Claims Supervisor Resume Samples

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M Hermann

Michele

Hermann

7036 Keagan Estates

San Francisco

+1 (555) 390 5306

7036 Keagan Estates

San Francisco

Phone

p +1 (555) 390 5306

Experience Experience

Boston, MA

Claims Supervisor

Boston, MA

Shanahan-Greenfelder

Boston, MA

Claims Supervisor

Assists Manager in evaluating department procedures and workflow regularly to identify opportunities for improvement
Identify trends and partner with Support team and Management to make recommendation and improve operational performance
Provide guidance to & manage multiple stakeholders in the management of complex claims
Reviews job performance, and provides direct feedback related to performance and success for each direct report
Evaluates overall performance of team as well as individuals. Coaches and counsels team members both individually and together toward improved performance
Develop good working relationships and workflows with other operational departments that impact claims processing
Manage the ongoing personal development, competency and performance of all direct reports

New York, NY

Casualty Claims Supervisor

New York, NY

Gorczany, Collins and Ernser

New York, NY

Casualty Claims Supervisor

Manages the development and training of subordinates, including monitoring and relaying information to the staff regarding changes in coverage and laws
Manages personnel administration including employee evaluations and salary administration
Completes regular quality audits of staff’s work, records results and counsels staff to bring work to or above standards
Oversees the handling of all aspects of the claims assigned to the unit including reserving, communication, documentation, litigation management, evaluation, negotiation and settlement
Reviews and analyzes processes, procedures and workflows to identify opportunities for process improvement and efficiency
Establishes and executes controls to assure that the quality of the work meets or exceeds standards
Other tasks as assigned by Claim Manager/Assistant Vice President/Vice President

present

Dallas, TX

Total Loss Claims Supervisor

Dallas, TX

Marquardt-Fadel

present

Dallas, TX

Total Loss Claims Supervisor

present

Works collaboratively with other departments on projects and offers assistance with expertise
Responsible for conducting performance appraisals and recommending salary actions including promotions and terminations
Responsible for overseeing Total Loss/Theft/Fire claims in all territories; monitors and adjusts performance criteria for Direct Tow, Total Loss, and Theft adjusters; ensures department goals and objectives are met; directs continuous process improvement effort within unit with an ongoing focus of improving customer service and delivery
Monitors workload and reviews claims to ensure quality processing
Recognizes employee achievement and counsels employee on performance issues
Trains, coaches, mentors employees for their individual career development
Participates in Personnel activities in cooperation with the Manager and Human Resources

Education Education

Bachelor’s Degree in Accuracy

DePaul University

Bachelor’s Degree in Accuracy

Skills Skills

Strong numerical skills · Excellent organization skills – able to prioritize work and meet deadlines
Maintain composure by responding calmly, quickly, professionally and decisively to the unpredictable or unexpected
Able to seek out best practice in order to effectively deal with diverse, complex and highly sensitive issues
Strong analytical skills to be able to evaluate claims and operational issues
Ability to multitask, this includes ability to understand multiple products and multiple levels of benefits within each product
Strong math and analytical skills, including the ability to analyze and organize data
Excellent ability to build and maintain business relationships with clients by providing prompt and accurate service
Excellent interpersonal skills – able to work within a team
Excellent communication skills and have the ability to create a customer focused culture
Ability to build professional relationships with your team while motivating them

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15 Claims Supervisor resume templates

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AC Claims Supervisor Resume Examples & Samples

Oversee the appropriate distribution and assignment of claims within the team to ensure customers/claimants are having their matters addressed within company and legal timeframes
Strong negotiation and organization skills
Ability to work having a high degree of accuracy; strong attention to detail
Thorough understanding of (multiple) state regulatory requirements related to personal lines claims settlement
Obtain state specific property casualty claims licensing as required

Home Claims Supervisor Resume Examples & Samples

Responsible for ensuring team member compliance with state regulations
Through strong performance management practices, provides feedback, coaching and skill/knowledge development to respective team members
Ensure adequacy of claims reserves reviewing on a pre-established schedule; assure the proper and timely disposition of claims that can be settled within the team's authority
Assign the level of settlement authority for each team member; personally authorize settlements that exceed direct reports limits but within personal authority limits
3-5 years of experience with personal lines property claims settlement
Ability to work having a high degree of accuracy; strong attention to detail Ability to coach and develop staff
Ability to obtain state specific property casualty claims licensing as required

Claims Supervisor Resume Examples & Samples

Accountable for building positive proactive relationships with internal and external customers
In the absence of the Asst. Mgr., resolve escalated issues that would normally be handled by the Asst. Mgr
Evaluates overall performance of team as well as individuals. Coaches and counsels team members both individually and together toward improved performance
Associates degree or equivalent education and experience. Minimum of 3 years relevant experience
Above average communication skills both verbal and written
Ability to manage multiple tasks
Demonstrated ability to grasp technical and complex concepts and be able to explain these clearly to subordinates and internal and external customers

Claims Supervisor Total Loss-depere, WI Resume Examples & Samples

Provide leadership to a team of claims representatives who initiate, investigate, evaluate, negotiate and finalize personal lines claims. Responsible for ensuring team member compliance with state regulations. Through strong performance management practices, provides feedback, coaching and skill/knowledge development to respective team members
Bachelor’s Degree or equivalent experience
3 to 5 years prior experience within auto personal lines
Strong Negotiation and Organizational Skills
Proven customer service skills and excellent interpersonal skills
Ability to coach and develop staff. Ability to work with high degree of accuracy, strong attention to detail
Associates in Claims Designation of Chartered Property Casualty Underwriters
Prior leadership experience as a team lead or as a mentor
Prior experience with Total Loss evaluations
Prior auto estimatic experience

Claims Supervisor Resume Examples & Samples

Supervises data entry, claims resolution, claims adjustments
Oversees and coordinates the distribution of imaged and controlled claims from document support to data entry associates on a scheduled basis
Ensures that pended work is maintained within acceptable levels, as defined by the Claims Manager
Maintains high quality and productivity standards as established by the Claims Manager
Coordinates training for new employees and assists in maintaining accurate and timely personnel records, including tracking attendance of each employee supervised
Completes employee performance evaluations and assists in special projects or tasks related to claims processing, as necessary
Associates degree required. Comparable work experience can be substituted for education
Two years’ experience in a claims processing production environment
One year supervisory experience in a production environment, preferably in Medicaid or health-care related field
Strong analytical skills and problem solving capabilities
Ability to communicate effectively, both verbally and in writing, with internal and external customers

Claims Supervisor Resume Examples & Samples

3+ years of Managed care experience as a Claims Examiner
Knowledge of all Claims adjudication processes, coding and benefit plan design
Proficiency with Claims processing systems
Microsoft Office/Suite proficient (Word, Excel, etc.)
Excellent communication skills (written and verbal)

Claims Supervisor Resume Examples & Samples

Provide expertise and/or general claims support to teams in reviewing, researching, negotiating, processing and adjusting claims
Responsible for driving employee engagement through communication, development and accountability
Responsible for partnering with business partners to ensure success of the business and the team
Work with other businesses upstream and downstream to ensure exceptional member experience
Consistently meet established productivity, schedule adherence, and quality standards
2+ years of Leadership experience in a Production Environment
2+ years of experience using MS Office Word (documents), Excel (formulas, charts, functions, and spreadsheets), Outlook (scheduling, folders, and email), PowerPoint (slides presentations)
Undergraduate Degree
Ability to multi-task (this includes ability to understand multiple products and multiple levels of benefits within each product)

Claims Supervisor Resume Examples & Samples

1-2 years experience in a lead or supervisor role
2 + years experience in the healthcare industry
2+ years of experience in the healthcare industry
1+ years of experience in a lead or supervisor role
Ability to consistently meet established productivity, schedule adherence, and quality standards
Ability to provide expertise and/or general claims support to teams in reviewing, researching, negotiating, processing and adjusting claims
Ability to authorize appropriate payment or refer claims to investigators for further review
Ability to analyze and identify trends and provides reports as necessary
Ability to respond to claims appeals
Ability to supervise, monitor, track and direct day to day operations to staff

Claims Supervisor Resume Examples & Samples

Ability to travel less than 10% of the time for training or meetings
1+ year of work experience using a computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product

Claims Supervisor Resume Examples & Samples

A graduate of a 4-year degree preferably in Business Administration
At least 2 yrs. of supervisory experience in insurance operations
Excellent customer service orientation

Claims Supervisor Resume Examples & Samples

Supervise all aspects of the claims department within the specified geographic region
Work with the National Compliance Manager to ensure that ADM Crop Risk Services is compliant with RMA guidelines
Provide a weekly recap report to the Decatur office outlining progress made and problems encountered
Contact the marketing rep, agent, underwriter (if needed), and the Decatur office to make them aware of any problems that arise in the field. The quicker the better
Talk with sales reps weekly to discuss any issues or concerns that agents are having
Accompany the sales rep on visits to agencies within your territory to have a face to face meeting with agents
Contact the National Compliance Manager or their designee when a claim turns into a $500,000 loss that needs reported to RMA
Complete the audit of adjusters’ expense accounts in a timely manner
Work with individual adjusters to ensure they are proficient with all programs used by the company
Effectively manage claims’ staff in your region, rewarding/reprimanding when necessary
Represent ADMCRS in a professional manner and make certain that adjusters in the area do the same
Promote the ADMCRS service standards to your adjusting staff
Complete yearly performance evaluations of all adjusters within the region under the direction of the Regional Claims Manager
Make an effort to personally visit with agents to ensure adjusters are satisfactorily handling claim load
Provide update at agent training meetings in the area
Communicate with the sales managers in your area on a weekly basis

Claims, Supervisor Resume Examples & Samples

Responsible for management and oversight of the Claims Team(s) to ensure timely adjudication of claims for health care services, received from contracted and non-contracted providers and to ensure all Federal, State and Client requirements are met timely and efficiently in accordance with regulations and client guidelines
Supervises a multi-functional unit of claim professionals and support staff
Provides day to day leadership to claim team in support of department initiatives and strategies in cost containment, case file handling, customer service and quality
Consistently monitors workflows to maximize accuracy and efficiency. Maintains an acceptable level of service and customer satisfaction and retention
Provides input in the quality review process
Monitors unit goals, objectives, processes, procedures and systems
Stays abreast of changes in health plan benefit and pricing methodologies
Facilitate periodic project tracking to management as needed
Validate and ensure departments compliance to company requirements
Participates in special projects and serves on committees as needed
Associate or Bachelor degree preferred
Extensive experience in health insurance claims processing with a minimum of 3 to 5 years management experience
HMO Claims or managed care environment preferred
In-depth knowledge of medical billing and coding
Knowledge of health insurance, HMO and managed care principles
Excellent interpersonal, oral and written communication skills
Strong attention to detail and organization
Able to work independently; strong analytic skills

Claims Supervisor Resume Examples & Samples

1 + years’ Experience as Team Lead, Supervisor, or Manager of a team of 10-20 people in office or clerical environment
Intermediate level experience with Microsoft Word, Excel, and PowerPoint (Word – creating and editing Word documents; Excel - data entry, creating simple spreadsheets; PowerPoint - creating slide shows from scratch
Functional knowledge of how to use Sharepoint or similar type system (Ability to open, add, save files)
2+ years’ Experience as Team Lead, Supervisor, or Manager of a team of 15-25 members processing insurance or healthcare claims
2+ years of UNET Software experience to process insurance or healthcare claims
Previous experience with leading and developing people including providing coaching to improve performance using performance metrics as guidelines
Experience in giving performance reviews to direct reports and documenting results in a formal Performance Evaluation Process
Experience in providing training to direct reports to develop skills

Claims Supervisor Resume Examples & Samples

2+ years of supervisory/leadership experience within a pharmacy or medical claims department
Experience with performance reviews and evaluations
Intermediate skills utilizing Microsoft Word (create letters) and Excel (create charts and graphs)
Knowledge of Med D compliance requirements and regulations
Experience with internal claims systems

Claims Supervisor Resume Examples & Samples

Ensure proper controls are in place to eliminate risks to the operations
Identify improvements and operational savings for the organization
Coordinate claim issues through resolution with adjustments, appeal, and business partners
Lead staff or improvements to ensure the delivery meets customer expectations
2+ years of experience with Medicare and Medicaid claims
1+ years of experience managing or leading a team of 10-30 people to achieve high performance in process driven environment
Proficiency with computer and Windows PC applications (this includes the ability to learn new and complex computer system applications)
Undergraduate Degree or higher
1+ years of experience managing or leading a team of 10-30 people in Business operations of Healthcare, manage care, or insurance industry

Claims Supervisor Resume Examples & Samples

Responsible for handling one or more of the following tasks within turnaround and quality standards as applicable
Manage escalations
Work with internal/external business partners
Submit new macro requests or macro updates
Review team quality rebuttals and support team remediation plans/initiatives
Provide expertise or general claims support to team in reviewing, researching, investigating, negotiating, processing and adjusting claims
Conduct analysis and identify trends and provide reports as necessary
Support team employee engagement and continually working to meet and/or improve vital signs results
Back-up for other supervisors or manager as needed
High school Diploma or GED
Moderate Proficiency with computer and Windows PC applications (this includes the ability to learn new and complex computer system applications)
Support core values within the team/organization
Support team engagement initiatives
Ability to work independently and make sound decisions in a fast paced environment

Claims Supervisor Resume Examples & Samples

2+ years of Team Lead, Supervisory or Managerial experience
Proficient experience with Microsoft Word (creating and editing documents), Excel (data entry, creating simple spreadsheets), and PowerPoint (creating slide shows from scratch)
Available to work during the hours of operation (6:00 am - 6:00 pm) Monday through Friday with overtime and weekends as needed
Bachelor's Degree or higher
Healthcare Industry experience

Claims Supervisor Resume Examples & Samples

3+ years of experience Supervising or Managing a team in an Operations or Production environment
Experience using Microsoft Excel and Microsoft Word to open, edit, and save documents
Experience using Microsoft PowerPoint to create presentations
Experience using Microsoft Excel pivot tables to analyze and manipulate data

Medicaid Claims Supervisor Resume Examples & Samples

Supervise all aspects of assigned teams
Monitor, report and track claim metrics and turnaround times
Maintain inventories and aging
Research issues escalated or delegated to them
Ensure vendors are handling claims according to policies and procedures
Manage the claim exchange and entry
Distribute work of pended claims
Reach out to customers regarding project status or policy clarification
Escalate issues as needed
Perform root cause analysis on denials
Represent the Claim Services department in meetings

Claims Supervisor Resume Examples & Samples

Manage claims operations overseeing Claims Examiners to monitor production, quality, timeliness and procedural compliance
Responsible for analyzing aged claims over 30 days old for all markets. Working with the managers of those markets as well as Network Operations, Provider Data Management (PDM) and Configuration to assess root cause and remediation
Develop employee’s skills, evaluate performance and provide feedback. Oversees resolution of employee relations issues. Conducts hiring, training, and evaluation of staff
Participates in operational meetings and training sessions as necessary
Address staff concerns related to day to day operational, system, customer service, quality, and professional issues
Assists with operations activities for a large region of the organization in compliance with organizational and government policies. Reviews operations systems and procedures, and recommends improvements to increase efficiency. Supervise operations activities within a functional or multi-functional area of the organization
Ensure privacy and confidentiality as required by HIPAA, company and departmental guidelines
Other special projects and tasks as assigned
High School Diploma required, Associate Degree preferred
Minimum of 2 years’ experience in experience in a claims processing environment and 2 years’ or more experience in a leadership role within Cigna HealthSpring
Proficiency with computer applications including Microsoft Office, Internet, and email
Strong knowledge of Medicare regulatory requirements
Demonstrated leadership skills and the ability to effectively develop, train and coach less experienced team members with the patience to explain details and processes repeatedly
Excellent communication, interpersonal and negotiation skills required
Strong verbal, listening and written communication skills
Inventory management and/or operations management environment experience
Ability to adapt in a dynamic work environment, make independent decisions
Ability to drive change and process improvements required
Ability to lead/motivate employees
Strong time management skills required

Claims Supervisor Resume Examples & Samples

Organizes department workflow and distributes assignments to Claims Examiners
Conducts bi-weekly department and training sessions
Meets with Claims Examiners to review pre check run and monthly random examiner quality audits
Performs pre-check run review and 100% new client audits
Supervises regular and special check runs as needed
Reviews pre check run errors with Claims Examiners and provides coaching and retraining
Ensures escalated issues are resolved while meeting customer expectations and company standards
Assists Manager in evaluating department procedures and workflow regularly to identify opportunities for improvement
Supports Manager in monitoring claims inventory and adjusts resources as necessary
Supervises provider dispute resolution (PDR) processing and ensures compliance with regulatory requirements
Supports implementation of new business procedures and improvements to ensure compliance with client, regulatory and company objectives
Supports Manager in ensuring regulatory compliance for timely filing and interest payments are up to date
Completes special projects directly or through subordinate staff
Supports staff development in the areas of leadership, teamwork, claims processing and continuous quality service
Works diligently and cooperatively leading the team to identify root cause issues and resolve them in a timely and efficient manner
Ensures the proper routing of all claims related issues
Performs annual reviews and counseling procedures for tardiness, absenteeism and performance issues with Claims Examiners
Assists in training new and tenured colleagues on MARCH systems and claim processing guidelines including setting standards and individual goals to optimize performance levels
Identifies training opportunities that arise from the monthly examiner audit results performed by the Quality Assurance and Recovery Department
Suggests, discusses and implements changes to the Provider Reference Guide claim section with Manager
Assists staff as needed
Attends operational meetings and other meetings as directed by Manager
Maintains and creates department job aides, policies and procedures as directed by Manager
Performs any other duties assigned by Manager
Candidates must be able to work a day shift schedule, 40 hours per week, Monday through Friday
Experience working in a managed care claims processing setting in a lead or supervisory position
Knowledge of CPT, HCPCS, ICD-9 and ICD-10 coding
Ability to interpret benefit, pricing and eligibility documents
Thorough knowledge of medical terminology
Knowledge of utilization review process and claims processing procedures
Knowledge of health plan benefits and CMS (Medicare & Medicaid) guidelines

Claims Supervisor Resume Examples & Samples

Consistently meet established quality standards, productivity, and schedule adherence
2+ years of Business and/or Process Analyst experience
1+ year of experience leading a team of 15 or greater in an office setting
Intermediate proficiency with Microsoft Word - basic document creation, PowerPoint including putting together a basic presentation and Excel including basic formulas, pivots and graphs, sorting, and navigating the application
Experience with computer and mouse navigation skills including the use of Windows based applications
Must be able to work Monday – Friday between the hours of 6:00 AM and 6:00 PM CST
3+ years leadership experience of 15+ employees
Prior leadership experience in a metrics driven environment achieving quality and production goals
UNET experience
Strong reading comprehension, written and verbal communication skills
Ability to build professional relationships with your team while motivating them

Claims Supervisor Resume Examples & Samples

Carry out monthly performance management reviews on all team members, while assuming responsibility of your team, including day-to-day management, motivation, attendance, conflict management, training, well-being and performance
Ensure a suitable training and development plan, agreed objectives and performance review process is always in place for all team members
Review and co-ordinate work flow in line with available staff and current inventory to maximise results
Responsible for monitoring claim service standards, being pro-active to highlight potential issues and creative to bring solutions
Manage claims handling processes to ensure maximum savings opportunities are realised and new opportunities developed; whilst ensuring approach is customer centric
Provide direction and guidance regarding policies, procedures, workflows, claim service quality, and training needs
Use independent judgement and discretion to review and resolve complex claims issues
Create and continually evolve customer centric mind set in all aspects of leadership from customer engagement to staff engagement. Encourage a positive, creative and solution driven environment
Develop proactive/effective business relationships (especially Client Management) to ensure a seamless delivery of service. Actively encourage all team members to do likewise
To support the Manager in achieving departmental and Company-wide goals and business plans
To be proactive in seeking and sharing ideas for innovation in business processes and contribute to initiatives
To produce/support meaningful, accurate management reports and statistical information in line with formats and timescales agreed with the Manager
Provide business analysis data for departmental projects and attend meetings if necessary
To carry out other ad-hoc tasks required to meet business needs
Takes ownership of the complete customer experience, and enhances it at every opportunity
Excellent communication skills and have the ability to create a customer focused culture
Ability to inspire and support a team towards the achievement of targets
Able to seek out best practice in order to effectively deal with diverse, complex and highly sensitive issues
Identify areas of improvement and assist in creating and implementing solutions
Ability to remain calm and focused whilst working under pressure
Works efficiently with both speed and accuracy when performing tasks
Personal flexibility and adaptable to change
Proven track record of meeting customer needs within a service industry environment, preferably insurance
At least two years management experience
Experience in complaints management - with a proven track record in improving customer service standards
Experience of coaching, managing, developing and motivating individuals to improve performance
Experience in dealing with personnel issues including absence management

Claims Supervisor Resume Examples & Samples

Become subject matter expert in the claims processing system’s functionality
Monitors claim staff for attendance, punctuality, and performance measurements. Implements disciplinary action as needed
Provides staff with regular feedback regarding performance, supplying monthly report cards and coaching
Supervises the claims processing team to ensure all service level agreements and client requirements are met
Enlists data driven management principles to track performance
Excellent communication skills, verbal and written

Claims Supervisor Resume Examples & Samples

Adhere to compliance/regulatory requirements, or Marsh’s Professional standards to maintain quality & avoid potential E&O situations
Build and maintain effective relationships with clients, colleagues, third parties or insurers
Effectively communicate with clients, colleagues, third parties or insurers as appropriate at all times, and as per local procedures
Ensure all applicable claims applications, records and files are kept up to date at all times
Proactively handle tasks and activities to ensure adherence to local or client service standards, or KPI's
Manage and prioritize workloads to meet deadlines, service standards or deliverables, escalate or seek assistance where necessary
Take ownership of your own personal development, maintaining and improving knowledge and skills
At least 5-7 years’ work experience with, 5+ years of previous insurance or financial services experience preferred
Clear and concise oral and written communication skills
Strong numerical skills · Excellent organization skills – able to prioritize work and meet deadlines
Excellent interpersonal skills – able to work within a team
Comfortable and experience working with technology (solutions)
Proficient in Microsoft Office tools (or equivalent) – Outlook, Word and Excel
Insurance/ claims handling knowledge
Relevant industry practice or Line of Business experience
Insurance market, clients and claims management skills related to area of expertise
Proven experience of effective resource and cost management
Strong leadership qualities
Strong networking skills
Strong problem solving capabilities
Ability to handle complex and difficult negotiations and influence stakeholders
Ability to handle very complex and difficult negotiations and influence multiple stakeholders Other requirements (licenses, certifications, specialized training)
Certification or licenses as required by jurisdiction

Claims Supervisor Resume Examples & Samples

5+ years of experience handling casualty claims
Non-standard auto experience preferred
CPCU/AIC is desirable, but not required
Must have claim related computer systems experience
Guide wire experience is a plus

Claims Supervisor Resume Examples & Samples

Direct, monitor, and be responsible for daily work distribution to achieve all turn-around-time standards for each line of business
Be fully accountable for team members achievement of all objectives
Display a demonstrated commitment to individual and team productivity and quality goals, holding team members accountable while encouraging forward movement
Proactively identify adjustment sources in order to minimize the volume of claims that require secondary handling
Monitor team coverage of responsibilities and accurately track daily attendance to assist with redistribution of work as necessary to achieve set targets
Successfully manages time in order to balance competing priorities in an ever changing environment in order to continue to move forward on department goals and initiatives
Multi task and keep organized without compromising quality
Maintain consistency in applying company and departmental policies
Build trust, respect and a commitment through communication and positive reinforcement to create a tradition of maintaining and exceeding internal and external expectations
Project a precise, vivid picture of excellence for your team, clearly communicating all expectations as well as future goals
Follow-through on handing all requests and projects, proactively communicating any delay in handling and conveying realistic completion dates
Effectively delegate and follow through on completion of assignments
Maintain a high degree of professionalism, consistency, and a positive demeanor at all times
Ensure a motivated culture by developing motivational programs to increase team loyalty and to create an atmosphere of fun in the department. Motivate employees by using a combination of individual, team, and department recognition
Be a visual and verbal support to team by remaining accessible and maximizing time on the floor on a daily basis communicating unavailability to staff in advance
Ensure balance and consistency towards approachability and a sense of urgency
Provide individual daily ,weekly and monthly statistics in a timely and accurate manner
Provide guidance and effectively coach employees to achieve desired results and overall performance, encouraging discussions for realistic achievement plans for long-term growth
Through coaching, counseling, motivating and leadership, develop team members to maximize their contribution towards the team and office goals
Identify training needs by closely monitoring individual and team performance and obtaining feedback from other departments
Be responsible for thorough, effective training
Conduct effective and timely coaching and counseling as needed
Initiate daily interaction and development with each employee by adapting communication styles to the situation and audience, creating an atmosphere conducive to success in varied situations
Performs task analysis and develops productivity standards for employees as well as effective and efficient methods of measuring productivity
Maintain consistency in applying company and departmental policy decision by accurately and timely documenting employee files, including attendance, performance information, documented warnings, time off requests, coaching information, training information, etc
Effectively interview for open positions
Identify internal candidates for additional responsibility while mentoring candidates for advancement
Provide timely and well documented employee evaluations, outlining realistic employee development plans
Stay up to date on and demonstrates necessary technical/specialty proficiency and knowledge and ongoing thirst to learn and grow
Understands how all internal roles effects and are effected by other functions
Use knowledge and imagination to resolve problems to obtain a win/ win outcome
Generate ideas and creative solutions to improve or simplify procedures, techniques and processes
Participate in office efforts and planning toward meeting overall efficiency and service objectives
Work closely with other departments to assure a smooth coordination of efforts and resources
Develops problem solving skills to assist in the analysis of resource allocation and project planning
Be proactive in identifying areas where improvement can be made and efficiencies gained
Shares new information, concepts and techniques quickly in order to improve technical/specialty practices within the team
Speaks and writes clearly, concisely and accurately
Listens actively and checks for understanding; uses clarifying questions to understand issues and commitments
Consistently projects a positive and professional image
Works well with others, understanding that the best results are achieved through promoting teamwork and collaboration among individuals with diverse skills, ideas and backgrounds, and by demonstrating versatility along with the ability to show appropriate sensitivity
Coordinate the AHCCCS encounter reporting and pend correction processing
Coordinates claims research projects, and work with IS department to root cause potential opportunities for system set up
Minimum of 3 years claims processing experience
Three years of Supervisory experience required
Bachelors degree and/or equivalent experience
AHCCCS and Medicare experience strongly preferred
Commercial experience preferred
Knowledge of medical terminology, ICD-9, CPT codes, pricing, and provider contracts
Knowledge of all claims processing types (IE, facilities, HCFA, RX, Dental)
Effective communication skills, with the ability to communicate to staff at all levels of the organization
Proven display of confidence and positive professionalism in all interactions with associates and outside contacts/ customers
Proven leadership, coaching, motivation, and conflict resolution skills
Demonstrated ability to prioritize and handle multiple tasks while maintaining flexibility
Proven ability to successfully direct and monitor workflow distribution
Proven consistency in applying policies and maintaining confidentiality
Sound decision-making, planning, and problem solving skills, with the ability to react quickly and calmly to fluctuations and changes
Experience in interviewing, hiring, and termination of employees
Working knowledge of Word, Excel and excellent computer skills
Effective stress management skills

Fscm Claims Supervisor Resume Examples & Samples

Supervises FSCM Claims Specialists in their assigned duties
Completes performance reviews and other periodic reviews as required
Train new employees in responsibilities providing them with exposure to the necessary techniques and skills. Train all employees in new systems and procedures
Establish relationships and maintain close contact with the appropriate business personnel. This includes Vice Presidents, Directors, Managers, and Analysts in order to effectively identify root cause issues and assist in the resolution process
Assists in mapping processes and identifying potential issues of newly acquired businesses
Make appropriate reports and recommendations on problems and issues to management
Bachelors degree in Business, Accounting, or related field - consideration will be given to relevant experience in lieu of this educational requirement
3 to 5 years of supervisory experience preferred
Requires excellent judgement on various complex matters. Extensive knowledge of company policies and procedures as related to deduction management. Needs to be creative when formulating solutions for correcting root cause issues

Claims Supervisor Resume Examples & Samples

Recruits, hires and provides coaching and development to the adjustors
Leads, motivates, supervises and drives performance for a team of individuals, ensuring KPI achievement
Assigns work, sets completion dates, reviews work, and manages performance in accordance with organizational policies, procedures, and performance management processes
Develops and coaches individuals on team and identifies training needs
Ensures that all customer claims inquiries are responded to promptly and professionally
Collaborates with other departments (Operations, Billing, Finance, Legal, Sales etc.) as well as third parties to ensure

Claims Supervisor Resume Examples & Samples

5 or more years’ experience handling casualty claims
Must have claim related computer systems experience; Guidewire experience is a plus
Fluent in English/Spanish a plus
Must possess knowledge of the principles of casualty insurance and auto casualty claims adjustment process

Claims Supervisor Resume Examples & Samples

Reviewing operational reports and analyzing staff needed to make the necessary adjustments and or plans to improve results
Minimum of 4 years of healthcare, health plan or benefits experience required preferably in a call center environment
Minimum 1 years of claims or claims processing experience
Group Health Plans (fully insured and self-insured)
Flex Spending Accounts (FSA), including limited FSAs
Individual Health Plans and Exchanges plans
Reviewing, interpreting, and researching Explanation of Benefits (EOB's) and denial letters
Knowledge of applicable law and resources regarding confidentiality of privileged patient information and appeals administration

Claims Supervisor Resume Examples & Samples

Positions in this function are responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims
Conducts data entry and rework; analyzes and identifies trends and provides reports as necessary
2+ years of experience in a Leadership or Supervisory position
1+ years of experience in a Healthcare Claims background
Candidate must reside in TN at time of hire

Liability Field Claims Supervisor Resume Examples & Samples

Analyze data to solve business problems
Think critically about data required and possible analysis approaches to solve business problems
Produce ad-hoc and recurring reports and analyses as assigned
Perform analysis using Excel, Access, and similar applications
Provide analysis and recommendations to leadership
Monitoring of claims volume
Reviewing production targets in collaboration with Liability leadership
Gather and provide information customer feedback to management for process, system and product improvements
Maintain current resident and non-resident adjuster’s licenses

Field Claims Supervisor Resume Examples & Samples

Supervises assigned personnel
Conducts case reviews and evaluates Claims Representative performance by continuous review of claims statistics, open and closed file evaluations, reinspection, and observation of activities in the field and office
Reviews the settlement activity of the Field Claims Office or Claims Service Center to ensure sound systems, service, and security
Sets and adjusts claim reserves within authority
Responsible for compliance with published company procedures
Recommends and carries out programs designed to meet the administrative technical training and overall development needs of all assigned personnel
Promotes coordination of Claims and Marketing relationships by instructing agents in methods and procedures of claims handling and by participation in meetings conducted by the Marketing Department
Approves and signs expense accounts for assigned personnel and all payments within authority for allocated adjustment expense on files supervised
Maintains communication with competent specialists (for example, doctors, attorneys, and repair facilities) to insure prompt, economical, and professional handling of all types of claims in assigned area
Employees assigned to the Catastrophe team will be required to travel away from their residence for a specified period of time, usually consisting of 23 days. Promotes safety at all times and complies with safety/ergonomic standards as outlined in relevant company published manuals. Performs other duties as assigned
Successful completion of technical competency exam (external hires have 90 days to take and pass the exam and should have a minimum of 3 years of prior claims experience), interview and completion of Claims Leadership Development Program required
External candidates should have a minimum of three years of prior claims experience
The same time-on-job requirement is preferred for internal candidates
Excellent communication skills – both written and oral
Computer skills - MS Word, Excel, Outlook

Claims Supervisor Resume Examples & Samples

3-5 years of claims processing adjudication experience
Thorough knowledge of claims processing regulations, systems, and procedures
Demonstrated supervisory background and experience
Proficiency with computer platforms and application
Claims processing adjudication experience in a managed care setting

Claims Supervisor Resume Examples & Samples

To be determined
3+ years of customer service and / or claims processing experience
2+ years of Team Lead, Supervisory, or Managerial experience
Proficient experience with Microsoft Word (creating and editing documents), Microsoft Excel (data entry, creating simple spreadsheets), and Microsoft PowerPoint (creating slide shows from scratch)
Available to work during the hours of operation (6:00 am - 6:00 pm) Monday through Friday and additional hours as business needs
ORS (online routing system) experience

Claims Supervisor Resume Examples & Samples

Responsible for the end-results achieved through direct report's work performance
Participates in analysis and decisions for denial or payment of claims, and other audits internal and external
Corresponds verbally and in writing with claimants, medical providers, legal and other departments
Performs claim audits by executing quality reviews for accuracy and adherence to procedures, sensitive transactions, and regulatory standards; SEC/SOX as a result of telephone calls or written requests
Works jointly with staff on performance by developing skills, increasing knowledge, setting objectives, and monitoring progress and providing feedback
Coordinates resources and creates methods to ensure production measures are met within established targets
Knowledgeable of the principles and practices of insurance claims examinations as it relates to timely filings, state specific information, interest calculations, etc
Participates in continuing education to remain current on industry trends and systems enhancements

Claims Supervisor Resume Examples & Samples

Oversee incoming file assignments and workload distribution, ensuring appropriate alignment within the team
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
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
Track employee goals and conduct employee performance reviews
Responsible for staff scheduling to include: employee vacations, employee breaks, and back-up for absent employees
Work with other departments to establish and maintain collaborative relationships toward achieving department and company goals
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

Triage Claims Supervisor Resume Examples & Samples

Manage a team of 9 Triage Specialists who are mostly based in the San Francisco office and have accountability for internal and external customers throughout the U.S. Therefore the hours of operations for the Department are 5 am – 5pm, Pacific Time, which may sometimes require a presence in the office during non-standard office hours. Currently the Department triages claims for workers’ compensation, liability and property claims. As the number of incoming claims fluctuates daily it is sometimes required that the Supervisor also actively triage claims to ensure all claims are triaged within one business day of receipt. This is particularly true when there is a vacancy on the team or multiple Triage Specialists are out of the office on PTO
Establish, refine and evolve best-in-class Triage claim management program operating characteristics, measurement criteria, and meaningful metrics benchmarking
Drive continuous improvement through initiatives involving the employees, processes and technology
Working with the National Claims Operations Director partner with key Claims Management to develop plans aimed at achieving efficiencies so that incoming claims are triaged correctly and quickly assigned to the appropriate department and the Triage department can meet its Critical Success Goals and the Company can meet both growth and profitability targets
Creates and maintains a positive working relationship with all direct reports, peers, and other claims department managers to ensure the Triage Department operations adds value and meets or exceeds the needs of internal stakeholders and are compliant with set expectations
Manage expenditures for the Triage Department to budget / plan
Support the professional claims selection process to retain claims professionals that consistently demonstrate appropriate technical expertise, maturity and a professional commitment to excellence and customer service
Conduct Development Reviews and engage direct reports in developmental and skill building opportunities
Train and mentor staff
Act as a role model demonstrating belief in, and commitment to, the aspiration values of Argo Group, continuing to build and lead a value-based organization committed to long-term success
Good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Group’s and our customers’ ability to be profitable)
Minimum 5 years claims experience, strongly prefer 3 years in a People Leadership capacity. Prior experience as a claims adjuster, particularly a workers’ compensation claims adjuster, is strongly preferred
Strong litigation management skills
A strong focus on execution in getting things done right. Proven ability to consistently produce and deliver expected results to all stakeholders
Client focus – the ability to effectively determine specific client needs and to provide value added solutions
Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis
Ability to develop and communicate claim management reports for accurate and timely reflection of support staff performance and impact on the claims department
A bachelor’s degree, preferably in business administration, insurance or a related field is required
Other relevant professional designation is desirable

General Liability Claims Supervisor Snow Related Claims Resume Examples & Samples

Understanding of general management and project management principals
Familiarity with or ability to quickly learn claims management and basic risk management principles
Ability to network and effectively collaborate with claims/insurance industry and commercial operations
Ability to manage the resources of outside service providers, specifically third party claims administrators
Skills to develop and monitor performance tracking programs
Working knowledge of data management systems
Familiarity with or ability to learn commercial snow removal operations
Advanced problem solving skills (both quantitative and qualitative)
Strong interpersonal and communication skills with the ability to develop strong personal and professional relationships at all levels of internal and external organizations
Proficient presentation skills - ability to communicate, verbally and written (data reporting) across all layers of the organization
Ability to handle multiple projects simultaneously with minimal supervision
Quick learner with enthusiasm for managing responsibilities efficiently and effectively
Organized, with a sense of urgency and high standards for accuracy
Two to Five years’ experience supervising General and/or Automobile Claims functions and personnel, or
Two to Five years’ general management or project management, or
Two to Five years’ in financial/operations analysis and reporting
Experience using general management, project and task management tools
Experience in commercial landscaping or snow removal operations (preferred)
Excellent written and verbal communication skills with the ability to communicate across all layers of the organization
Proficient presentation skills
Demonstrated creative and innovative thinking
Effective listening skills, with flexibility in approach to solutions
Strong problem-solving, decision-making and organizational skills
Capable of managing multiple demands and priorities simultaneously
Strong bias for action and ability to manage to deadlines
Strong interpersonal and team building skills
Experience organizing and handling multiple projects simultaneously with minimal supervision
Proficiency in Microsoft Office Suite – Excel, Word, Power Point
Bachelor’s Degree in Project Management, Finance, Risk Management, Construction/Landscaping or related discipline or equivalent work experience

Claims Supervisor Resume Examples & Samples

The incumbent is responsible for claim processing, assessment and investigation within specified limits of authority
Liaise with claimant, agents and medical professionals for claims assessment purposes
Ensuring that claims are managed efficiently and professionally in accordance with Company’s’ guidelines and standards
Updating documentation process and preparing monthly reports
Maintain a high level of claims service standards adopting the guidelines and standards set by the department and statutory bodies
To handle enquiries and assist in customer service

Claims Supervisor Resume Examples & Samples

Supervise, monitor, and track team’s productivity, schedule adherence, and quality results
Serve as first point of escalation for staff on procedural and technical issues; and coach staff regarding how to effectively resolve the issue(s)
Maintain a positive work environment that supports a quality driven staff and identify any issues that may inhibit an individual’s or the team’s performance
Investigate trends, surface issues, identify root problems and collaboratively work with specific team / individuals to resolve issues
Serve as a leader by directing the team and ensuring the team successfully applies proper claim procedures strategy to each interaction
Identify skill development needs associated with career progression opportunities and ensure employees receive appropriate coaching / training to validate needs are met
Communication throughout work day via a high volume of emails
Maintain a strong sense of urgency to drive issues to closure
2+ years of Supervisory experience with 8+ direct reports
2+ years of Customer Service experience
2+ years of experience creating and editing documents with Microsoft Word and filters with Microsoft Excel
Medical Claims experience
Insurance Industry Knowledge

Claims Supervisor Resume Examples & Samples

Maintain knowledge of products and services to provide direction and respond to escalated issues
Cultivate positive relationships with internal and external customers to accomplish organizational goals
Identify, analyze, recommend and implement process improvements in functional areas
Ensure team achieves specific key performance indicators and strive to find better ways to improve overall service delivery
Provide the leadership, mentoring and guidance necessary to build and sustain a high performing workforce
Supervise team by coordinating and communicating employee tasks, measuring performance and providing feedback to achieve department standards and goals
Manage budgeted resources by anticipating expenditures, accurately forecasting resource needs/costs and properly accounting for expenses to meet requirements and achieve fiscal responsibility
Provide a positive environment by modeling cultural expectations and influencing others to reward performance and value “can do” people, accountability, diversity and inclusion, flexibility, continuous improvement, collaboration, creativity and fun
Adopt QBE values in personal work behaviors, decision-making, contributions and interpersonal interactions; manage own career development by soliciting feedback and valuing other perspectives
6 years relevant experience
Working knowledge of procedures and systems, managing files and records and other office procedures and terminology
Understanding of performance management techniques and best practices
Demonstrated knowledge and interpretation of insurance policy and contract language
Working knowledge of Microsoft Office Suite, common computer software, communication and concepts
Organize people, tasks and activities to yield efficient work flow
Manage one’s own time and the time of others
Provide appropriate structure, direction and feedback
Ability to manage expenditures to budget
Conceptualize creative solutions that yield effective process improvements
Motivate, develop, and direct people as they work; share knowledge with others and provide effective performance feedback
Collaborate with people at different levels within the organization to accomplish a common goal
Manage multiple projects or responsibilities concurrently and effectively
Utilize established procedures to guide decision-making
Understand team dynamics and utilize the individual strengths of each member to achieve results
Facilitate discussions and manage and resolve conflict to reconcile differences among others and between self and others
Utilize effective written and oral communication; Present information in a clear, well-organized, and professional manner
Adapt and be flexible in a complex changing environment; multi-task and handle competing priorities
Maintain composure by responding calmly, quickly, professionally and decisively to the unpredictable or unexpected
Adjust plans, goals, actions or priorities to meet changing situations; adapt and be flexible in a complex, changing work environment
Effectively present complex information to key stakeholders to influence acceptance of innovative suggestions

Branch Claims Supervisor Resume Examples & Samples

Makes work assignments and supervises activities of personnel involved in adjusting and claims processing
May have responsibility for supervising a drive-in claims operation
Monitors work loads of Claims employees and oversees their handling of claims to ensure compliance with company policies and procedures and state insurance guidelines
Audits opened and closed claims to maintain consistent and accurate claim handling and documentation
Monitors reserves to assure they are adequate, and approves settlements within a scope of authority as defined in the Claims Administrative Manual
Assists adjusters with duties as necessary, providing policy interpretations, and resolving problems and complaints relating to coverage
Maintains relationships with outside vendors
Keeps abreast of claims laws and rulings, policy language and provisions, and provides technical interpretations and advice to claims personnel and Agents
Participates in selection, hiring and training of new employees, and performs personnel related functions for supervised employees, including regular performance reviews and initiating promotions, transfers, terminations and salary recommendations
Performs ergonomics inspections and company car inspections
Makes decisions regarding files that should be briefed, transfer of files to subrogation status, salvage matters, and recommending reserves for pending claims
Identifies cases which may involve fraud or other abuses and makes appropriate referrals
Prepares for, and gives deposition and/or testimony in litigated claims as required
Serves as member of Claims Committee to make joint decisions on claims beyond individual scope of authority
Makes periodic field trips to work with adjusters or visit agents
May act as replacement for Branch Claims Manager upon request when Manager is not available
Serves as instructor in Home Office and field Claims Seminars and training schools
Performs other duties as requested by the Branch Claims Manager
Superior leadership and communication skills, both orally and written are required
Ability to comprehend and apply insurance policies, claims laws and management reports is required
Thorough knowledge of insurance claims operations, and specifically of Shelter's policies and claims procedures is strongly preferred
Works under the general supervision of the Branch Claims Manager, and is accountable for training, supervising and assisting assigned personnel in claims handling procedures to ensure accuracy and adherence to established procedures and policy provisions according to legal and contractual obligations
Allocates work loads, reassign claims, negotiates and settles claims within defined dollar limits, and institutes administrative procedural changes as appropriate
May be responsible for oversight of Automobile Direct Repair program, Priority Tow program, drive-in claims operation, or catastrophe losses as a storm captain
Responsible for maintaining safety awareness for unit or department, including addressing ergonomic issues and other matters involving overall safety of employees' work areas

RCM Claims Supervisor Resume Examples & Samples

Perform supervisor-level administrative and operational management for EPIC HB claims RCM department
Provide administrative and operational management
Team-building. Supervises staff of functional areas within department, delegate as appropriate. Builds and empowers teams within RCM department. Ensure collaboration throughout RCM
Policies and procedures. Assist in the design, implementation, maintenance and monitoring of policies, standard operating procedures and processes. Assist in compliance and regulatory efforts, and monitor to ensure compliance
Department operations. Assist in developing operations plans that support RCM, Finance and HCMC strategic plan and business objectives with input from Manager; assist in setting department direction and priorities, provide oversight and monitor day-to-day office operations
Job descriptions. Assist in the design, implementation, and monitoring of job descriptions within department. Clarify roles and responsibilities
Staffing. Assist in the development of staffing requirements, recruit and hire with HCMC HR, comply with HCMC rules and procedures in recruiting, hiring, selection, offers of employment, etc. Understand union contracts and which employees are in which contract
Training. Assist in the development of orientation, initial and on-going training standards, and staff development. Ensure compliance with new employee and annual mandatory training
Performance management. Manage performance of direct reports. Build competencies of staff through training and providing resources and facilitating individual development plans. Ensure staff are given feedback on a regular basis; actively coach and counsel employees and set performance improvement goals; conduct performance evaluations in timely manner using appropriate feedback mechanism. Handles conflicts early on and in a collaborative manner. Department performance. Understand, assist in defining and utilize standards for department performance (including productivity, financial, customer satisfaction, employee engagement, etc.), communicate across service areas, build employee commitment, set accountability, evaluate and report department performance against those standards, and take appropriate actions to ensure performance
Assist in providing subject matter expertise on technical and compliance areas that impact claims processing including HCMC processes, EPIC HB system, and payor requirements. Maintain certification or proficiency in EPIC Resolute Hospital Billing Insurance Follow-Up
Assist in developing budgets for department in conjunction with Manager. Allocate and monitors FTE’s and utilizes staff and other resources efficiently and effectively within own department and collaboratively across RCM. Assist in monthly operating review and interpreting monthly financial statements. Takes appropriate corrective action in response to variances and trends. Recommend purchasing equipment or services to provide necessary tools
Practices LEAN and continuously analyze data and feedback for trends, reasons, system issues to identify performance improvement initiatives. Leads employees to follow a systematic improvement process. Create an environment where staff and customers can bring problems or issues. Identify barriers and solutions, initiate and facilitate problem-solving. Project leader as assigned by Manager. Uses good project planning processes, templates, etc. Updates to Manager on progress to include a communication plan. Develop cross-functional relationships. Work in collaboration with clinical, E.H.R and other leaders in 6
RCM strategies, coordinate efforts with other leaders around infrastructure planning, procedures, issue resolution and improvements. Communicate RCM information to all areas on a regular basis with the result of excellent customer service
Bachelor’s degree in Business, Finance, Health Care Administration, or related field or approved equivalent education/experience
A minimum of two (2) years of experience in supervising insurance claims billing and follow-up in an inpatient healthcare setting
Excellent problem-solving & communication skills (verbal & written)
Knowledge of EPIC claims processing systems and electronic health records
Ability to coach, train, and develop others
Adaptable to changing priorities, tasks, and work schedules to meet department standards
Knowledge of the quality improvement processes
Ability to effectively involve department staff in the application of quality measurement and improvement tools
Demonstrated ability to quickly learn new technologies and systems and provide instruction on complex processes
Ability to appropriately prioritize and carry-out work
Certification in EPIC Resolute Hospital Billing Insurance Follow-Up preferred

Claims Supervisor Resume Examples & Samples

Enhance communication via effective team meetings, huddles, and employee one on ones
Identify trends and partner with Support team and Management to make recommendation and improve operational performance
Manage special projects
Meet deadlines and turnaround times set by management (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both)
Supervise and monitor ongoing performance of team members. Continually examine team performance against department standards. This includes timely employee feedback via employee scorecards
Work in conjunction with other Supervisors to allocate and adjust team resources as daily needs required
Minimum 3 years of health insurance experience preferred
Working knowledge regarding Coordination of Benefits
Ability to handle multiple priorities in a fast-paced production environment
Some travel may be required. Must be able to serve as a positive extension of the management team
Previous Commercial, Medicaid, or Medicare insurance related experiences is highly preferred

Subrogation Claims Supervisor Resume Examples & Samples

Assigns new subrogation claims to unit members based on complexity and skill set of staff
Oversees the handling of all aspects of the subrogation portion of claims assigned to the unit including communication, documentation, litigation management, evaluation, and lien resolution
Ensures subrogation efforts are consistent with applicable policies, procedures and department guidelines
Reviews issues and complaints that Adjusters are unable to resolve and prepares formal response to consumer complaints
Analyzes and approves lien resolution above the subrogation analyst authority and prepares claim for review when lien resolution is above the supervisor’s personal authority
Completes special projects as assigned
Other tasks as assigned by Cost Containment Manager or other AmTrust Senior Claims Management. Job Qualifications
Leadership skills; ability to plan, organize, delegate and develop corporate human resources
Sound command of the English language and ability to operate business technology
Experience with Intercompany Arbitration is preferred

WC Claims Supervisor Resume Examples & Samples

May oversee the handling of all aspects of the claims assigned to the unit including reserving, communication, documentation, evaluation, negotiation and settlement
Ensures all claims eligible or ineligible for payment conform to quality, production standards, and specifications
Analyzes and approves workers compensation claims Completes regular quality audits of staffs work, records results and counsels staff to bring work to or above standards
Prepares regular periodic reports and monitors system reports to ensure adherence to corporate and regulatory standards
Establishes and executes controls to assure that the quality of the work meets or exceeds standards
Reviews and analyzes processes, procedures, and workflows to identify opportunities for process improvement and efficiency
10+ years’ experience in workers compensation insurance industry
Valid adjusters license in appropriate jurisdictions or ability to obtain such
Leadership skills: ability to plan, organize, delegate, and develop corporate human resources
Ability to work with little supervision and direction

GL Claims Supervisor Resume Examples & Samples

Assigns new claims to unit members based on complexity and skill set of staff
Ensures all claims eligible or ineligible for payment conform to quality, production standards and specifications
Analyzes and approves insurance claims
Assures that all customers receive quality service
Other tasks as assigned by Claim Manager/Assistant Vice President/Vice President
May recruit, hire and recommend or initiate promotions, transfers and disciplinary action
Valid adjuster’s license in appropriate jurisdictions or ability to obtain such, if required by subordinate position duties
Ability to operate business technology

Total Loss Claims Supervisor Resume Examples & Samples

Responsible for overseeing Total Loss/Theft/Fire claims in all territories; monitors and adjusts performance criteria for Direct Tow, Total Loss, and Theft adjusters; ensures department goals and objectives are met; directs continuous process improvement effort within unit with an ongoing focus of improving customer service and delivery
Communicates and enforces administrative policies, operating procedures and safety rules, communicates changes in policy and procedures, ensures compliance of company procedures and DOI regulations, monitors workload distribution for staff, arranges and conducts meetings as required for the efficient operation of the department, participates in team meetings when needed, monitors customer service levels in department and ensures ongoing service quality improvement at every level. Responsible for insuring DOI and Customer complaints are resolved in a timely manner
Monitors goals and targets for employees in support of Total Loss department strategy
Sets and monitors required goals and targets for the staff in support of the Enterprise, Divisional and department strategy
Ensures consistent and high quality service levels; consistent ongoing monitoring of customer service levels and service quality improvement
Oversees the investigation
Processing and conclusion of all claims
Oversees the use of internal and external resources to effectively manage costs
Responsible for human resources functions to include recruiting and interviewing prospective employees, conducting performance appraisals, recommending salary actions including promotions and terminations, and administering disciplinary procedures in conjunction with management, recognizes employee’s achievements and counsels employees on performance issues, promotes growth and development of staff thorough coaching and mentoring, provides feedback and guidance to staff relative to productivity, responsiveness and customer satisfaction, coordinates training needs of employees and ensures employees receive training relevant to their job duties and with a focus on achieving superior customer relations
Participates in Personnel activities in cooperation with the Manager and Human Resources
Communicates and enforces administrative policies and operating procedures
Communicates changes in policy and procedures
Responsible for conducting performance appraisals and recommending salary actions including promotions and terminations
Recognizes employee achievement and counsels employee on performance issues
Trains, coaches, mentors employees for their individual career development
5+ years Claims experience

Cs-claims Supervisor Resume Examples & Samples

Intermediate level of working knowledge of GAAP; ability to effectively use accounting knowledge to collaborate with varying levels of employees and senior management to drive sound business decisions
Excellent process management and improvement skills
Excellent communication and organizational skills
Strong analytical skills and process improvement/automation focus

General Liability Claims Supervisor Resume Examples & Samples

Reviews appeals and complaints that Adjusters are unable to resolve and prepares formal response to consumer complaints
Analyzes and approves insurance claim payment
Provides file authority as appropriate to unit staff

Claims Supervisor Resume Examples & Samples

Associate's degree in business or related discipline, may be substituted for directly related work experience
Minimum 5 years experience within a customer, claims, or similar industry
Ability to communicate and motivate a team
Valid driver's license and access to reliable transportation

Commerical Claims Supervisor Resume Examples & Samples

Prior Leadership experience required
Claims handling in multiple states required
Litigation- preferred

Claims Supervisor Resume Examples & Samples

Provide technical assistance and customer service to clients
Prepare reports and conduct data analysis for client meetings and presentations
Analyze and identify trends and provide reports as necessary
Respond to claim appeals
Resolve or address new or unusual claims errors/issues as they arise, applying appropriate knowledge or prior experience
Identify and resolve claims processing errors/issues and trends, as needed
Communicate and collaborate with external stakeholders and/or internal business partners to resolve claims errors/issues
Serve as day to day contact with internal claim system technical team
Coordinate business requirements with technical team
Support claims system management, change requests, testing and upgrades
Organize and track key information and documents
Use appropriate systems/platforms/applications to process claims
Apply knowledge of applicable laws, X-12 formats, regulations and compliance requirements to ensure that claims are processed properly (e.g.,HIPAA, state-specific regulations/grievance procedures)
Knowledge of electronic (X-12) and paper (1500s) claims processing
Full understanding of all claim types and the respective processing - originals, resubmissions, voids, etc
Use appropriate documentation, reference materials and/or websites to ensure that claims are processed accurately and efficiently
Collaborate with business partners to help address identified issues related to claims processes and procedures (e.g., Legal, Compliance)
Identify/develop/implement new claims processes procedures/solutions as needed, and document appropriately for future use
Identify and communicate opportunities to improve claims processing efficiency and reduce rework
Supervise, monitor, track and direct day to day operations staff
Provide advice/consulting/direction/support to colleagues as needed to enhance their ability to process claims accurately
Collaborate with operational partners to help improve claims processing workflows, efficiencies, etc
Oversee annual internal reviews of claiming operations as part of an on-going quality control process
Design of various standard reports including operations, trend analysis, revenue maximization and other reports
Minimal travel may be required
Knowledge of claims life cycle, medical terminology, CPT, and ICD-9/ICD-10 required
Strong math and analytical skills, including the ability to analyze and organize data
Excellent ability to build and maintain business relationships with clients by providing prompt and accurate service
Excellent organizational, oral presentation and written communication skills
Proficiency in MS Office products, including PowerPoint, Excel and Word
Strong aptitude for learning new technology applications
Proven ability to lead team members in a positive and productive manner
A Bachelor's Degree or Medical Billing Certificate preferred
5+ years' experience with medical billing and claiming
Medical claims adjudication experience
TPA experience preferred
3+ years Claims supervisor experience

Casualty Claims Supervisor Resume Examples & Samples

Ensures claim processing is consistent with applicable policies, procedures and department guidelines
Supervises maintenance of all claim records
Completes regular quality audits of staff’s work, records results and counsels staff to bring work to or above standards
Reviews and analyzes processes, procedures and workflows to identify opportunities for process improvement and efficiency
Manages personnel administration including employee evaluations and salary administration
Thorough understanding of laws, principles of coverage, liability and insurance industry in general
Ability to carry out detailed written and verbal instructions
College degree or 7 years equivalent experience and skills required
Valid adjuster’s license in appropriate jurisdictions or ability to obtain such, if required by subordinate position

Claims Supervisor Resume Examples & Samples

The Benefits and Claims Management unit aims to safeguard the Funds and Investment of our policyholders and shareholders by paying legitimate and meritorious benefits in a timely and accurate manner, in fulfillment of a promise embodied in the Policy Contract. The Senior Claims Assistant reports to the Claims Supervisor/Senior Supervisor/Assistant Manager/Head of Claims
This position provides administrative support to achieve the department’s goal of accurate, timely and efficient settlement of death benefits to claimants
Handles different claims transactions such as death claim, living benefits, maturities and annuities’ processing. Coordinates with Finance to ensure that the benefits are processed and released within the set TAT
Provide timely service, which ensures prompt and fair settlement of claims in accordance with the company policies and guidelines. Analyzes, verifies completeness and authenticity of submitted claim documents and provide immediate feedback to clients regarding outstanding requirements. Evaluates and computes benefit of each beneficiary and make sure that payment of benefits is accurate and released to the rightful claimant
Maintain proper files and documentation of all claims transactions. Ensure all records and monitoring system are regularly updated and completed transactions are submitted for scanning. Proper posting of accounts including monitoring and prompt investigation of un-reconciled entries
Compliance to legal and regulatory requirements, claims authority and standard operating procedures and Finance disbursement requirements in processing claims transactions
Interact with clients/co-employees and distributors to provide immediate feedback regarding products or services and ensure that complaints are investigated and given proper handling
Prepares weekly and monthly reports for submission to Actuarial, Finance and Products
Monitors and follow-up submission of signed Release Waiver & Quitclaim form

Recovery Claims Supervisor Resume Examples & Samples

Ensures all subrogation claims conform to quality, production standards and specifications
Other tasks as assigned by Cost Containment Manager or other AmTrust Senior Claims Management
8 years experience in Property and Casualty Claims or Workers’ Compensation Claims
Specific prior experience in a dedicated subrogation unit is preferred

Claims Supervisor Resume Examples & Samples

Oversee the daily activities of the claims processors and their assignment of work, processors productivity, inventory reports, cost containment, and quality measures
Ensure departmental quality standards, goals, and objectives are met and/or exceeded
Initiate one on one’s with direct reports and review monthly quality audit and production results
Ensure departmental productivity standards, goals, and objects are met and/or exceeded
Managed the claims processing functions to ensure accurate and timely payment of claims
Develop good working relationships and workflows with other operational departments that impact claims processing
Reviews job performance, and provides direct feedback related to performance and success for each direct report
Responsible for the monitoring of attendance, time sheets, and payroll
Ability to work well under pressure and manage conflict in an effective and positive manner
Conduct weekly team meetings with staff
Develop, educate, and train the staff on policies and procedures. Identify and create written processing guidelines and SOP’s
Identifies system deficiencies and works with internal partners to correct
Works closely with the Manager of Claims on special projects or priority cases. Will be accountable for timely response and resolution of those cases
Working knowledge of Procedure Codes (e.g. CPT) Diagnosis Code (ICD-9), and DRG Pricing
Interpret and apply all applicable processing policy, procedures, and guidelines
A minimum of 1-3 years’ experience as a lead or supervisor in a claims department with a proven track record of maintaining compliance, high quality results, and ability to build effective working relationships is preferred
Must have working knowledge of all product lines, which include: Medicaid, Medicare, and Commercial
Must have working knowledge of medical terminology, claims processing procedures/guidelines, claims quality, and customer service experience
Further requirements include: excellent verbal & written communication skills a must. Must be proficient in Excel, Word Perfect, and Windows
Ability to read and interpret documents and systems files such as; Policy and Procedure Manuals and Guidelines, Contracts, Charts and Grids, and Benefits
Ability to speak effectively before groups, customers and other employees within the organization
Excellent verbal and written communication skills at all level of the organization
Apply knowledge and skills to provide superior customer service
Ability to multi task and utilize multiple computer screens
Ability to actively listen and resolve problems

Claims Supervisor Resume Examples & Samples

High School Diploma / GED (or higher)
2+ years of experience in a supervisory role or leadership position
Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
Moderate proficiency with Microsoft Word (create and edit), Microsoft Excel (formulas, filter, create and edit, and pivot tables), and Microsoft Outlook (create and edit emails, manage calendar, with meeting invites - be able to create and accept)
Ability to work from 8:00 am - 4:30 pm Monday through Friday with weekends or overtime as needed
Undergraduate Degree (or higher)

Claims Supervisor Resume Examples & Samples

Keeping professional knowledge permanently up to date in order to anticipate what is coming and to evolve in line with company growth and expectations of clients
Follow-up on trends in the health care market
Fluent level of English and Spanish. A third language would be desirable
Team management experience in operations
Used to work with KPIs and strong focus on productivity
At least 5 years of relevant work experience
Solid knowledge of administrative processes and customer services
Advanced knowledge of Microsoft office - and own IT- applications

Claims Supervisor Resume Examples & Samples

Oversee day-to-day activities of the Claims Department and other Reimbursement Services areas/functions
Meet with Director on a regular basis to assess departmental operation and activities
Resolve staff issues related to the operation, claims system or specific claim
Achieve financial objectives
Communicate job expectations to staff
Plan, assign, monitor, and appraise employee’s job results
Develop, implement, and enforce policies and procedures
Maintain, train, orient, mentor and evaluate staff
Set example of proper behavior and accountability to employees and serve as a role model for what is expected of a Health Choice employee
Claims are processed within the allotted time frame provided by regulatory agencies
Staff is maintained at an adequate level
Policies and procedures are updated annually (more often if necessary)
Employee issues (performance, behavior, compliance with policies, etc) are addressed timely and appropriately in accordance with company policies
Claims are paid in accordance with contractual guidelines, Health Choice Arizona policy and procedure, provider contract rates, and contracted fee for service
Benchmarks are achieved or exceeded, ensuring compliance with standards and guidelines
Staff is kept updated regarding changing information
Requests are appropriately evaluated as needed
Staff is kept up-to-date regarding system updates and new processes
IS and Claims work together toward mutual goals
Demonstrated leadership qualities build cohesiveness within the department, and increases effectiveness and efficiency throughout the department
At least two (2) years supervisory experience, preferred
At least two (2) years claim processing experience in HCFA 1500s and UB92s or Medical Claims Billing, preferred
At least one (1) year computer/data entry or 10 key by touch

Asst Claims Supervisor Resume Examples & Samples

Negotiates settlement of claims within designated authority
Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy through the life of the claim
Calculates and pays benefits due; approves and makes timely claim payments and adjustments; settles claims within designated authority level
Prepares necessary state filings within statutory limits
Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients
Manages claim recoveries, including but not limited to subrogation, Second Injury Fund excess recoveries and Social Security and Medicare offsets
Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner
Leads team meetings and assigns accountability for follow-up items
Gathers important compliance/claims processing information to be presented at team meetings
Assists in interviews of adjusters, clerical staff and provides feedback to hiring manager
Excellent oral and written communication, including presentation skills

Claims Supervisor Resume Examples & Samples

Coordinating daily activities of claim team
Ensuring performance guarantees and service goals are maintained
Providing expertise or general claims support to team in reviewing, researching, investigating, negotiating, processing and adjusting claims
Authorizing the appropriate payment
Determining appropriate course of action
Identifying and analyzing trends
2+ years of coaching / mentoring, supervisory, or leadership experience
Intermediate proficiency in Microsoft Word (creating documents, editing, and merging data) and Microsoft Excel (creating spreadsheets, editing, pivot tables, and vlookups)
Bachelor's Degree (or higher)
1+ years of customer service experience
Medicare insurance experience
Medical insurance claims or medical billing experience
Experience working with senior population

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