Claims Support Resume Samples

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Guide the recruiter to the conclusion that you are the best candidate for the claims support 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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H Skiles

Hildegard

Skiles

8473 Maggio Via

New York

+1 (555) 195 2371

8473 Maggio Via

New York

Phone

p +1 (555) 195 2371

Experience Experience

New York, NY

Claims Support Specialist

New York, NY

Koelpin, Ferry and Johnston

New York, NY

Claims Support Specialist

Performing support functions including email, calendar management, and word processing with a strong emphasis in excel
Works on simple tasks using established procedures
Contacting or receiving communication from customers or additional claim related third parties to obtain and/or provide necessary claim information
Work is typically reviewed by others
Processing total loss claim files and payments
Complying with quality and process standards
Retrieving, prints, faxes, or mail supporting documentation to vendors or others as directed

San Francisco, CA

STD Claims Support Specialist

San Francisco, CA

O'Conner, Rolfson and Klein

San Francisco, CA

STD Claims Support Specialist

Provides feedback to unit managers on individuals' performance
Partners with the STD Unit Leader to analyze, identify and implement strategies to enhance claim management, customer centricity and efficiency of their team while monitoring strategy effectiveness
Expertise knowledge of system and tools, ie…MDG, DPA, Intellis and how to leverage tools to improve claim management effectiveness
Provides candid and specific feedback to team members in order to support their growth and development
Coaches, coordinates, and develops claims specialists
Conducts weekly quality audits; assists with training; resolves escalated phone calls
Basic knowledge of medical conditions, treatments, prognosis

present

Boston, MA

Senior Claims Support Coordinator

Boston, MA

Veum, Lowe and Feest

present

Boston, MA

Senior Claims Support Coordinator

present

Working with other team members to coordinate the management of the shared email box
Monitor claims within a workflow system
Determines claim eligibility based on established criteria. Administration of all waiver claims, determining eligibility for continued benefits and offering conversion options for clients whose benefits are reducing or terminating
Maintain excellent working relationships
Responsible for performing all tasks within department quality and service level agreement standards
Other duties as assigned
Microsoft Office Suite

Education Education

Associate’s Degree in Business

Drexel University

Associate’s Degree in Business

Skills Skills

3 to 5 years of claims or related administrative experience
Proven customer service and follow up skills
Intermediate to advanced computer skills (Word, Excel, Claims Station)
Strong written and verbal communication skills
Attention to detail
Strong organizational skills
Ability to work independently or in a team
Gainshare bonus of up to 16% of salary (Our annual Gainshare bonus program rewards employees based on the company's achievement of annual performance objectives)
Ongoing training, tuition assistance and opportunities for career advancement
Award winning, supportive environment including Employee Resource Groups

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13 Claims Support resume templates

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Advertising Claims Support Manager Resume Examples & Samples

Bachelor's Degree (or equivalent life experience)
5+ years in fields related to advertising, marketing (CPG or Pharma), regulatory or R&D
Excellent teamwork and problem-solving skills
Proficiency in Microsoft Office programs
Strong time management and task prioritization skills
Strong analytical/quantitative skills
Ability to work in a dynamic, fast-paced environment

Senior Claims Support Service Specialist Resume Examples & Samples

Receives, screens and routes incoming telephone calls and other electronic correspondence
Generates and sends appropriate forms to insured/claimant for completion
High School Diploma/General Education Diploma (GED) required
One year of customer service experience in an office environment
Experience with data entry on a 10 key pad preferred

Claims Support Specialist Resume Examples & Samples

Retrieving, prints, faxes, or mail supporting documentation to vendors or others as directed
Contacting or receiving communication from customers or additional claim related third parties to obtain and/or provide necessary claim information
Complying with quality and process standards
High School Diploma or Associate’s degree
Prior customer service experience in an office environment
Good organization skills with timely follow-up skills

Claims Support Specialist Resume Examples & Samples

Sort and file prescriptions/patient demographic forms (may include lifting up to 30 lbs.)
Locate and retrieve prescriptions/patient demographic forms when requested
Label older prescription file boxes for off site storage
Cross train and work in all processes when needed
Repetitive movements including: sit, stand kneel, reach, and climb ladder
Service center environment with Representatives, computers, printers, floor activity
Ability to stay organized, focused and prioritize in order to complete tasks Limited work experience
Works on simple tasks using established procedures
Depends on others for guidance
Experience in a support role in either an office environment or a service center environment
Experience with computers and Windows PC applications (this includes the ability to learn new and complex computer system applications)
Experience in a Medical Office
Experience in the Healthcare Industry

Claims Support Associate Resume Examples & Samples

High School Diploma/General Education Diploma (GED), plus one year of customer service experience in an office environment
Excellent customer service skills and a passion to help others
Strong computer, typing and grammar skills - Microsoft Office

Claims Support Associate Resume Examples & Samples

Retrieves, prints and faxes, or mails supporting documentation to vendors or others as directed
Process, sort, index and route incoming and outgoing communications related to claim operations
Receive, screen and route telephone calls and other electronic correspondence
Maintain internal and external customer relationships and deliver outstanding customer service
Strong computer, typing and grammar skills

Associate, Claims Support Resume Examples & Samples

Analyzes and processes claims by investigating, gathering and obtaining information to make basic claim determinations
Analyzes claimants coverage contracts to determine basic payment eligibility is met
Collaborates with appropriate internal stakeholders to determine basic claim eligibility
Conducts basic interviews with external stakeholders (e.g. physicians, claimants, and/or lawyers)
Evaluates and makes recommendations regarding basic claim eligibility determinations to management
Makes claim determinations for his /her assigned claims
Reviews and provides assessments to facilitate settlement of claims up to designated authority level and makes claims payments
Interpret a variety of policy provisions and apply the interpretations to complex claim situations, which require a broad understanding of insurance products as well as other insurance functions outside the Claims department
0 - 1+ Years Experience in claims that directly aligns with the specific responsibilities for this position(Required)
2-3 Years Long Term Care claims 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 Support & Process Consultant Resume Examples & Samples

Bachelor's Degree or Finance, Mathematics, Industrial Engineering or related field
Experience in data acquisition and manipulation applications (MS Access, Business Objects, Excel)
Experience organizing hypotheses, results and analysis into an effective communication package (PowerPoint, Tableau)
Ability to thrive in both structured and project-oriented work environments
Prior experience or knowledge in 1st Party medical claim handling a plus

STD Claims Support Specialist Resume Examples & Samples

Coaches, coordinates, and develops claims specialists
Acts as resources for claim-related and technical issues
Monitors case managers' work queues to ensure claims team is meeting expectations and applicable performance guarantees
Conducts weekly quality audits; assists with training; resolves escalated phone calls
Provides feedback to unit managers on individuals' performance
3+ years insurance claims experience

Dir, Claims Support Resume Examples & Samples

Responsible for the day to day operations of the department including the establishment of acceptable performance standards to ensure compliance and regulatory requirements are achieved
Assure performance standards are achieved by daily monitoring of inventory, conducting quality audits of the team’s work product and surveying customer’s as appropriate
Produce trending and analysis reporting of the team’s performance as requested
Participate in the implementation of claim operational strategies, policies, workflow processes and standards. Ensure effective utilization of these strategies and policies
Seek out and propose more cost efficient means to support the claims department within the scope of these administrative services
Responsible for the training, supervision and performance of the associates supporting the administrative functions of the department
Support sales in the training of claim processes
Manage vendor relationship supporting financial transactions post claim decisions
5-7 years of management responsibility within a customer service focused organization
3 - 5 years experience in process flow re-engineering and optimization (people, process and systems)
Understand greater vision for the company, and is able to translate changes in business environment to opportunities outside of the department for overall organizational effectiveness
Able to promote a culture of performance, teamwork, customer focus and integrity
Has full managerial and staffing responsibilities for area
Communicates and interfaces with all levels of management
Develops and maintains close agent and customer ties, articulates customer needs, keeps priorities in focus with the desires and expectations of the customer
Experience in analyzing trends; developing and interpreting reports; and designing solutions to operational challenges is required

Administrative Claims Support Specialist Resume Examples & Samples

2+ years of administrative - clerical support experience
Professional communication skills with speaking ability to be clear and patient while providing phone support
Good business judgment and professional demeanor
Commitment to providing excellent customer service support
Proven ability to work with sensitive information and deadlines
Strong proficiency with Microsoft Office software, specifically strong tying and data entry skills

Offshore Claims Support Manager Resume Examples & Samples

Assist the Offshore Manager with performance management utilising valid MI to identify opportunities for improvement to contribute to the profitability of Direct Line Group
Support the optimising of performance within the offshore operation across multiple sites 400+ Fte ensuring service standards are met in line with the resource/capacity plans
Develop in depth knowledge of offshore governance, supporting the Offshore Manager to ensure adherence to process and procedure across multiple Claims processes including Customer Voice & back office activity
Support the Offshore Manager with engaging with all key stakeholders for offshore projects across both DLG & strategic out-source partner
Collaborate with Offshore Manager and UK stakeholders to identify off shoring opportunities
Act as a Deputy to the Offshore Manager as and when required
Have an in depth knowledge of Quality Assurance Testing ensuring controls are fit for offshore environment and align 1LOD governance
Demonstrable offshore and/or Customer operations experience
Effective stakeholder management skills
Ability to embrace and drive change
Commercial acumen
A diverse outlook, in line with the DLG Values and organisational culture
Flexibility in your approach and demonstrate and maintain a high level of professionalism at all times
A customer centric approach
Attractive holiday entitlement
Free Travel insurance

Claims Support Coordinator Resume Examples & Samples

High school degree, 1-2 years of secondary education is preferred
Microsoft Office Suite – {Excel – Advanced (Stop Loss)}
Ability to multi-task and prioritize workload in a workflow environment
Critical Thinking: Thoughtful process of analyzing data and problem solving data to reach a well-reasoned solution

Claims Support Analyst Resume Examples & Samples

Index claims related documents for various lines of businesses
Create first notice of loss & setup incident only claims in our claims systems
Reconcile coinsurance bordereau and enter payments/reserves in our claims systems
Work together with onshore teams to resolve complex scenarios and ask for additional information when needed
Maintain proper documentation of all the procedures and updates
Be part of the process meetings and participate in monthly/quarterly audio & video conference calls
Make sure to achieve service level agreements and meet set quality standards at all times
Proven experience in insurance industry preferably in (re)insurance claims area (ability to read and interpret insurance data) will be an asset
Excellent data processing skills
Fluent English and German, both spoken and written are a must
Inquisitive mind with strong analytical thinking skills
Excellent people skills; communicative and open to new challenges

Administrative Claims Support Resume Examples & Samples

2+ years administrative or clerical support experience - desired
Ability to type and enter data with accuracy and proficient with MS Office
Understanding and ability to work with confidential information with accuracy
Commitment and interest in learning new skills and contributing to company success

Senior Claims Support Coordinator Resume Examples & Samples

New claim setup , correspondence , and coverage eligibility
Analyze and determine claims eligibility meeting compliance requirements
Generate internal and external customer correspondence
Monitor claims within a workflow system
Maintain excellent working relationships
Participate in problem solving activities in a team environment
1+ years insurance experience
Proven analytical and problem solving skills and attention to detail
Excellent Data Entry skills maintaining top quality
High level of compassion and commitment to customer service

Claims Support Frontline Leader Resume Examples & Samples

Provide guidance and leadership to associates and serve as a mentor for their day-to-day activities
Identify reasons for variation in individual performance and take appropriate actions that will result in improved production and quality performance
Analyze data to guarantee key performance measures are met, while aiding in the removal of barriers to success of organizational goals
Conduct deeper dives into what is causing claims rework
Review projects and tasks submitted and identify gaps and opportunities
Conduct meetings with Network or other departments to present findings with recommendations
Maintain proactive communication and collaboration with other departments to ensure efficient, accurate and timely responses to internal/external customer needs
Ensure timely trainings on errors identified from internal or external customers with hands on experience to support team success
Accountable for managing workflows, policies, and inventory meeting all Service level agreements (SLAs)
Two years of previous leadership experience
Experience managing 7 or more associates
Must have two years of medical claims experience in a production based environment
Intermediate in Microsoft Office Programs Word and Excel
Ability to build and run complex queries in Microsoft Access or SQL
Knowledge of PowerPoint
Prior work experience in an operational setting

Manager, Claims Support Resume Examples & Samples

Minimum 3-5 years experience in Managed Care claims payment in IPA, Medical Group, MSO or health plan setting
Comprehensive knowledge of CPT, ICD-10, inpatient procedure coding, HCPCS, Revenue Codes, medical terminology and COB Required
Comprehensive knowledge of various fee schedule for professional, facility, and ancillary claims—CMS pricers, DRG, APC, ASC, SNF-RUG and other CMS fee schedules
Knowledge of enrollment and eligibility processes and requirements
Working knowledge of Claims information systems
Microsoft Excel, Work, and Access skills
Detail oriented with excellent verbal and written communication skills
Demonstrated effective communication, interpersonal, and organization skills
Ability to plan and identify opportunity to effectively utilize resources

Claims Support Specialist Resume Examples & Samples

Three or more years HMO claims and Claims Correspondence processing experience required in a managed care environment, preferably PMG/IPA setting within the last three years or any combination of education and/or experience which produces an equivalency
Knowledge of medical terminology and coding
Familiar with CMS and Department of Managed Care mandates
Ability to type 35 WPM uses a ten‑key adding machine, perform data entry and make mathematical calculations
Effective communication and follow-through skills
Spanish bilingual

Claims Support Unit Team Leader Resume Examples & Samples

Meet department targets, objectives and SLA’s through managing department workloads. Complete allocation by 4pm
To assist and work collaboratively with the wider leadership group regarding ad-hoc requests as required
To ensure suitable and sufficient cover by team is in place in the event of absence
Manage work queues, ensuring effective processes and controls are in place that will deliver a consistent, high quality claims to a handler
Review distribution of Rebalancing work queues daily
Ensure personal and team compliance with the provisions of CSU Best Practice
Building & implementing training programs and ensure all staff have sufficient knowledge of all processes
Understanding of MI to ensure effective reporting and production of CSU specific data to support management of the team and allocation across BI Pro-Active
Proactively identifying trends and using relevant data / information to understand emerging issues
People management of team, specifically conducting one to ones and monitoring and assessing team performance
Role modelling, through positive behaviours,
Manage pay view hierarchy and cost centre
Escalation for HR issues - Understand and apply the relevant people processes and procedures e.g. disciplinary, absence, timekeeping, dress code and conduct
Ensure active staff records are managed and maintained as well as carrying out quarterly & annual reviews and agreeing training and development plans
Deal sensitively with highly confidential information
Unlocking the full potential of your people through engagement, identifying and arranging learning and development, coaching, feedback , both individually and collectively
Resource plan department recruitment needs
Manage workday account as required in terms of business requirements
To possess sound working knowledge of MOJ Portal, and claims handling and Best Practice processes
Develop self in order to maximise personal contribution to your role. Possess a sound working knowledge of MOJ Portal, claims handling process and Litigation process. Keep an up to date comprehensive business rules document relating to workload management for the entire BI function

Claims Support Analyst Resume Examples & Samples

Have excellent communication, grammatical, research and analytical skills
Exhibit attention to detail
Have ability to solve problems logically and creatively
Learn complex procedures quickly and adapt to new/changed procedures with ease
Establish and maintain effective working relationships with co-workers, company personnel, and the general public
Type at least 40 words per minute with a high degree of accuracy
Proficient computer experience in PC, Windows, Excel, Access and Word
At least two (2) year’s experience working in an office environment; OR Any equivalent combination of experience and training that provides the required knowledge, skills and abilities

Receptionist Claims Support Resume Examples & Samples

High school diploma (or equivalent)
Knowledge of medical terminology, CPT coding and physician reimbursement methodologies such as RBRVS
Strong computer experience (minimum 1 year experience with EZ-Cap preferred)
Experience with computer programs (Windows, Word, Excel, Mail Merge, Fax Blast, PowerPoint)
Excellent communication and assessment skills
Willingness to learn new tasks

LTD Claims Support Specialist Resume Examples & Samples

Provides coaching, mentoring, and direction to associates
Identifies issues and works with associates to increase individual and organizational capabilities
Works in tandem with Unit Leader to resolve all claimant escalations
Performs EA and Claim reviews on decisional and financial elements as needed
Provides real-time coaching to ensure associates are making the right decision in a timely manner supported by proper documentation and with effective communication
Identifies performance issues and/or trends and provides Unit Leader with feedback on individual’s progress, performance and opportunities
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
Resource for implementation of new accounts from a technical and process perspective, as needed
Partners with Learning & Development and Documentation team on work instruction and office training as deemed appropriate
Embraces and promotes change initiatives within team and office-wide
Performs other related duties as assigned or required
5+ years Disability claims and/or clinical experience
Must be able to communicate clearly and effectively, both written and verbal

STD Claims Support Specialist Resume Examples & Samples

Partners with the STD Unit Leader to analyze, identify and implement strategies to enhance claim management, customer centricity and efficiency of their team while monitoring strategy effectiveness
Drives Claim Management Accuracy and Customer Centricity through the QQA program by auditing claim file reviews including monthly call monitoring for Claims Specialist to identify improvement opportunities, skillset gaps, trends for quality, service and/or compliance
Fully engages in customer focused training; model learned behaviors
Supports and guides assigned team member(s) to ensure that they have the knowledge, skills, tools, and resources to be successful in achieving expectations
Supports team to meet or exceed regulatory and compliance requirements, and performance guarantee commitments
Coaches and mentors new hires to enhance their skills, knowledge, and effectiveness as Claim Specialists. Assesses new hire readiness or independent work
Reviews and approves key decisions made by team member(s) within authority limit
Assesses and provides information, trends, and observed behaviors of assigned team members to the STD Unit Leader. Partners with the STD Unit Leader as appropriate to enhance the performance of those team members
Identifies and facilitates claim discussions on highly complex claims with the appropriate resources including STD Unit Leader, Clinical Resources and Vocational Rehabilitation Consultants
Supports team members to ensure that team members are effectively transitioning claims to LTD (as appropriate)
Mentors team members to ensure they are identifying and facilitating Return to Work opportunities through their own efforts or by engaging the appropriate resources
Provides candid and specific feedback to team members in order to support their growth and development
A comprehensive understanding of the disability contractual provisions, especially the definition of disability
Strong communication skills, including the ability to coach Case Specialist to interview claimants dynamically with the goal of setting claimant expectations and obtaining information necessary to administer the claim
Basic knowledge of medical conditions, treatments, prognosis
Expertise knowledge of system and tools, ie…MDG, DPA, Intellis and how to leverage tools to improve claim management effectiveness
Strong Coaching/Mentoring skills
Ability to give and receive feedback using specific measurements and observed behaviors
Openness to receiving feedback
Strategic-thinking skills
Prioritization skills. Ability to balance quantity and quality
2 - 5 years of insurance claims experience

Claims Support Associate Resume Examples & Samples

This position is part of a job family. Placement will be determined by skills and qualifications of the candidate
Reviews, evaluates, and ensures accuracy of incoming claims by navigating multiple computer systems and platforms for efficiently making claims assignments and reassignments to appropriate units. Completes all data entry required on a daily basis to document and communicate extensively with supervisors and adjusters regarding reporting requirements, adjustments, and reassignment of claim files
Accesses systems (i.e. Siebel Passport, Internet, vendor database) to support general claims processing including: verification of coverage, draft data entry, ordering of claims related reports, and preparing letters, forms, and correspondence required for the claim
Provides administrative assistance to multiple claims departments including the generation of claims support documents, assist with mail and imaging, answers phone calls and emails, backs-up other CSR's during high service times, compiles claims specific data for supervisor reports, and provides back-up assistance during peak periods, storm situations, leaves, etc
At least 1 year of customer service experience in the insurance industry
Excellent oral and written communication skills (including telephone etiquette)
Ability to work with a wide variety of staff, management, claims personnel and external contacts
Good personal computing skills, including basic knowledge of Microsoft Office Word and Excel (or their equivalents)
At least 4 years customer service experience in the insurance industry
Knowledge of property/casualty claims operations and experience working with Claims reporting systems
Can perform Claims Support functions in an independent manner and serve as a resource to others
Demonstrates strong relationship-building skills, initiative, and work prioritization and organizational skills

Temporary No-fault Claims Support Resume Examples & Samples

Promptly and accurately type claims form, file jackets and documents, including timely maintenance of these forms and documents
Data entry, including claims related information for vendors, legal and finance
Photocopy, print and mail correspondence when necessary
Print and distribute diary to examiners
Compiling claims information for statistical purposes
Record and file retrieval
Ability to adapt to new situations and learn quickly
Must perform well in high-energy, dynamic and team-oriented environments
Expected minimum typing speed of 40 words per minute
Proficient in Microsoft Office (Word, Excel, Outlook)
Prior insurance or office support experience

Claims Support Technician Resume Examples & Samples

File Review and Document Redaction; includes printing, mailing and faxing documents
Ordering ISO, Police, Fire, Weather, Duplicate Policies, and Medical Records
Prepare packages for Worker's Compensation Board
Research files provide lists/photocopy of documents, attorney, vendors, etc
Successful candidate will be asked to cross-train in other processes in order to achieve individual goals and organizational needs

Claims Support Resume Examples & Samples

Data entry of claim payments for both Indemnity & ALAE into the appropriate operating system
Filing, scanning and maintaining claim files, mail and mailing records
Collect and distribute fax correspondence
Conform to internal workflow standards
High School Diploma or general education degree (GED)

Senior Claims Support Coordinator Resume Examples & Samples

PC skills, to include word processing
Previous experience with Microsoft Excel and Outlook; to include Pivot Tables and Macros
Previous Insurance experience is highly preferred

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