A Claim Team Leader is a managerial or leadership role, wherein the individual deals with several different tasks related to claims processing, and management. The job duties associated with the role are listed on the Claims Team Leader Resume as – maintaining claims files, reviewing files, ensuring payments are made, recording of the report of the claim, checking coverage, requesting notices such as medical diagnose and accident log; determining the amount of the damage, organizing the removal or repatriation, payment of damage amount to the insures, and controlling insurance frauds.
Skills that are crucial for excelling in this role include – knowledge of risk management, claims administrator experience, the ability to design, manage and implement claims strategies, familiarity with carriers, brokers, and large deductible programs, and knowledge of general claims related accounting and financing. There is no specific specialization to become a Claims Team Leader, however, successful resumes denote a degree in business administration or management.
Summary : An accomplished Claims Team Leader professional and trainer with 20 years of combined experience with a proven ability to deliver results through: effective leadership, communications, customer service, problem solving, team development, accountability, integrity, adaptability and solution implementation.
Skills : Customer Service Management, Community Relations, Calypso, Avaya, NICE, Aspect, BluePumkin, CMS, SalesForce.
Description :
Supervised the day-to-day operations for the claims staff by establishing priorities, scheduling and assigning work, and coaching employees in reviewing, analyzing, investigating, negotiating and settling claims in compliance with Claims Quality Standards.
Created a high-performing, results-oriented staff through candidate selection, on-boarding, ongoing development, and managing individual performance with regular coaching focused on behavior and technical skill sets.
Led and actively contributed to a culture of continuous improvement and ensures utilization of tools and behaviors within the Liberty Management System to foster critical thinking and innovation around problem solving and development of standard work.
Built and maintained internal and external customer relationships.
Served as a primary point of contact for agents, brokers and policyholders.
Hosted and facilitated in person and/or telephonic claim reviews on a continuous cycle and ensures Special Service Instructions are managed appropriately.
Provided management oversight of claims files (non-litigated or litigated) within the unit, to include Manager Reviews on open inventory and reviews files to measure quality assurance discusses individual training and development needs.
Experience
10+ Years
Level
Senior
Education
Bachelor's In Criminal Justice Administration
Claims Team Leader Resume
Objective : As a Claims Team Leader, responsible for Acting on the information as necessary to ensure service, quality and quantity standards are met and maintained, and also Providing the team with the resources and training necessary to develop and maintain the teams technical knowledge while meeting established production and quality standards.
Managed and developed seven direct reports in a client-facing role specializing in personal injury.
Utilized integrated coaching to foster the highest performing injury resolution team.
Trained direct reports on standard operating procedures, policies, client interactions, and company strategies earning a 75% succession rate to promotion in the first year.
Analyzed reps performance-driving behaviors to formulate an action plan to coach and develop them in their careers.
Developed the highest performing rep in New York closing 86% of accounts within 90 days.
Cultivated inbound leads to address client satisfaction to surpass Net Promoter Score expectations by 8% YTD.
Applied a Customer Service Plan with a consultative approach that was proactive in identifying concerns leading to 89% closures within 30 days.
Experience
2-5 Years
Level
Junior
Education
BS
Claims Team Leader Resume
Headline : Responsible for Monitoring claim inventory and production on a daily basis to ensure that staff allocation is at an appropriate level to meet TAT and client performance guarantees, Evaluating claim inventory, production and quality outcomes on an on-going basis.
Skills : Microsoft Word, Excel, Outlook, Management, Training.
Description :
Completed a heavy volume of field assignments in a timely manner and made fair and accurate settlements.
Investigated the facts of an automobile accident to make a liability determination.
Cleared insurance policy coverage concerns, ultimately paying or denying a claim.
Estimated property damage for cars, trucks, motorcycles and boats, and negotiated the cost of repairs with the auto repair facility, insureds and claimants.
Negotiated bodily injury settlements with claimants and plaintiff attorneys.
Assisted the Special Investigative Fraud Unit in the prosecution of an auto fraud ring.
Managed and trained staff for quality assurance and accuracy.
Experience
5-7 Years
Level
Executive
Education
Bachelor Of Science
Claims Team Leader Resume
Objective : Claims Team Leader with 4 years of experience in Recommending and implementing workflow, systems and operational changes to eliminate impediments to delivering service excellence and meeting company and team goals or established metrics.
Skills : Microsoft, CCC, Mitchell, Xactimate.
Description :
Improved work quality while increasing productivity by 15% and increasing customer service measurements to top score within region.
Responsible for training, developing, and coaching team members located in four different offices in the region.
Developed, implemented, and monitored the statewide pilot of a claims assignment workload program that improved efficiency of claims assignment.
Improved work quality by assigning and tori aging claims based on twenty different factors to ensure claims were assigned to the most capable associate while balancing individual workloads.
Successfully rehabilitated struggling associates by providing daily feedback and implementing effective time management techniques while increasing associate job satisfaction.
Participated in regional and statewide quality diagnostics to analyze areas of opportunity and to develop new best practices.
Improved branch and region work quality by 18% compared to year prior to employment.
Experience
2-5 Years
Level
Executive
Education
BS In Political Science
Claims Team Leader Resume
Objective : Organized, analytical, independent thinker with process improvement, change advocacy, records and information governance, law firm and corporate experience; Demonstrated attention to detail and initiative in problem solving; Experienced in leading globally diverse teams, developing and delivering cross-functional training, working with stakeholders and vendors to develop and execute national, enterprise-wide strategic initiatives and managing compliance risk.
Skills : Records Management, Training & Development, Six Sigma, Operations Management, Vendor Management, Process Improvement, Strategic Planning.
Description :
Managed a team of 6 insurance claims specialists handling Insurance Agents Errors & Omission claims across 26 states, who each maintained an average claim count of 200 active claims.
Responsible for hiring, training, coaching, supervising and conducting performance management reviews.
Managed a portfolio of large exposure, complex professional liability claims.
Supervised litigation assigned to and handled by outside defense attorneys.
Directed outside counsel in regard to the legal issues of each case and granted ultimate settlement authority, as required, to effectively resolve litigation.
Advised and consulted with Underwriters, Sr. level executives and corporate counsel on policy language, large exposure claims and other legal issues.
Revised litigation guidelines and developed standardized processes for claims set up, vendor payments and deductible collections.
Experience
2-5 Years
Level
Junior
Education
BA
Claims Team Leader Resume
Objective : Seeking a Claims Team Leaderprofession with an outstanding career opportunity that will offer a rewarding work environment along with a winning team that will fully utilize management skills.
Skills : Customer Service, Teaching English Language Learners, ESL, Teaching All Ages, Bilingual English-Spanish, Microsoft Office.
Description :
Coordinated with 25 behavioral health facilities that we contract with to help them reconcile their claims.
Checked online portals or calling insurance companies to find out if claims had been paid or denied.
Able to get a family and a facility several thousands of dollars worth of claims paid through several level appeals.
Able to research and use my problem solving skills to figure out things that people who were much more experienced did not know.
Helped the entire company get ahead with the insurance companies.
Led the implementation of document imaging and outsourcing projects within the claims department; developed procedures; trained diverse teams across India and Mexico.
Decreased turnover rate of associates from over 60% to 0% in last two years in position.
Experience
2-5 Years
Level
Executive
Education
MS
Claims Team Leader Resume
Objective : Claims Team Leader Professional with legal background. Experienced includes corporate HR generalist responsibilities; employee relations, staffing management; EEOC/Title VII complaint investigations, agency responses and position statements; state and federal law compliance; corporate policy and procedures; and unemployment insurance benefit claim management. Specialty areas include: Employee Relations Talent Acquisition Corporate Policy and Procedures EEO/Title VII Claim Defense Alternative Dispute Resolution.
Skills : MS Office, Lotus Notes, HRIS.
Description :
Conducted group classes and individual training of associates regarding department policies and procedures.
Responsible for reviewing, summarizing and recommending disciplinary action for registered sales representatives on customer complaints, inappropriate sales practices, investigations, and the use of sales and marketing materials which failed to comply with the agents' collective bargaining agreement, applicable regulations, and compliance with company policies and procedures.
Played a key role in implementing terms of the multi-state task force sales practices class action settlement, working in an analytical and operational management role.
Analyzed over 1000 complex cases with settlement offers for a class-action suit against Prudential.
Ensured company's compliance with internal, regulatory and task force requirements through thorough review of sales activity and customer claims.
Awarded Prudential Piece of the Rock for outstanding contributions to Policyowner Relations Department.
Effectively developed associates to transition into other areas of specialty.
Experience
2-5 Years
Level
Executive
Education
Bachelor's In Marketing
Claims Team Leader Resume
Summary : As a Claims Team Leader, responsible for Maintaining awareness of existing and proposed legislation, court decisions and emerging trends in claims litigation to monitor team compliance with Unfair Claims Practices.
Skills : Team Member, Planning Skills.
Description :
Provided technical assistance and supervises the daily activities of a team of Sr. Claims Examiners.
Developed and implemented programs to meet claims goals/objectives and ensuring the team operates at maximum efficiency by understanding our product lines and customers and providing suggestions for improvement.
Developed, managed and trained the first entry-level benefit analyst class.
Selected to transition a line of business from our California campus to Richmond.
Responsible for the creation of a new team In addition, the Team Supervisor will execute on projects related to the above.
Supervised the efficiency, accuracy and timely adjudication of all claims.
Investigated and resolved complex issues received from providers, clients and team members.
Experience
10+ Years
Level
Senior
Education
Bachelor's In Criminal Justice Administration
Claims Team Leader Resume
Objective : To obtain a challenging, fast paced position with room for advancement that utilizes my skills and abilities to benefit myself as well as my employer.
Skills : Taxes/Audits, Manager/Team Leader.
Description :
Performed analysis using the EDI transmission to obtain what was submitted for electronic claims.
Reviewed the claims to make sure everything falls within the provider's contract and/or guidelines that need to be followed.
Managed, trained, and developed, Claims Representatives.
Monitored metrics to ensure SLAs are met daily, quarterly, and yearly.
Read, wrote, and edited controlled documents including SOPs and Work Instructions.
Handled and resolved customer complaints.
Leveraged KPI's to drive accuracy and efficiency while delivering exceptional customer service to capitalize on retention.
Experience
2-5 Years
Level
Junior
Education
High School Diploma
Claims Team Leader Resume
Summary : Experienced leader responsible for ensuring organizational success while maintaining high standards and adherence to key corporate initiatives. Held variety of leadership positions over 10 years across multiple states and processes. Led several corporate initiatives and developed local process improvements across Maryland and Delaware. Impeccable written, verbal and interpersonal skills.
Promoted to this position after services as High-Cost Claims Adjustor (2 years) and Health Claims Processor (2 years).
Performed project management functions and developed efficiencies to process claims quickly and accurately.
Monitored performance and provided feedback to management.
Performed claim adjustments for high cost claims.
Processed edits on skilled nursing facility claims for Medicare and focused on pre-existing conditions for Individual Products.
Selected to participate in system migration and testing due to excellent communication skills and attention to detail.
Led, mentored and supervised a team or unit within Claim Operations ensuring the timely and effective accomplishment of the departments business objectives.
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