time frames written in contractual agreements
Verify payment is not duplicated
Correctly adjudicate claims for contracted/ non-contracted providers
Verify presence of all required data fields and that applicable medical records are included (when required)
Identify and refer potential fraud and abuse cases to the Grievance Department
Staff is maintained at an adequate level
Demonstrated leadership qualities and skill applications build cohesiveness within the department, increasing effectiveness and efficiency throughout the department

216

Claims Director Resume Examples & Samples

Achieve financial objectives
Communicate job expectations to staff, ensure understanding of the expectations and expectations are met or exceeded
Plan, assign, monitor, and appraise employee’s job results. Ensure staff performance goals are met or exceeded and, if not, appropriate action is taken
Maintain, train, orient, mentor and evaluate staff
Appropriately staff production areas, ensure cross-training
Develop and implement policies and procedures to ensure appropriate work is completed timely and accurately and maximizes the staff productivity; ensure policies and procedures are documented according to organizational protocols; this is inclusive of all training materials
Identify, develop and implement opportunities for streamling and improving processes
Attend appropriate management meetings to integrate Reimbursement Services Services into the organization in appropriate and useful ways
Set example of proper behavior and accountability to employees and serve as a role model for what is expected of a Health Choice employee
Work with other Reimbursement Services management to ensure optimum efficiencies, staffing appropriation and daily operational functions
Employee issues ( performance, behavior, compliance with policies, etc) are addressed timely and appropriately in accordance with company policies
Staff is met with regularly to assess departmental operations
Timeliness, quality standards and claim payment guidelines are routinely met
Staff is directed and appropriate changes and recommendations are made in accordance to HCA and AHCCCS guidelines
95% of clean claims are processed in 30 days or less, from received date
99% of all claims are processed in 60 days or less, from received date
Areas of additional educational needs to improve quality are continually identified
Ensure information regarding training needs and policy/procedure revisions are appropriately disseminated to claims staff
Continuous quality improvement plans and procedures are developed and implemented
Sufficient resources are allocated
Ongoing communication is provided
Assure staff is trained in measuring, assessing, and improving performance
CPT, HCPCS, and ICD-10
Claims billing- 1500s and UB92s
Managed Healthcare
Medicaid requirements and procedures
Knowledge of Health Choice Cultural Competency and Business Continuation Plans
Proficient in Excel and Word applications
Ability to follow through

217

Claims Review Assistant Resume Examples & Samples

High school graduate
Current enrollment in a medical billing and/or coding certification program. Must have a reference letter from school or program official
Basic working knowledge of CPT, HCPCS, and ICD-10 codes
Basic working knowledge of third party payer processes including patient registration
Basic computer skills required; EMR experience preferred but not required
Detail oriented and demonstrates high quality work product
Review and prepare charges submitted to the MSO for insurance billing
Communicates effectively, both verbally and in writing, to other members of the team
Ensures pertinent information relating to patient accounts and / or payer interaction is documented in the billing file
Data enters registration updates as necessary
Performs appropriate billing/payment posting functions as assigned

218

Warranty Claims Validator With English & Portuguese Resume Examples & Samples

Warranty claim validation based on checking invoices (proof of purchase), warranty policies and available external resources (e.g. DTAC, parts catalogs, sales information)
Clarification with repair service providers in case of discrepancy
Repair service providers invoice checking (i.e. comparison with payment proposal)
Delivery of checked invoice to the client's accounting department
Documenting and adding comments (e.g. to slow pay list or to the claim)
Fluent knowledge of Portuguese and advanced level of English
Be willing to learn new things
Have high school diploma
Possess good communication skills (be able to build, maintain and enhance professional relationships with clients and others)
Have Data processing accuracy, be detail oriented, and able to evaluate/research a warranty claim
Be stress resistant
Be able to work efficiently within a team
Have knowledge of warranty processes or mechanical knowledge of machinery

219

IWD Claims Resume Examples & Samples

Provide customer support for pre order activities (pricing, availability, proposal, quoting, technical specifications, non-standards, parts identification and custom solutions)
Facilitates and follows up any sales inquires. Prepares quotations, pro-formas and bids for sales such as state contracts, strategic accounts, National Accounts, direct customers, GSA and NAF government sales, etc
Process customer orders (promise dates, order entry, collaboration with supply chain and operations)
Performs credit evaluations, approves/denies credit requests on all incoming orders and lease requests up to $250K. Establish credit lines for each transaction
Manage customer orders from placement to invoicing through multiple channels, including phone, fax, EDI, E-Mail, and websites to ensure 100% customer satisfaction
Manage customer expectations by clearly communicating our commitments (i.e. delivery dates or problem resolution), and keeping customers informed of status of orders, issues, backorders, supersession’s, etc
Provide high quality service through efficient use of all Oracle/Siebel/Mapics/Operating Systems functionalities related to order fulfillment and relative to customer activity
Coordinate with the transportation provider to maximize efficiency of deliveries from a cost and delivery performance perspective
Process claims and product returns in line with policies
Responsible for driving customer satisfaction with assigned portfolio of customers
Respond to and/or refer product and technical questions to appropriate channel
Drive pricing and order processing consistency within the channels
Participate as necessary
Bachelor's Degree in Business, Marketing, Supply Chain or Finance
5 years of experience in a customer service, inside and/or outside sales preferably in an industrial environment

220

Director, Claims & Configuration Resume Examples & Samples

Oversees and provides leadership for the Plan's Provider Inquiry function. Responsible for the submission, research, and resolution of provider inquiries and/or disputes. Ensures resolutions are compliant
Proactively assesses and audits business processes to determine those most effective and efficient at resolving provider problems
Serves as primary interface with Corporate Claims and Configuration counterparts and ensures standard processes are implemented
Oversees preparation of narratives, graphs, flowcharts, etc. to be used for committee presentations, audits and internal/external reports; oversees necessary correspondence in accordance with regulatory requirements
Maintains call tracking system and database of correspondence and outcomes for provider inquiries/disputes; oversees monitoring of each provider submission/resolution to ensure all internal and regulatory timelines are met
6 years experience in healthcare claims review and/or provider inquiry/dispute processing and resolution, including 2 years in a manager role
Experience reviewing all types of medical claims, e.g. HCFA 1500, Outpatient/Inpatient UB92, Universal Claims, Stop Loss, Surgery, and Anesthesia, high dollar complicated claims, COB and DRG/RCC pricing

221

Director, Configuration & Claims Management Resume Examples & Samples

Advanced problem solving, critical thinking, and process analysis skills to lead teams responsible for client configuration
Strong process improvement, implementation and team development skills
Working knowledge of health plan compliance including government programs such as Medicare, Medicaid and FFM plans
Subject matter expertise to produce innovative solutions, and advance understanding of configuration best practices
Understanding of healthcare industry, including competitors, the regulatory environment, and industry trends
Knowledge of CPT, ICD-9/ICD-10, HCPCS, Revenue Codes and pricing methodologies
Minimum of 5-8 years Health Care industry knowledge and operations (example: claims processing, enrollment, provider file maintenance) with ability to interpret and document business requirements
Demonstrated proficiency in processing health care claims and to understanding of claim life cycle
Knowledge of health plan benefits, fee schedules and configuration
Experience working with provider data with a focus on ensuring accuracy
Advanced knowledge of core processing systems in relation to configuration set-up
Experience working with government agencies such as CMS, Medicaid, etc. along with interpreting agency and contract requirements
Strong computer skills with proficiency in MS Word, Excel, Outlook, and Access, and Visio
Ability to partner with associates, managers, directors and senior leadership in order to advance process improvement
A.Education/Skills
Ability to organize and prioritize work to meet deadlines
Superior judgment, initiative and problem solving abilities
Ability to handle and resolve complex issues independently
Knowledge of Medicaid, Medicare Advantage, Tricare and Health Care Exchange programs preferred
Knowledge of claims processing, system configuration, edits, adjustment adjudication and claim department processes
Ability to learn, develop and implement new policies and processes based on written material and observation
Ability to establish and maintain professional, positive and effective work relationships
Minimum 5-8 years Healthcare experience with Managed Care experience required
Bachelor's degree required with Master's degree preferred

222

LTD Claims Trainee Resume Examples & Samples

Claim Specialist Trainees will be routinely evaluated for increases in their authority levels as they become more experienced in their decision making and demonstrate consistency in meeting metrics
Learn to develop an action plan and identify the Likely Claim Progression including identifying the return to work potential. Complete regular updates on financial offsets such as SSDI
Bachelor degree preferred and 2-4 years’ customer service experience preferred

223

Claims Processing Manager Resume Examples & Samples

Support client implementations through development and implementation of client specific operational requirements *Support and supervise employees as they develop knowledge of drug database and assists with questions and processes related to drug database, NDC/HCPCS crosswalk and drug pricing calculations and loads
Oversees the processes of daily drug claim review and assists in resolving related issues, performing related reports, and conducting routine claim rejection process
Access internal and external databases and sources (providers) to obtain needed information
Monitor the Pharmacy and Drug Review incidents and facilitate the resolution of incidents related to drug and miscellaneous code claim review ·
Liaison for the site including oversight of the Administrative Assistant to the building
Manage seat chart with facilities
Forecast future space needs
Facilitate site repairs and maintenance
On-boarding coordinator
Assist new colleagues with access to the building (badge distribution, picture taking)
Cube assignment
Receive, distribute and return laptops for new hires and terminated hires
Emergency site responder
Pharmacy Technician Certification or at least 2 years of equivalent experience

224

Claims Team Lead-assistant Resume Examples & Samples

Analyzes and processes complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution
Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy through the life of the claim
In-depth knowledge of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business

225

LTD Claims Case Manager Resume Examples & Samples

Ability to prioritize caseloads to meet turnaround times
Understanding of medical terminology and medical conditions helpful
Minimum 1-2 years of previous claims or case management experience preferred

226

Claims Apprenticeship Resume Examples & Samples

Adherence with all company processes and procedures
Basic level of numeracy and literacy
Respect for confidentiality
Good time-keeping
Step 2: Online assessment - Once a member of our Recruitment Team has reviewed your application and you’ve passed the eligibility screen, you will be invited to complete an online Maths and English assessment. This should take no more than 30 minutes, and is designed to capture your Maths and English skills
Step 4: Assessment Centre- This is a chance for you to come in for a face-to-face meeting and group exercise to find out more about Direct Line Group and the role you have applied for, as well seeing the office you’ve applied to work in

227

Legacy Claims Team Leader Resume Examples & Samples

Leading and developing the team to ensure operations claims targets are delivered
Guiding and coaching the team to increase professional and technical capability and improve claims service standards
Resolving or facilitating resolution of complex claims queries and problems that the team have escalated
Working closely with other team leaders to effectively implement change and claims strategy to deliver agreed business benefits
Managing relationship with internal & external suppliers such as Panel Solicitors

228

Lead Claims Processing Resume Examples & Samples

Keyboarding
Mousing
Lift up to 10 pounds
Push/pull up to 10 pounds
Carry up to 10 pounds
Minimum 8 years of experience in the healthcare industry or a Managed Care environment (HMO, Medicare, Covered California, Medi-Cal) with demonstrated performance that consistently exceeds expectations. Experience and knowledge of on-line claims systems
Excellent organizational, time management skills and ability to multitask
Proven knowledge of benefits, covered and non-covered services, Provider Dispute Resolution process, billing, and reimbursement procedures for HMO's/medical groups
Proven knowledge of ICD-9/ICD-10 codes, CPT, HCPCS, RBRVS, DRG's, UB04, and CMS-1500 claim formats and medical terminology
Ability to prepare monthly, quarterly and annual timeliness reports for submission to Sharp Health Plan’s Regulatory Department and Department of Managed Health Care
Demonstrated leadership and experience in motivating and developing staff
Bachelor’s degree in business or related field or equivalent knowledge/experience in related field preferred
Certified Coder preferred

229

Mgr, Medicaid State Ops Claims Resume Examples & Samples

Requires BA/BS in Business; 7 years of related experience, including 3 years of management experience and 2 years of experience in data assimilation; or any combination of education and experience, which would provide an equivalent background
Requires Claims Processing experience
FACETS experience is required
Requires at least 5 years’ experience in Medicare/Medicaid within managed care
Contract Interpretation and analysis experience is preferred
Claims appeals processing experience preferred
Management experience is required
Executive dashboard and SharePoint experience preferred

230

Claims Adjustment Specialist Resume Examples & Samples

Providing expertise or general claims support to teams in reviewing, researching, investigating, and correcting claims
Conducts data entry and re-work; works for reports to investigate and correct claims
Requires outreach to providers to obtain corrected claim information
Extensive work experience, possibly in multiple functions
Work does require established procedures
Mentors others
Coordinates others' activities
Able to work with minimal supervision
Needs to works well both alone and as a team member
Required to consistently deliver quality work

231

Claims Intern Resume Examples & Samples

Must be a full-time student pursuing a 2-year or 4-year degree in any business or communication-related major
Ability to recognize, prioritize, and perform required activities with minimal supervision required
Must be detail-conscious, organized, responsible, and dependable
Ability to handle a variety of tasks with an appropriate sense of urgency required
Excellent interpersonal and communication skills required, with the ability to function independently as well as in a team environment with both internal and external customers
Keyboarding, Windows, Word, and Excel proficiency required
Must be able to consider all inputs in making sound decisions in choosing a course of action
Must be willing and able to assume additional duties, responsibilities, and assignments as needed

232

Director, Claims Processing Resume Examples & Samples

Provide leadership and oversight of management for claims operations
Participate in the formulation and execution of the division’s claims operations strategy and vision
Establish, monitor and work with team to continuously improve on all aspects of claims operations
Direct the daily production activities of team members to deliver accurate, timely and efficient service to customers
Direct assigned claims processing, review and adjustments as well as all claims related activities
Ensure all operational processes are in compliance with established quality standards, government and industry regulations, and client requirements
Accountable for CMS required reporting and operating a CMS regulated business in compliance with Medicare C&D regulations
Direct all ongoing Blue Cross Blue Shield network sharing and ITS activities while actively engaging and advancing government compliant policy changes and ITS enhancements to the Association
Identify, distinguish, and knowledgeably evaluate government regulatory changes and operational performance risks to formulate and synthesize operational direction for compliant performance and cross departmental efficiencies
Direct Coordination of Benefits activity, including Other Party Liability, Medicare Secondary Payer, validation, special status updates, member outreach communication and investigation along with associated payment recovery activities and strategies to include Medicare Advantage and Part C and D as appropriate
Other duties as assigned or requested
Experience to effectively manage, direct, and motivate staff
Demonstrated track record of operational effectiveness
Strategic thinking and planning
Must be willing to travel to meet with clients, attend conferences as well as assist Sales with site visits to potential clients
Financial and budget/expense management experience
Ability to handle multiple priorities and the ability to identify, analyze and solve problems independently
If required: Ability to interpret and understand complex government/CMS regulations
(If required: Comprehensive knowledge of Medicare regulations, law and coverage issues.)
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233

Director, / II Claims Resume Examples & Samples

Responsible for directing the processing and payment of claims. Provides guidance on the most complex claims
Develops short/long-term objectives and continually monitors procedures to ensure these are met by staff
Stays abreast of state/federal regulations. Staff is typically located in multiple sites and/or states and utilizes multiple systems
Position requires significant and regular external contact with customers or agencies
Has significant budget accountability and manages special projects
Management duties to include hiring, training, coaching, counseling and evaluating performance of direct reports
Requires BA/BS; 9 + years of professional/leadership experience or an equivalent combination of education and experience
MA/MBA preferred
Excellent written, oral and interpersonal communication skills, including negotiation skills required
Excellent analytical ability
Strong PC skills required
Advanced strategic planning, organizational, managerial and leadership skills required

234

Junior Claims Team Manager Resume Examples & Samples

To evaluate and measure compliance with Best Claim, Service and Communication practices through system reporting and file audits
To identify development opportunities within the team and provide appropriate training and mentoring resulting in improved performance
To ensure assigned team’s clear understanding and importance of achieving goals and critical objectives
To provide updates and direction to team regarding results versus objectives to ensure continual focus in maintained to achieve desired performance levels
To create and foster a service focused environment
To plan and manage work of staff, makes decisions regarding pay, performance management, development, employment, and staffing. - To provide authority on cases evaluated within assigned authority levels
To escalate and consult with Regional Express Leadership decisions that may have a broader impact on the relationship with the client

235

Claims Director VA Resume Examples & Samples

Ensure claims operation is functioning to achieve client requirements with regards to timeliness and accuracy, as well as meeting State and Federal regulations
Operate within budgetary guidelines with specific attention to the claim unit cost in order to Ensure cost effective, efficient operations and attainment of financial goals
Ensure team is managed responsibly as to support budgetary objectives as well as goals or performance guarantees for the client. Use and maintain consistent staffing models. Recruit, attract, develop, motivate and manage a high caliber of Supervisors. Establish an effective matrix partnering relationship with service centers and Corporate departments. Effectively complete and utilize tools including Individual and Department scorecards, performance appraisals and IPDs
Represent Service Operations on the Client's JOC by coordinating and directing tasks necessary to complete all related action items. Maintain the Magellan project plan to include owners, support, dates, deliverables, milestones, results and course correction when necessary. Drive projects and initiatives that add value to the Corporation and the client while improving the client relationship
Manage and direct technical conversions as necessary to support client requests, and administrative efficiency requests as identified. Work with applicable areas to ensure a system without interruption of agreed upon service levels
Manage and direct implementation of all client initiatives, support client requests, and provide appropriate responses to the complete satisfaction of the client
Maintain a positive work environment that supports self-directed teams, provides a structure to optimize the experience, skill, knowledge and capability of the team. Reward employees based on contribution and performance

236

Claims Academy Lead Resume Examples & Samples

Utilize cost effective resources to manage all program administration, coordination and metrics
Introduce a scalable, ‘one-stop shop’ for Global Claims COE content and curriculum
Working autonomously, leads the strategic design, development and implementation of the “Global Claims Academy” that spans the broader Global Claims Organization
Defines, aligns and refines Claims Academy operating model structure and scope as required (e.g. Governance, Infrastructure, Deliver and Administration Model, etc.) in alignment with the business direction but end-learner focused
Focuses on the attraction, development, and retention (or rotation to/from operations) of Claims Academy associates (e.g. Adjunct Business Trainers, project-based work)
Establishes key metrics, reporting, and analytics aligned with desired Claims Academy outcomes
Conducts continuous research within and external to MetLife analyzing and recommending ‘best in class’ programs, practices and policies to apply to Claims Academy
Manages critical relationships with consultants and vendors, internal end users, and business customers/leadership
Develops detailed project plans, schedules, resource estimates and status reports
Works, manages and aligns resources and tasks in a matrix environment
Runs project meetings and is responsible for project tracking and analysis
Provides monthly and quarterly updates to senior leadership regarding project status and the application and implementation of new or revised procedures, processes, and/or initiatives specific to the Claims Academy through defined committees (e.g. Academy Board, Operating Committee)
Maintains close alignment with Global L&D initiatives and offerings
Partner with other enabling functions (i.e. IT for Learning Technologies; HR for competency/career pathing) as applicable
Designs, implements, and monitors the progress of initiatives, milestones, and budgets to ensure timeliness and deliverables are met
Provides information and/or training to end users to help resolve inquiries related to assigned processes, procedures, and/or initiatives
Leads and motivates project team members, in a non-direct matrix environment, that span the entire organization and provides guidance and direction to lower level associates and staff members
Experience in building and/or developing a strong learning culture in a large financial services/claims organization
Learning operational experience (people, process, technology elements)
Strong client relationship skills
Advanced knowledge of the supported business functions, processes/procedures, workflow, systems, and transactions
8 - 10+ Years of related work experience
Bachelor’s degree preferred in related field or equivalent experience

237

Manager, Life Claims Resume Examples & Samples

Provides strong leadership and direction to a team of approximately 12 claims professionals who specialize in claims investigation and adjudication
Directs all phases of the Life claims adjudication process including service strategy, resource and training requirements, business partnerships and appropriate utilization of technology
Develops and implements improved productivity and work process strategies across all blocks and products to achieve optimal efficiency and effectiveness
Ensures the highest level of professionalism and integrity within direct team and the Group Life Benefits organization
Supports a learning environment by ensuring continuous development, training, and growth of claims professionals to support retention of well-motivated employees
Contributes to operating effectiveness through information sharing, monitoring of metrics, analyzing of work processes and potential implementation of change
Contributes to organization and department goals through leadership of, or participation in assigned projects, committees, initiatives, etc

238

Claims Resume Examples & Samples

Conduct thorough investigations which can include obtaining necessary documents and forms from claimants and insureds and may include conducting recorded statements
May need to negotiate timely and appropriate settlements with claimants, insureds and attorneys and issue appropriate payments
Open and process correspondence related to assigned claims
0 – 6 months of property insurance, customer service, underwriting, legal or total loss claims adjusting experience preferred, but will also accept experience in the general service industry
Effective verbal and written communication, time management, organization and negotiation skills

239

Claims Resume Examples & Samples

Plan and conduct investigations (including but not limited to interviewing parties involved, collecting and evaluating documentation and securing evidence and protecting the chain-of-custody, determine inspection needs, order police reports, scene investigation, take witness statements, review material damage photos, etc.) to analyze coverage, determine liability, compensability, and extent of damages
Identity and work to resolve minor injury claims with early settlement opportunities eliminating the need to transfer file to the Casualty Unit
Assume responsibility for property damage claims; including attorney represented and non-represented parties, for both first and third party claimants
Adherence to proper procedures relating to inspection and evaluation of property damage claims and make recommendations for the disposition of claims in excess of individual settlement authority
Evaluate policy coverage, contact insureds, claimants, attorneys, body shops while determining and establishing reserve requirements
Maintain accurate records and handle administrative responsibilities associated with processing and payment of claims. Record and update status notes, and document results of contacts per Best Practices
Determine need for independent adjusters, cause and origin experts, economists, accident re-constructionists, and engineers
Computer experience (MS Office, excel, word, etc.)
Minimum of two (2) years of property claims handling experience

240

Manager Itd-rcm Charging & Claims Resume Examples & Samples

Leads all activities related to the department's technology services and defines and enforces Corporate IT Standards
Promotes the continued education, training, and refinement of the department staff
Communicates appropriate corporate compliance standards and procedures for all department employees
Supervises and administers hiring and firing, performance reviews and evaluations, staff counseling, etc. for the department
Coordinates department activities with other ITD departments and interfaces with CCF user departments
Directly influence the success of new programs and strategic plans at CCF as they relate to information processing, access and utilization
Acts as consultants to CCF divisions to determine information needs and strategies
Four years in a supervisory/management capacity
Additional progressively responsible IT experience may substitute for the degree requirement
Experience with financial budget planning, managing, analysis and reporting
Experience in Human Resources practices and laws. This includes hiring and firing, conflict resolution, group dynamics, diversity understanding etc
Experience with Epic Resolute (PB and HB Claims, PB and HB Charge Review)
Epic Certifications in any of these areas a plus

241

Warranty Claims Validator With Spanish Resume Examples & Samples

Investigating warranty claims, facilitating recovery and assigning appropriate responsibilities
Coach rest of the team on quality aspects or new learning when required (in person or via conference calls)
Delivers a service to the client in an effective manner
Always adheres to contractual service levels across the client base
Demonstrates excellent problem solving ability, escalates to the supervisor when necessary
Flexible approach and actively looks for ways to grow skills and experience within the team
Native / Advanced Spanish speaker (C1/C2)
Communicative level of English
Interpersonal skills to deal with suppliers, warranty engineers, etc
Data processing accuracy, detail oriented
User level MS Office
Organized, timely, pro-active and highly productive
Attention to detail and ability to multi-task
High School degree in minimum
Experience in Warranty is an advantage
Experience with suppliers and strategic sourcing is an advantage
Mechanical knowledge of machinery is a definite plus
Strong displayed problem solving and analytical skills
Self-Motivated, positive attitude and approach
Flexibility to take on additional responsibility and tasks

242

Claims Resume Examples & Samples

Investigate applicable personal lines automobile claims and assist the claims department in the resolution of suspicious claims
Prepare and identify applicable files for Examinations Under Oath (EUO) and whenever possible attend the EUO
Prepare and summarize EUO results and make recommendations to the claims department on the handling of the claim
Conduct in person and over the phone recorded statements of insured’s and claimants as necessary in conjunction with plan of action on the file assigned
Assist the claims department in the utilization of databases such as NICB, Accurint and Lexis-Nexis
Assist SIU management in providing claims fraud awareness training to the Regional Claims Office staff
Assist the claims department and give guidance in the handling of questionable claims on a daily basis as needed
Update the SIU Database to maintain a record of daily and monthly activity on all suspect claims investigated
Maintain active membership in professional organizations that provide SIU assistance and resources
Establish and maintain relationships with law enforcement, Department of Insurance officials and insurance industry personnel and assist them when required
The ideal candidate will have 5 + years of SIU and/or law enforcement investigative experience and/or 5 years of personal lines automobile claims handling/adjusting experience
Demonstrated ability to evaluate personal lines automobile claim and policy information and other data sources for fraud indicators and analyze the data to detect fraud trends or red flags
Ability to interpret public record information systems and claims history in order to support the investigative process
Ability to develop and present fraud related training programs
Prior insurance fraud investigative experience or industry related designations (FCLS, CIFI, CFE) as well as a college degree are a plus
Prior experience in conducting personal lines automobile SIU claims investigations is desired

243

Lead, Core Ops-claims Production Resume Examples & Samples

Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure
Perform daily troubleshooting procedures to support enrollment, disenrollment, claims, and claims support functions as needed
Participates in or leads quality improvement efforts to improve claims processes and/or policies
7-9 years

244

Managing Director Claims Resume Examples & Samples

Bachelor’s Degree and insurance industry professional designations, preferred
Ten or more years of claims adjusting, advocacy and risk management experience in an insurance company, TPA, top 10 brokerage environment, or as an in-house claim/risk management position within a Fortune 500 company
Five years as a department manager of at least 10 or more people
Ability to work independently in a fast paced, team environment
Top level professional skills in managing multiple relationships and demands in short time frames with successful results
Participate in new sales opportunities and presentations
Able to prepare training material using PowerPoint (or similar) and present to clients and colleagues
Conduct internal and external industry educational seminars and training
Proficient with technology including, but not limited to, all Microsoft Products, and ability to learn additional industry software programs

245

Claims Trainee Resume Examples & Samples

Participates in training classes to learn the policies, practices and procedures related to being a Claims Representative
Investigates, confirms coverage, determines liability, establishes damages, reports status and negotiates the settlement of assigned cases in a supervised learning environment
Has authority to make payment of assigned claims within prescribed limits, with supervisory review and approval
Estimates the cost of repair or replacement of damaged or stolen property and vehicles
Represents the Company from a public relations standpoint and must conduct oneself as a member of Management at all times

246

Claims Examiners Resume Examples & Samples

Data Entry and/or typing experience
Ability to multi task and prioritize is required
Social, verbal and written communication skills
Dependable and flexible

247

Summer Intern, Claims Resume Examples & Samples

Undergraduates majoring in Mathematics / Science / Information Technology or other analytical studies
Strong skills in Microsoft Excel and analytical abilities
Experience working with complex data sets is preferable
Strong capability of business data analysis and business modelling
Excellent interpersonal skill and ability to interact and network with senior managers independently

248

Manager, Workers Comp Claims Resume Examples & Samples

Minimum 10 years of claims adjusting or claims supervision
2 years of management within a risk management department involving claims and program creation
Proven expertise in working with and understanding the key risk features inherent in businesses and how this translates to overall workers’ compensation claims management
Ability to lead communications with vendors and internal/external stakeholders
Understanding of statutory laws related to workers’ compensation claims
Excellent verbal and written communication skills with employees at all levels of the organization
Excellent presentation and facilitation skills, including building of Powerpoint documents to be used during client interactions
Proficient in Microsoft Office Suite and desire for continuous learning of technology advancements
To perform the job successfully, an individual should demonstrate the following competencies
Analytical - Collects and researches data; Designs work flows and procedures
Problem Solving - Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully; Develops alternative solutions
Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs
Team Work - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views
Cost Consciousness - Works within approved budget; Develops and implements cost saving measures; Contributes to profits and revenue
Ethics - Works with integrity and ethically
Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions
Judgment - Exhibits sound and accurate judgment; Includes appropriate people in decision-making process
Some travel required, up to 50% travel
Work in clean, pleasant, and comfortable office setting

249

Claims Resume Examples & Samples

Evaluates and negotiates settlement of automobile first and third party physical damage claims within established settlement authority limits and negotiates any excessive storage charges
Explains procedures and answers inquiries for adjusting auto total loss claims
Analyzes information obtained to establish compliance for regulatory requirements and settlement value
Properly manage Total Loss settlement process and rental expenses by working closely with appraisers, rental facilities, body shops, and salvage vendors. Includes managing deductibles and policy limits
Provides coordination with internal functions to include appraisal operations, SIU, Subrogation and Salvage
Meet all quality standards and expectations per company best practices and comply with state specific regulations
Acquisition and maintenance of insurance adjuster’s license within designated number of attempts
2 years of customer service/sales experience; or completion of military service; or 1 year customer service/sales experience plus 30 hours of college credit; or 1+ years experience multi-tasking in a Windows operating system environment
Strong organization and effective time management skills
Excellent negotiation skills and ability to effectively handle conflict
Successful completion of a job-related assessment may be required
This position will require an Insurance Adjuster's license. You must pass a licensing exam within a designated number of attempts and have the ability to become licensed in all applicable states

250

Claims Resume Examples & Samples

Review claim files for accuracy and compliance with company policy and procedures
Provide guidance and direction with regard to coverage analysis, liability investigation and determination, bodily injury evaluation, negotiation and settlement
Ensure productivity, quality handling, budget goals, and related KPI’s are achieved by the unit
Complete the Claims Audit process, providing feedback and coaching to drive top performance within the assigned adjusting unit
Effectively handle and resolve consumer complaints and address adjusters who are the source of the complaint
Develop, analyze, and complete reports to submit to management on team performance
Supervise staff in accordance with company policies and procedures
Work in concert with recruiters to conduct interviews, determine best candidates and partner with training team in new hire onboarding, training and next level education
Responsible for staff scheduling to include: employee vacations, employee breaks, and back-up for absent employees
Other duties as determine necessary
College degree preferred or relevant work experience
3-5 years of liability claim handling experience with one year supervisory experience required
Demonstrate excellent time management, organizational, reading comprehension, analysis, and math skills
Demonstrate well-developed knowledge of claims Best Practices, processes, procedures, and technology
Proven ability to communicate effectively, orally and written, with all internal and external parties
Strong leadership ability with proven capability to train, mentor, and develop subordinates for next level roles in the organization
Demonstrate ability and desire to assume additional leadership responsibility as opportunities within the organization may arise

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