Claims Manager Resume Samples

The Claims Manager job description is responsible for managing the insurance claims of the organization. Typical work activities depicted on the Claims Manager Resume include one or all of the following tasks – operating one or more claims, proper disposition of claims as per the insurance coverage norms, overseeing insurance claims for property, life, and casualty loss based on appraisal and coverage, ensuring completeness and accuracy of claim settlements, reviewing the legality of the claims and investigating the claims if there is any breach.

To work at this level, candidates are expected to fulfill the following attributes – the ability to review and analyze claims, awareness of personal and commercial claims, and experience working with a variety of insurance claims. A College Degree in business, finance or business administration is the minimum education required for this post.

 

Claims Manager Resume

Summary : Highly qualified Claims Manager with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and I would excel in the collaborative environment on which your company prides itself.

Skills : EHS, Excel, Word, Powerpoint, Customer Service, Employee Relations, Training And Development, Risk Assessment, Sharepoint, Data Analysis, Design, Networking, Leadership, Management, Safety, Business Development, Marketing.

Description :

    1. Investigated and vetted claimant eligibility status for Short-Term Disability claims, reviewing contracts and medical documentation to ensure that all claims were competently handled within an appropriate timetable.
    2. Communicated with customers and physicians via telephone and mail, conducting interviews and requesting information to facilitate the outcome of the evaluation.
    3. Worked with clients to assist them in going back to work on a full-time or modified schedule.
    4. Paid covered benefits and claims, accurately identifying and calculating offsets, residual benefits, and over/under payments.
    5. Developed in-depth knowledge of medical terminology and procedures, with the ability to clearly communicate technically sophisticated information to employers and claimants.
    6. Achieved a 95% accuracy rate according to case manager quality reviews, while simultaneously maintaining strict decision timelines and accomplishing a 50% decision rate within 5 business days and 80% decision rate within 10 business days.
    7. Acted as Key player on the Finalist Presentation Team for New Business.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor Of Arts


Sr. Claims Manager Resume

Summary : Accomplished claims leader with 13+ years in the Property & Casualty, and Managed Care Insurance industries with an emphasis in Claims Management and Operations. Proven success with controlling operating costs and seizing opportunities to increase profitability in order to achieve departmental and company objectives. Thorough knowledge of lender placed hazard claims operations and statutory requirements.

Skills : Microsoft Office.

Description :

    1. Planned, coordinated, and processed claims for payment against businesses and manufacturers of Wal- Mart products.
    2. Investigated claims, analyzed product records, prepared reports, negotiated and authorized settlement payments.
    3. Assisted in conducting physical inventory and production analysis by inputting critical information and running various reports including production, due today, shipping and daily duplication log.
    4. Determined product liability and appropriate course of action, as well as processed and maintained records of accounts, billings, shipping / receiving, product repairs, returns and recalls.
    5. Completed accounting and bookkeeping records for all accounts for payment and prepared computer spreadsheets for billing and record keeping purposes.
    6. Entered claims information into database to generate billing as appropriate.
    7. Demonstrated exceptional supervisory skills supporting claim assistants and sales associates.
    8. Continuously utilized excellent communication skills to educate staff on new developments and procedures required for accuracy and legal accountability.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Human Resource


Jr. Claims Manager Resume

Objective : Over 20 years of well rounded insurance industry experience working as a CSR / Account Manager, Producer, Claims Adjuster, Manager and Private Insurance Consultant. Seeking to utilize experience and expertise in joining a company dedicated to outstanding customer service and highly efficient coverage processing. Exceptional written and verbal communication skills along with an enthusiastic, conscientious nature and acute attention to details provides the foundation of excellence in customer service and staff support.

Skills : Type 60 Wpm, Filing, Faxing, Scanning, Time Management, Team Leadership.

Description :

    1. Accountable for the Claims Department and five staff claims adjusters for all reported losses corresponding with commercial coverages provided to the cargo transportation industry.
    2. Responsible for assigning new claims to staff adjusters, supervising all open claims processing and monitoring the claims database for updated claim file information.
    3. High departmental proficiency resulted in outstanding independent file audits by principle insurers.
    4. Designated as the sole adjuster responsible for handling large and/or complicated losses and claims for high profile accounts.
    5. Authorized with $100,000.00 claims settling authority and the responsibility for approving all claim settlements above the $20,000.00 authority of staff adjusters.
    6. Reviewed and approved all claim declinations regardless of claim amount.
    7. Interceded and mediated on behalf of staff adjusters on problematic claims and hostile claimant confrontations preventing further escalation and fostering an industry-wide reputation for excellent customer service and knowledgeable claims handling.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
A.A. In General Studies

Claims Manager/Supervisor Resume

Summary : Meticulous Claims Manager motivated to succeed in a fast-paced, data and deadline-driven professional environment. Comprehensive knowledge of claims adjustments with special knowledge in the field of Worker's Compensation. Focused on quality and customer service. Offers superior oral and written communication skills.

Skills : Report analysis Healthcare insurance claims processing Spreadsheet development Medical terminology Quickbase management Current Procedural Terminology SharePoint management Claims Appeal Procedures.

Description :

    1. Managed eight direct reports and 40 indirect reports, leading various elements of the claims business unit to include process evaluation and change management, auditing, and human capital development.
    2. Ensured efficient processing and proper handling of claims, from initial notice through closure.
    3. Developed strategic initiatives for the Department regarding resource allocation, expense reduction, and service goals.
    4. Financial Management: Following a significant catastrophic event in which 12,000 claims were filed with approximate $100M valued payout, identified incorrect transaction processing which inflated the company's experience.
    5. Initiated project to review suspect claims for processing errors and facilitate proper corrective actions.
    6. Actualized change, effecting a positive reversal of $7M in overstated transactions.
    7. Performance Audit Model Design: As file documentation quality had deteriorated, identified a lack of audit standards to be the root cause.
    8. Developed audit 'scoring' and recommended incorporation into an employee performance review.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor Of Science

Regional Claims Manager Resume

Objective : Demonstrates leadership in maintaining high standards of customer service through strategic thinking, improving operations and increasing profitability. Leverages preventative approach to claims and liabilities in order to mitigate risk. Regular and effective online and face to face interaction with senior executives, customers and legal representatives in a variety of professional environments.

Skills : Leadership, Customer Service, Process Improvement, Public Speaking, Business Strategy, Training & Development.

Description :

    1. Managed a team of 13 claims adjusters who handled new property, automobile and general liability claims.
    2. Provided technical direction and supervision for all aspects of the claim process, while ensuring quality work product, compliance with applicable statutes and rules, and adherence to established claim standards and guidelines.
    3. Developed staff through coaching and by providing performance feedback.
    4. Managed direct reports; Responsible for employee performance, quality and expense management to optimize planned business results.
    5. Facilitated training, unit meetings and other meetings mandated by company.
    6. Responsible for interviewing job applicants for potential employment as well as helped facilitate job fairs.
    7. Implemented detailed action plans for performance improvement to ensure goals were met and employees were successful.
    8. Top team to consistently meet company goals Top team in retaining employees Instrumental in developing and maintaining the Drive in Program which saved the company millions of dollars.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Bachelor Of Arts

Claims Manager III Resume

Summary : Highly rewarding career where I can use my skills and knowledge to help the company and my coworkers be successful.

Skills : Intermediate in microsoft suite, able to navigate through several systems,.

Description :

    1. Make recommendations and/or take corrective action to manage performance as appropriate.
    2. Organizes and coordinates employee meetings, activities or programs to support open communication, motivate staff and foster employee morale.
    3. Utilizing management tools, resources, and business routines, monitors work performance for standardization and consistency.
    4. Coaches and counsels staff to support performance improvement, individual accountability, professionalism, collaboration and creative business solutions.
    5. Provide claim support to customers/dealers, along with with 3PL duties Daily A/P and A/R duties for customers, dealers, and drivers Acts as a critical point of escalation and works to resolve denied or pending claims as expeditiously as possible.
    6. Works cross-functionally with other departments to address customer or business issues and resolve errors in a timely manner.
    7. Serves as an example to the Customer Service Team for collaboration and consistent customer focus.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Diploma

Claims Manager II Resume

Summary : Innovative supervisor seeks position offering opportunities for new professional and personal challenges. Self-starter with a positive, can-do attitude who is driven to learn, improve and succeed. Over 19 years of progressive experience in the Healthcare industry.

Skills : MS Word, MS Excel, MS PowerPoint, Outlook GuideWire Adobe Acrobat.

Description :

    1. Established claim strategies in partnership with AVPs, risk managers, legal partners, and other stakeholders to contribute to the overall Risk Management Strategy.
    2. Fielded all reported Workers Compensation, General Liability, Property, Builders' Risk, Mold, and Environmental claims, including appropriately notifying insurance companies and brokers.
    3. Collaborated with internal operation teams to obtain pertinent information on individual claims, and support and facilitate the claims resolution process.
    4. Directed the litigation process including negotiating external defense attorney firm rates and determining cost effective strategies for file resolution.
    5. Coordinated Workers Compensation managed care and Return To Work issues involving Duke Realty Associates.
    6. Conducted internal accident/incident investigations and worked with Safety Coordinators to establish procedures to mitigate workplace risk.
    7. Examined claim data to determine trends, root causes, and present findings to field operations.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Bachelor Of Science

Claims Manager I Resume

Summary : Demonstrates leadership in maintaining high standards of customer service through strategic thinking, improving operations and increasing profitability. Leverages preventative approach to claims and liabilities in order to mitigate risk. Regular and effective online and face to face interaction with senior executives, customers and legal representatives in a variety of professional environments.

Skills : Management, Customer Service, Administrative Support, Conflict Resolution.

Description :

    1. Responsible for directing all claims activities for clients with a focus on limiting exposure and driving profitability.
    2. Ensure all claims and liability cases are proactively handled to achieve the most favorable outcomes.
    3. Manage daily operations of Personal Auto Insurance Departments with an emphasis on quality of service to customers.
    4. Liaison between the Department of Insurance and the Company.
    5. Responsible for overseeing all aspects of the claim process consisting of Property and Casualty claims.
    6. Identify key elements that measure claim results and other metrics.
    7. Monitor processes and systems to enable the claim staff to effectuate and improve all levels of service and reduce all elements of claims.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor Of Science

Claims Manager/Analyst Resume

Summary : Accounting professional with corporate management and general accounting experience, encompassing multiple areas such as budgeting, cost control analysis, financial statements, ledger analysis and projection. Demonstrated ability of achieving greater fiscal accountability through analysis and restructuring of financial and operational procedures resulting in stabilization and improvement of P&L position.

Skills : Microsoft Office, Quickbooks, SBS.

Description :

    1. Claim Manager for self-insured clients for workers compensation and liability claims.
    2. Processed all required state filings for TN and VA in compliance with respective state laws.
    3. Organized and managed over 1,700 claimant files, in totality, for accuracy and ease of authorized disclosure.
    4. Manually transitioned current open and closed claims within a 10 year historical period for two clients, upon acquisition, into the company reporting software and completed all required acquisition filings and all current payments on schedule without loss of service to clients or claimants.
    5. Created and maintained custom electronic data interchange software program.
    6. Created and maintained custom website for client use to obtain multiple reports.
    7. Worked in conjunction with multiple attorneys, multiple TDOL and VADOL representatives, case managers, investigators, pharmacies, hospitals and claimants.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
BBA In Accounting

Lead Claims Manager Resume

Summary : Extensive background has afforded me the ability to thoroughly investigate claim information to detect fraudulent submissions, analyze claim data to determine root cause and remediation efforts, perform benefit analysis to determine maximum liability, interview members to obtain claim details and mentor new hires with regards to policy interpretation and processing guidelines.

Skills : Basic Computer Skills, Team Building, Money Handling, Customer Service Skills, Conflict Resolution, Leadership Development.

Description :

    1. Accountable for team performance measurements, associate and team development, monthly scorecards, corrective action plans, staff communications and administrative tasks.
    2. Manage claims quality and ensures all guidelines are met.
    3. Interview and recruit talent and develop a high performance team.
    4. Evaluate and manage claim operations including processing new day claims and correspondence, reimbursements, appeals/disputes, contact logs, IRU service forms, HRA's, claim adjustments and large projects.
    5. Approve Facets security level authority for entire department.
    6. Work with account managers and health plans to resolve issues to include benefit configuration, pended claims, provider data management, fraud and nurse case management.
    7. Prepare and analyze all standard claim reports including, aging pended claims, analyst production, claim quality, provider refunds, daily claim receipts, etc.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
Computer Science

Claims Manager/Executive Resume

Objective : Accounting management position where I can utilize my experience gained through private and public accounting companies and further my professional career. Having experience as an accounting clerk in private companies and as a staff accountant in a public accounting firm, and having just completed my graduate work, I would like to find a position overseeing a small accounting department, thereby combining my past experience and taking my career to the next level.

Skills : MS Word, MS Excel, MS PowerPoint Outlook, GuideWire Adobe Acrobat.

Description :

    1. Gathered documentation and evidence from retailers for warranty claims and presented to the manufacturers for consideration.
    2. Mitigate potential risk and work with both customers and suppliers to find reasonable solutions for both parties while concentrating on maintaining customer focus.
    3. Gave presentations to the sales force to communicate new processes, department goals, and updated contact info.
    4. Reduced the total number of average outstanding claims per month from approximately 140 to 60.
    5. Implemented metrics to find resolution for both our customers and our company within 7 days and 30 days, respectively.
    6. Resolution was credit in hand or claim denial.
    7. Reduced the average balance of the prepaid claim account so the company was carrying less of a liability each month.
    8. Promoted from temp, to accounting assistant, to claim manager in only 5 months.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Junior
Education
Education
Professional Accountancy

Claims Manager Resume

Summary : Highly qualified Claims Manager with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and I would excel in the collaborative environment on which your company prides itself.

Skills : Claims Management.

Description :

    1. Claims Training and Audit Manager Customer Service to all customers.
    2. Trained claims employees on handling claims.
    3. Prepare training budget for department or organization.
    4. Evaluate instructor performance and the effectiveness of training programs, providing recommendations for improvement.
    5. Analyze training needs to develop new training programs or modify and improve existing programs.
    6. Conduct or arrange for ongoing technical training and personal development classes for staff members.
    7. Plan, develop, and provide training and staff development programs, using knowledge of the effectiveness of methods such as classroom training, demonstrations, on-the-job training, meetings, conferences, and workshops.
    8. Confer with management and conduct surveys to identify training needs based on projected production processes, changes, and other factors.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
MS