Supervisor Claims Resume Samples

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R Koch

Ross

Koch

936 Lorenz Corners

Philadelphia

+1 (555) 714 5634

936 Lorenz Corners

Philadelphia

Phone

p +1 (555) 714 5634

Experience Experience

Phoenix, AZ

Supervisor Claims

Phoenix, AZ

Lemke, Ondricka and Swift

Phoenix, AZ

Supervisor Claims

Manage a team or provide guidance in absence of the leader to ensure assignments are completed and performance expectations are achieved
Establish departmental performance standards and coach individual employee performance to meet and exceed production and quality metrics
Conducts data entry and rework; analyzes and identifies trends and provides reports as necessary
Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary
Identify barriers in workflows, P&P's and bring new / fresh ideas to improve procedures
Manage inventory and performance to business metrics
Support team employee engagement and continually working to meet and/or improve vital signs results

Los Angeles, CA

Supervisor, Claims

Los Angeles, CA

Monahan, Conn and Franecki

Los Angeles, CA

Supervisor, Claims

Provide expertise and/or general claims support to teams in reviewing, researching, negotiating, investigating, processing and adjusting claims
Participate in interviewing, hiring, and training of team members
Supports claim processing functions including investigations, payments, research, analysis
Establish, refine and evolve best-in-class claim management program operating characteristics, measurement criteria, and meaningful metrics benchmarking
Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis
Attends management staff meetings as directed. Monitors management reports focusing on regulatory compliance timeframes
Provide direction, leadership and training to in-house claims professionals

present

Detroit, MI

Supervisor Claims CRT Telecommute

Detroit, MI

Romaguera, Friesen and Wehner

present

Detroit, MI

Supervisor Claims CRT Telecommute

present

Partner with Business Manager to recruit, develop and manage a high caliber workforce with minimal turnover
Coach employees to identify and develop career goals; assist employee development
Provide formal and informal performance feedback to individuals and the team; conduct annual performance reviews
Provide regular performance reports to the Business Manager
Use a balanced scorecard to manage the team's performance
Maintain a positive work environment that supports a quality driven team and identify any issues that may inhibit performance
Consistently meet established productivity, schedule conformance, and quality standards

Education Education

Bachelor’s Degree in Related Field

University of South Florida

Bachelor’s Degree in Related Field

Skills Skills

Excellent professional communication skills, both written and verbal
Ability to build professional relationships with your team while motivating them
Excellent attention to detail and time management skills
Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
Ability to delegate
Demonstrated ability to manage multiple priorities at the same time
Proven ability to build and maintain customer relationships through communication, collaboration and efficiency
Ability to navigate a computer while on the phone
Ability to work independently in remote environment
Strong reading comprehension, written and verbal communication skills

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15 Supervisor Claims resume templates

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Supervisor Claims Manager Resume Examples & Samples

Supervises claims program administration to ensure proper claims practices and procedures
Supervises billing, claims and associated administrative activities to ensure compliance with laws, regulations, policies, agreements and contractual arrangements
Assists in implementing procedures to adjust claims when original demographic, sponsor or charge information is in error; monitors and controls resubmission of denials, rejections and appeals
Intercedes with third parties in unusual situations involving payment or adjustment of charges on accounts; consults with departments concerning services which affect collection of charges
Assists examiners in investigating claims and assists and/or performs settlement negotiations. Supervises claim settlement processing
Assumes supervisory responsibility for electronic and paper claims submissions; oversees analysis, correction and resubmission of registration and eligibility of edits and errors
Researches coding and reimbursement requirements for compliance with local, state and federal regulations
Bachelor's degree in business administration, insurance or related field preferred
Four or more years of claims experience
Two or more years of leadership experience included
Experience working with proper claims handling, policies and procedures
Experience working with computer based analysis tools
Experience working with insurance and/or medical terminology
Organizational skills to balance and prioritize work
Negotiation skills to interact with claimant
Ability to understand and convey applicable laws, regulations and practices regarding the insurance industry
Ability to work independently and lead group activities

Supervisor Claims Resume Examples & Samples

Supervise and direct the claims staff, including performance counseling and yearly performance evaluation. Ensure that regular feedback is provided to employees regarding performance particularly as related to productivity and quality
Supervise and support claims staff day-to-day activities to consistently meet established productivity, schedule adherence and quality standards
Responsible to ensure the proper training for employees
Monitor claim volumes and evaluate additional resource requirements
Oversee the recruiting process for new hires in conjunction with Human Resources to establish candidate requirements, overall recruiting strategy and conduct interviews
Establish departmental performance standards and coach individual employee performance to meet and exceed production and quality metrics
Participate in writing and updating manual claims procedures
Exhibit active support of five core values – Integrity, Compassion, Relationships, Innovation and Performance
Actively collaborate with management and staff to ensure that "best practices" are followed and continually seek efficient and innovative processes, technologies and approaches to optimize use of resources and enhance operations
Responsible for resolution of escalated issues, claims research and coordinating with Account Management, Customer Care and Benefit Administration teams as needed
Answer claim questions from within team, internal departments, clients and/or members
Bachelor’s Degree or 2+ years of supervisory experience within a pharmacy or medical claims department
Prior Supervisory and/or Team Lead experience
Experience with pharmacy or medical claims processing
Strong analytical skills to be able to evaluate claims and operational issues
Intermediate proficiency with Microsoft Word and Excel to create letters; create charts and graphs within Excel
Excellent professional communication skills, both written and verbal

Supervisor Claims CRT Telecommute Resume Examples & Samples

Maintain a positive work environment that supports a quality driven team and identify any issues that may inhibit performance
Facilitate daily meetings to communicate team performance goals/results
Partner with Training/QA team to identify skill development needs associated with performance and ensure employees receive appropriate coaching and training
Partner with Training/QA team to identify skill development needs associated with career development opportunities
Basic proficiency with MS Word and PowerPoint (Ability to create, edit, format docs in Word and presentations in PowerPoint independently)
Intermediate proficiency with MS Excel (ability to sort, filter, formulate and display data)

Supervisor Claims Resume Examples & Samples

2+ years of experience as a Team Lead, Supervisor or Manager with coaching, mentoring and goal setting
1+ years of experience analyzing data in a professional work office environment
Ability to use MS Excel to analyze data, formatting, and creating charts and tables
Ability to use MS Word to generate professional correspondence
Ability to use MS Outlook to manage multiple email boxes and calendars
Ability to use MS PowerPoint to creating and editing presentations
Associate’s Degree or Higher
1+ years of Claims Processing experience within a Healthcare environment
1+ years of experience with Human Resource Procedures
Supervisory experience within a Healthcare Claims role
Knowledge of Medical Terminology

Supervisor Claims Resume Examples & Samples

Respond to claims appeals and/or issues
Supervise, monitor, track and direct day to day operations for staff
Associate's Degree (or higher) or HS Diploma with 8+ years of experience in claims
5+ years of experience analyzing and solving customer problems in an office setting environment
Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications

Supervisor Claims Resume Examples & Samples

Respond to claims appeals
Create and/or present to peers and leadership
5 + years of experience analyzing and solving customer's problems in an office setting environment
Intermediate/Advance with Excel: data analysis (pivot table, sorting/filtering, charting and grafting, etc.) basically manipulating data
Intermediate in PowerPoint: create presentation, (design, data, etc.)
Intermediate with Word and Outlook (or comparable email format): edit and create documents within an existing format in Word and have experience working within a corporate email system

Supervisor, Claims Quality / Claims Audit Resume Examples & Samples

Supports claim processing functions including investigations, payments, research analysis
Provide expertise and or general claims support to teams in reviewing, researching, negotiating, processing & adjusting claims
Authorize appropriate payment
Supervise, monitor, track and direct day to day operations of staff of up to 10 employees. Coordinates supervisors and is accountable for the daily activities of business support & auditing team
Research, identify and obtain data / information needed to help process claims or resolve claims issues
Identify and resolve claims processing errors / issues and trends, as needed (i.e., related to system configuration, network eligibility, data accuracy, vendor-related, provider) and provided reports as necessary
Communicate and collaborate with internal and external stakeholders
Document & communicate status of claims audits to stakeholders as needed, adhering to reporting requirements
Monitor performance metrics (i.e., productivity, quality, Turn Around Times)
Conducts traditional supervisory tasks such as singing off on employee time cards, regular 1:1 employee meetings, training, annual performance evaluations, performance management, Replacement Positions working directly with Talent Acquisition
Attends management meetings, offsite IPA office manager meetings
3 years of experience as a medical claims examiner / auditor / biller with HMO knowledge
1 year of experience as a Supervisor or Team Lead
Knowledge of Health Care and Medical Terminology
Understanding of Coding for ICD9, ICD10, CPT, HCPCS
Claim Form Knowledge: UB04 & CMS 1500
Understanding of lines of business with the HMO arena: Commercial HMO, Medicare Advantage, Point of Service, Medi-Medi
Provider & Facility / Hospital Contract knowledge: FFS, Capitation, PerDiems, StopLoss
Experience with State & Federal Regulations
Familiarity with Title 28

Supervisor Claims Resume Examples & Samples

Current verifiable Current Florida Residency
1+ year of experience analyzing and solving customer or claim problems in an office setting environment
1+ year of experience with Medicare and Medicaid claims ( MMA, MMA LTC, & CHIP products)
Ability to create, edit, save, & send documents utilizing Microsoft Word and Excel
1+ year of experience managing or leading a team of 10-30 people to achieve high performance in process driven environment
1+ year of experience managing or leading a team of 10-30 people in Business operations of Healthcare, manage care, or insurance industry
Understanding of UHC Claims processes and claim systems to process a claim to payment utilizing SOPs, 411s, and claims policies and procedures

Supervisor, Claims Resume Examples & Samples

Supports claim processing functions including investigations, payments, research, analysis
Provide expertise and/or general claims support to teams in reviewing, researching, negotiating, investigating, processing and adjusting claims
Authorize appropriate payment or refer claims to investigators for further review
Supervise, monitor, track and direct day - to - day operations of staff up to 15 employees. Coordinates, supervises and is accountable for the daily activities of business support & production team
Research, identify and obtain data/information needed to help process claims or resolve claims issues (e.g. verify pricing, prior authorizations, applicable benefits)
Identify and resolve claims processing errors/issues and trends, as needed (i.e., related to system configuration, network, eligibility, data accuracy, vendor - related, provider) and provides reports as necessary
Communicate and collaborate with external stakeholders (i.e., members, family members, providers, vendors) to resolve claims errors/issues, using clear, simple language to ensure understanding
Collaborate with internal business partners to resolve claims errors/issues (i.e., Subject Matter Experts, Network Management, IT/Systems staff, Compliance, vendor management teams, contract teams)
Document and communicate status of claims/investigations to stakeholders as needed, adhering to reporting requirements (i.e., status letters/reports)
Monitor performance metrics (i.e., productivity, quality, TAT)
Conducts traditional supervisory tasks such as signing -off on employee time cards, regular 1:1 employee meetings regularly, annual performance evaluations, working with an employee on any necessary CAPS (Corrective Action Plans), works with Talent Acquisition on any open positions
Attends management staff meetings as directed. Monitors management reports focusing on regulatory compliance timeframes
Conducts limited employee trainings for new employees and performance management needs
3+ years of experience as medical claims examiner/auditor with HMO knowledge
1+ year of experience as a Supervisor or Team Lead
Knowledge of Health Care and Medical terminology
Understand Coding for ICD9, ICD10, CPT, HCPCS
Claim Form Knowledge; UB04 & CMS 1500
Understanding of Line of Business within the HMO arena; Commercial HMO, Medicare Advantage, Point of Service, Medi Medi
Provider & Facility/Hospital Contract Knowledge; FFS, Capitation, Per Diems, Stop Loss
Experience with both State & Federal Regulations and Title 28
Medicare Billing Manual

Supervisor Claims Resume Examples & Samples

Lead a team of 25-30 claims adjusters
Dependable with strong work ethics, must be able to lead by example
1+ years of experience leading a team of 15 or greater in an office setting
Experience with Microsoft Word basic document creation, PowerPoint including putting together a basic presentation and Excel including basic formulas, sorting, and navigating the application
Must be able to provide after hours, weekend, and holiday coverage on occasion, as business dictates
Bachelor’s Degree or Higher
3+ years Leadership experience of 15+ employees
Prior Leadership experience in a metrics driven environment achieving quality and production goals

Supervisor Claims Resume Examples & Samples

Previous supervisor and customer facing experience preferable. This position will be responsible for managing the UMR-NRECA team as well as manage day-to-day operational duties for NRECA. In this role, the supervisor will be customer facing, NRECA's conduit to UMR support areas, troubleshooting on their behalf within UMR, identifying impact to NRECA and proactively managing. In this modified model, this supervisor will have customer specialists and customer first representatives reporting to them
Solid experience with MS Excel including: data entry, sorting, creating/modifying pivot tables, and formulas on spreadsheets
Ability to navigate a computer while on the phone

Supervisor Claims Resume Examples & Samples

The role of a supervisor has many responsibilities including but not limited to
Inventory management; meeting turnaround times and ensuring performance guarantees are met
Maintaining quality metrics monthly
Holding daily huddles, weekly team meetings and monthly one on ones with each staff member
Helping develop staff to meet production and quality goals
Monitor attendance
Identify barriers in workflows, P&P's and bring new / fresh ideas to improve procedures
Motivate and recognize good performance and overachievers
Yearly MAP reviews
Employee Scorecards completed on time (communication/writing skills key factors)
Accurately complete all Daily, Weekly Monthly Tasks within established timelines
Achieve/Exceed all PG Account Metrics
Demonstrates personal responsibility for achieving high quality results
Gets things done on time and within budget
Accepts responsibility for success and failures
Uses feedback to modify behavior when necessary
Demonstrate the ability to complete assignments timely and within departmental standards/expectations
Follows through on commitments
Represents information and data accurately
Attendance and punctuality conform to department and company needs
Changes course quickly and effectively when necessary
Remains open to new ideas, new approaches, new ways of doing things and dealing with people to achieve results
Demonstrates willingness to proactively address current and potential challenges and opportunities
Willingly accepts increased responsibilities
Seek new opportunities to improve a task or process
Demonstrates a sense of urgency to achieve results
Acts decisively to prioritize workload
Meet deadlines and achieve deliverables
Efficiently manages time, projects and resources across multiple priorities
2+ years of experience with Inventory Control
2+ years of experience in a Leadership role as a SME, Supervisor, or Manager
Experience with MS Word (document creation) and MS Excel (data entry, and sorting)
1+ years of experience with FACETS Claims System
Effective communication skills, both written and verbal
Willingness and ability to develop team
Ability to place employees on corrective action as needed

Supervisor Claims Crt-telecommute Resume Examples & Samples

Supervise, monitor, track and direct day to day operations to staff
Motivate individuals and teams to process claims accurately, and in a timely manner
Assume accountability for ensuring individuals/team meet their performance metric goals, and support/adhere to improvement initiatives
Serve as first point of escalation for SME's on procedural and technical issues; coach staff regarding how to effectively resolve the issue(s)
Provide regular performance reports to the Business Manager
Provide coaching to associates based on quality results; develop improvement plans when needed
Coach employees to identify and develop career goals; assist employee development
Investigate trends, surface issues, identify root problem and collaboratively work with specific team/individuals, and other business areas to resolve issues
Identify high potential staff for succession planning Perform Human Resource administrative duties
Partner with Business Manager to recruit, develop and manage a high caliber workforce with minimal turnover
Impact of work is most often at the team level
1+ years of Team Lead, Supervisory, or Managerial experience
Ability to use Microsoft Excel to sort, filter, formulate and display data
Previous healthcare industry experience
Previous claims processing experience within the healthcare industry

Supervisor Claims Resume Examples & Samples

Monitor performance and address opportunities as they arise
Support on going initiatives with the Heath Plans or internal projects and provide claims guidance
Manage a team or provide guidance in absence of the leader to ensure assignments are completed and performance expectations are achieved
Able to run macros as need and identify additional automation needs to increase the auto vs manual percentage of claim processing
2+ years of experience analyzing and solving customer or claim problems in an office setting environment
Ability to use Microsoft PowerPoint to Develop Presentation of Data/Information to present to a group which might include management
Proficiency with computers and Windows PC applications (this includes the ability to learn new and complex computer system applications
Knowledge of CSP Facets Claims software usage

Supervisor Claims Resume Examples & Samples

Provide overall leadership to direct reports
Authorizes the appropriate payment or refers claims to investigators for further review
5+ years of experience analyzing and solving customer's problems in an office setting environment
Moderate Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
Ability to multitask, this includes ability to understand multiple products and multiple levels of benefits within each product
1+ years of Healthcare Claims background

Supervisor, Claims Client Resume Examples & Samples

Manages client accounts and meets with clients on a regular basis
Reviews outstanding and rejected claims
Ensures the submission of claimable events supported by completed service orders
Ensures that all efforts are made to recover revenue for submitted claims
Ensures the integrity and accuracy of work processes by auditing completed work
Learns all functional and technical aspects of the area(s) assigned
Ensures all process and procedure (SOP) documentation is updated in line with the BPO (off shore team) requirements
Identifies process improvement opportunities within assigned area(S) and within the Center as a whole and integrates relative
Information and define reasonable alternatives
Drives claims filing and reject recovery process improvement
Works closely with the field to obtain information and feedback results
Performs supervisory functions, including but not limited to, making employment decisions regarding hiring, promoting, demoting
And terminating, conducting performance appraisals and coaching and developing associates
3-4 Years Home Services or Claims Management experience
Ability to make decisions based on company needs
Problem solving skills. Analysis skills are required
Balance long-term strategic goals with short term priorities
Good computer skills, including Excel experience to include formulas, pivot tables, v-lookups
Clear speaking voice, with a good command of the English language
Ability to perform multiple tasks with strong attention to detail
Ability to periodically work flexible schedules based on business needs
Ability to maintain a professional image at all times
Ability to prioritize and meet deadlines as required
Frequent sitting, some standing and walking and bending and reaching as necessary
Ability to communicate with customers and co-workers at various levels of the organization
Bachelor's Level Degree or Equivalent Work Experience
Home Services experience
Microsoft PowerPoint, Word

Supervisor Claims Resume Examples & Samples

Provide general claims support to teams in resolving and reviewing claim inventory
Analyze and identify trends and provide coaching and feedback based on trends as necessary
Respond to claims escalations
Lead culture and engagement activities and support employee development
Coordinates, supervises and is accountable for the daily activities of a team of claim processors
Ability to travel less than 25% of the time
Work shift is typically 7:30am-5pm Monday-Friday
3+ years of experience in Operational Leadership

Supervisor Claims Resume Examples & Samples

HS Diploma/GED
3+ years of experience analyzing and solving customer problems in an office setting environment
Experience with MS Word (creating documents/templates /lists), Excel (data entry, sorting/filtering), Outlook (send/receive email, create tasks, update calendar, set out of office), and PowerPoint (creation and presentation)
1+ years leadership/supervisory experience
Undergraduate degree (or higher)
Medical claims experience in a production environment

Supervisor, Claims Audit Resume Examples & Samples

Acts as a Subject Matter Expert (SME)
Reviews all second level rebuttals
Reviews Peer Review scores with Auditors and recommends process improvement
Works with Manager to maintain appropriate work balance in the department in order to maximize productivity
Assists in developing of long-range goals for claims audit specialist and Sr. claims audit specialists
Accept the responsibilities of the manager of Claims Audit in his/her absence and ensure that the department runs smoothly & without disruption to the daily routine
Researches and recommends solutions for escalated issues. Presents proposed solutions in a clear and concise manner
Responsible for performance management responsibilities for direct reports
Assists with developing and maintaining departmental policies and procedures including desk top procedures
Assists with developing training materials for the department and facilitate training as needed
Analyzes errors and performs root cause analysis in order to determine appropriate classification
Presnts audit findings and / or mediates issues external to the department
Assists with identification and communication of process improvement opportunities across operation areas based on quality reviews
Performs additional duties as assigned
LI-JL1
Required A High School or GED
Required 5+ years of experience in a healthcare organization
Required 5+ years of experience in understanding and interpreting contracts as related to claims processing and system configuration
Advanced Knowledge of healthcare delivery
Intermediate Demonstrated organizational skills
Intermediate Demonstrated time management and priority setting skills
Advanced Demonstrated analytical skills
Advanced Demonstrated problem solving skills
Advanced Demonstrated interpersonal/verbal communication skills
Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
Intermediate Ability to work as part of a team
Intermediate Ability to work in a fast paced environment with changing priorities
Intermediate Ability to multi-task
Intermediate Other Decision making ability that requires the use of considerable judgment in the analysis of processes and problems/errors resulting from those processes
Intermediate Other Knowledge of HCPCS Coding
Advanced Other Ability to facilitate small group meetings
Advanced Other Ability to remain calm under pressure
Intermediate Other Ability to concentrate for extended periods on specific tasks
Preferred Other Certified Medical Coder
Required Intermediate Microsoft Excel
Required Intermediate Other Demonstrated technical expertise in performing quality reviews along with analysis of results
Preferred Intermediate Other Knowledge of Perot / Peradigm system

Supervisor Claims Resume Examples & Samples

Hours of operation between 6:00 am - 6:00 pm
1+ year experience as a supervisor or team lead
Intermediate level of proficiency with Microsoft Word and Excel (Word – creating and editing Word documents; Excel – creating and editing spreadsheets, sorting/filtering)
CSP FACETS experience

Supervisor Claims Resume Examples & Samples

3+ years of work experience in an Operations or Production environment as a Team Lead, Supervisor or Manager
6+ months experience using an email tool for professional/business communication
Experience with Microsoft Excel (i.e. data entry, filter and edit spreadsheet)

Supervisor, Claims Resume Examples & Samples

Human Resource Mgmt - Plans, organizes, staffs, leads and controls activities pertaining to the Claims department to include: planning projects and capital and human resource budgets; interviewing, selecting and training subordinate staff; monitoring and appraising performance of subordinates to hold them accountable for end results including human resource management; coaching and motivating subordinates; administers disciplinary action as needed; administers compensation to subordinates; and ensures the department complies with affirmative action guidelines
Procedural Compliance and Process Improvement - Remains current on pertinent federal and state legislation affecting business processing and claims handling. Ensures all departmental activities support the division's effort to meet or exceed corporate policies, procedures, and/or directives while meeting or exceeding expense management objectives. Assesses and analyzes any areas of procedural non-compliance, modifies and/or enhances existing processes, and initiates corrective actions where appropriate. Leads and/or participates in cross-functional work groups that analyze, develop and implement processes, procedures and activities that enhance corporate profitability, efficiency and/or quality. Leads the development of short range business plans and budgets. Leads and/or participates in the planning and execution of organizational initiatives
Business Leadership - Effectively represents the Claims department as a subject matter expert within and outside of the division/operation. Interacts frequently with key external customer and internal stakeholders. Handles significant volume of escalated issues. Exercises appropriate discretion in formulating and implementing department business decisions. Works with the Law Division on any legal matters, and may participate in depositions or trials. Reviews, analyzes and takes appropriate action to resolve claims issues, attorney inquiries
Training and Development - Develops staff through training, communication and delegation of responsibility. Establishes, implements and monitors training requirements and effectiveness. Develops and demonstrates strong leadership skills in the areas of talent, visionary and business leadership
This position requires you to lift, move, or carry heavy objects
Minimum of 2 years of Individual Claims processing or customer service experience
Personal computer operation with skills in various software applications, including word processing, spreadsheet, electronic mail and presentation
Extensive product, distribution and industry knowledge
Strong judgment, communication, presentation, planning and organizational skills
Effective analytical, problem-solving, and decision-making skills
Understanding of Corporate policies, philosophies and objectives
Ability to work in a fast-paced, dynamic environment

Supervisor Claims Resume Examples & Samples

Ability to effectively and objectively manage a team of hourly staff
Knowledge of prescription and/or medial terminology
Intermediate skills utilizing MS Office Word and Excel
Knowledge of Med D compliance requirements and regulations is preferred
Experience with internal claims systems is preferred (RxClaim)

Supervisor, Claims Audit Resume Examples & Samples

Reviews benefit plans to ensure that claims are being adjudicated accurately and consistently according to Magellan contracts. Audits claims for statistical and financial accuracy
Responsible for documenting and reporting issues found
Assists with the establishment and updating of processes and audit manuals
Identifies areas where issues exist and works with appropriate individuals to ensure resolution
Completes special focused audits as assigned by management
Trains and mentors new auditors; works with trainers to audit and develop trainees
Act as a resource for the auditing team

Supervisor Claims Resume Examples & Samples

Manage inventory and performance to business metrics
Submit P&P update requests
Perform monthly mentoring or coaching and development for team members
Provide team members with monthly scorecards
Complete required individual development courses/trainings
Work/Lead special projects as assigned
Support and participate in social responsibility events throughout the year
Host/Attend meetings as required
Moderate proficiency with Windows PC applications - Word (Ability to create/edit document); PowerPoint (Ability to create and send presentations); Excel (Vlookup and formulas)
Effective communication skills (verbal and written)

Supervisor, Claims Resume Examples & Samples

Manage the post-foreclosure servicing functions as required by MI, investor, insurer, and internal guidelines including
Eviction management
Property inspection and maintenance
Conveyance of Title
Title Delivery
Maintenance of HOA, Taxes, and/or property insurance during the GSE REO process
Filing claims for reimbursement of expenses
Reconciliation of claim proceeds and filing supplemental claims as needed
Develop required process infrastructure, policies, procedures, and operational routines
Audit functions/quality assurance of key processes to ensure compliance
Data accuracy
Report key metrics associated with process
College Coursework or Equivalent
3+ minimum years of experience
Should have previous management experience
Process management experience is a plus
Default-related experience is preferred
An aptitude for data, reporting, and working with numbers, is desired
MS office, and Visio
Familiar with GSE, and Insurer servicing guidelines

Supervisor, Claims Resume Examples & Samples

Develop and lead a team of liability claims specialists who have accountability for customers in multiple jurisdictions. This includes ensuring that there are performance objectives and performance metrics in place to both support and meet department goals
Provide direction, leadership and training to in-house claims professionals
Partners with key Claims Management to develop strategic and operational plans aimed at achieving efficiencies so that the department can meet its Critical Success Goals and the business unit can meet both growth and profitability targets
Work closely with other business partners to create and implement business plans for the region which highlight marketing, loss cost and expense management
Establish, refine and evolve best-in-class claim management program operating characteristics, measurement criteria, and meaningful metrics benchmarking
Provide advice and oversight into claim disposition strategies
Work closely with claims adjusters and outside counsel to ensure cost-effective and appropriate litigation management strategies are in place that will lead to the best overall outcome
Drives continuous improvement through initiatives involving the employees, processes and technology
Managing expenditures to budget / plan
Supports 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
Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Insurance’s and our customers’ ability to be profitable)
8 years claims experience, preferably with 3 years in a Claims Supervisory capacity
Strong leadership and management skills or potential to develop them
Polished and professional written and verbal communication skills with the ability to build consensus both internally and externally. The ability to read and write English fluently is required. The ability to read and write Spanish fluently is considered a plus
Strong analytical and presentation skills
Ability to work with Business Unit leaders at strategic level or learn to do so
Ability to travel, sometimes overnight, approximately 10% of the time
Intellectual curiosity. Consistently considers all options and is not governed by conventional thinking
Ability to build commitment both internally and externally. Ability to communicate corporate vision and to gain support for your views, opinions and decisions
Strong focus on selection – determined to have the right people who do the best job. Able to identify, attract and hire talented people
Desire to developing talent. Understands and is committed to developing people so that they realize their full potential
A team builder, someone who understands that success is dependent upon the performance of the team and not individual team members. Creates strong morale and spirit within the team: shares wins and celebrates success as a team
Ability to establish mentoring relationships with key employees and participates in the development of succession and training plans for critical positions
Ability to develop and communicate to claim management reports for accurate and timely reflection of support staff performance and impact on the claims department
Ability to develop and maintain productive relationships with clients, business partners and organizational peers with a focus on timely and meaningful exchanges of information
Measure his/her own success by performance in quickly identifying issues and bringing resolution to outstanding issues
Have an aptitude for working with complex medical and legal issues, while staying focused on managing those issues to the appropriate financial outcome
Have a collaborative orientation and ability to work with multiple partners (insured, claimant, doctors, and attorneys)
Possess a real passion for improving results through proactive claim management

Asst Supervisor Claims Resume Examples & Samples

Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution
Manages the litigation process; ensures timely and cost effective claims resolution
Coordinates vendor referrals for additional investigation and/or litigation management
Communicates claim activity and processing with the claimant and the client; maintains professional client relationships
Ensures claim files are properly documented and claims coding is correct
Refers cases as appropriate to supervisor and management
Provides limited assistance/support to Team Lead with monthly review of adjuster workloads; notes trends and suggests adjustments when necessary
Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business

Supervisor Claims Resume Examples & Samples

Is able to bring together information from a number of different sources when forming a decision
Makes decisions on the best course of action based on available data
Clarifies key issues and weighs up the pros and cons of alternative solutions before reaching a decision
Takes personal responsibility for decisions

Supervisor, Claims Resume Examples & Samples

Hire, inspire, motivate, coach, counsel and supervise staff
Monitor performance of employees
Assess and allocate work volumes on a daily basis
Special project work as assigned
Ensure task completion and performance goals are met, such as Quality, Adherence, service levels
Accountable for daily/weekly/monthly activities of all team members

Supervisor Claims Resume Examples & Samples

Provide expertise and / or general claims support to teams in reviewing, researching, negotiating, processing and adjusting claims
1+ years of experience in a leadership role
2+ years of experience in CSP facets platform
2+ years of experience with computer and Windows PC applications
Experience with Microsoft Excel (create / update spreadsheets, filters, sort, pivot tables), Word (create / update documents, formatting), and PowerPoint (creating / updating / formatting slides)
2+ years of Claims Adjustment experience
Ability to learn new and complex computer system applications

Supervisor Claims Resume Examples & Samples

1+ years of claims processing and/or claims review, claims research
1+ years of Supervisor / Team Lead experience leading a team of 15+ in an office setting
Experience with Microsoft Word (basic document creation), Microsoft PowerPoint (putting together a basic presentation), and Microsoft Excel (basic formulas, sorting, and navigating the application)
Ability to work Monday through Friday between the hours of 6:00 am and 6:00 pm CST and provide after hours, weekend, and holiday coverage on occasion, as business dictates
Bachelor’s Degree or higher
3+ years of Supervisor experience of 15+ employees in an office setting
FACETS knowledge and experience

Supervisor Claims Resume Examples & Samples

Able to effectively communicate to direct reports, Sr. Leadership and matrix partners on a consistent basis
Ability to work independently in remote environment
Proven ability to build and maintain customer relationships through communication, collaboration and efficiency
Excellent attention to detail and time management skills
Demonstrated ability to manage multiple priorities at the same time
Willingness to take calculated risk
Anticipates and drives change through the organization, equipping staff to adapt quickly

Supervisor, Claims Resume Examples & Samples

Manages cross-functional team members to meet or exceed service requirements. Independently examines and analyzes the team's performance; develops, recommends and implements plan(s) of action to improve the team's service level. Evaluates multiple reports to assess work distribution/delegation in order to meet client expectations and/or state regulations. Reports performance results to account management. Demonstrate flexibility in assigning resources based on business need and fluctuating inventory. Adheres to budget allocations
Provides ongoing feedback and coaching to ensure appropriate levels of performance. Recognizes and rewards effectively; provides appropriate levels of direction and support; Consistently follows corporate and departmental polices and guidelines; Utilizes corporate tools for performance appraisals; engages team members in development planning and progress. Identifies training needs within the team; works independently and/or through other sources to develop a training plan
Maintains a positive work environment that supports self-directed teams; provides a structure to optimize the experience, skill, knowledge and capability of the team; facilitates collaboration among team members
Interfaces with customers (internal and external) by telephone, correspondence and/or in person to answer inquiries and resolve concerns. Assesses, investigates and resolves difficult issues; Assist in preparing and/or conducting customer presentations; Partners with account management to achieve customer satisfaction
Facilitates regular team meetings, with an agenda and minutes; disseminate information consistently and timely; ensure all claims processing documentation is current and accurate; Interacts professionally, and presents ideas and information with confidence
Recruits, attracts, develops, motivates and manages a high caliber of employees; Trains employees on products, policies and procedural changes; Orients new employees
Expert knowledge of medical terminology and ECD-9/CPT-4 coding experience
Experience in processing various products including HMO/PPO and Indemnity under both fully insured and self-funded arrangements
Experience managing budgets- 1+ years direct supervisory experience- Strong influencing, negotiation and analytical skills
Team advocate

Supervisor, Claims Resume Examples & Samples

Ensure team performance meets or exceeds claim timeliness and quality standards for regulatory compliance and performance guarantees
Maintain a positive work environment through employee recognition and interaction
Participate in interviewing, hiring, and training of team members
Strategize, plan, organize, and execute efficient inventory management
Bachelors degree in business, health care or management related field or equivalent experience
Minimum 3 years leadership experience (leading, mentoring, coaching, or teaching)
Excellent planning, communication, documentation, organization, analytical and problem solving abilities
Medical Terminology or medical billing experience
High level of professionalism, enthusiasm, and initiative on a daily basis
Working knowledge of Commercial, Medicaid and Medicare plans
Ability to maintain quality and production designated standards established for handling work, problem solve effectively and organize workflow

Supervisor Claims Resume Examples & Samples

Consistently meet established productivity, schedule conformance, and quality standards
Facilitate daily meetings to communicate team performance goals / results
Assume accountability for ensuring individuals / team meet their performance metric goals, and support / adhere to improvement initiatives
Serve as first point of escalation for SME's on procedural and technical issues; coach staff regarding how to effectively resolve the issue (s)
Use a balanced scorecard to manage the team's performance
Able to review data, determine trends, gaps, issues, and identify ways to drive improvements
Provide formal and informal performance feedback to individuals and the team; conduct annual performance reviews
Incentive and reward individuals based on contribution and performance
Investigate trends, surface issues, identify root problem and collaboratively work with specific team / individuals, and other business areas to resolve issues
Partner with Training / QA team to identify skill development needs associated with performance and ensure employees receive appropriate coaching and training
Partner with Training / QA team to identify skill development needs associated with career development opportunities
Able to work across multiple time zones
Ability to use Microsoft Excel to sort, filter, pivot, formulate and display data
Ability to use Microsoft Word to generate professional correspondence
Ability to use Microsoft PowerPoint to create and edit presentations
Knowledge of Community and State line of business

Supervisor Claims Resume Examples & Samples

Respond to claims appeals which includes appropriate rerouting as needed
3+ years of experience with medical claims processing
1+ years of experience managing staff, team metrics and/or team inventory
Experience utilizing Microsoft Excel, including the ability to create a spreadsheet, pivot tables, V - lookups, and filter / sort
Experience working with FWA (Fraud, Waste, and Abuse) claims
Claims processing experience utilizing the COSMOS platform

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