Claims Manager Resume
Summary : Dynamic Claims Manager with a decade of extensive experience in the insurance sector, specializing in claims operations and management. Known for optimizing processes to enhance efficiency and minimize costs while ensuring compliance with industry regulations. Adept at building strong relationships with stakeholders and leading teams to achieve strategic objectives. Committed to fostering a culture of excellence in customer service and operational integrity.
Skills : Claims Compliance Management, Team Leadership, Claims Risk Analysis, Claims Data Management
Description :
- Conducted thorough investigations to determine claimant eligibility for Short-Term Disability claims, ensuring compliance with company policies and medical guidelines.
- Facilitated effective communication with claimants and healthcare providers to gather necessary information for timely claim evaluations.
- Collaborated with clients to develop return-to-work strategies, balancing their needs with organizational requirements.
- Processed claims payments accurately, identifying offsets and ensuring correct reimbursements for medical services.
- Enhanced knowledge of medical terminology to provide clear and precise communication during claims assessments.
- Maintained a 95% accuracy rate in quality reviews while adhering to strict timelines for decision-making.
- Contributed as a key member of the Finalist Presentation Team for New Business initiatives, showcasing exceptional presentation skills.
Experience
10+ Years
Level
Senior
Education
B.S.B.A.
Claims Manager Resume
Summary : Accomplished Claims Manager with over 10 years of experience in the insurance industry, focusing on claims management and operational excellence. Expertise in streamlining claims processes to enhance efficiency, reduce costs, and ensure compliance with regulations. Strong leader with a proven track record in building collaborative relationships with cross-functional teams and stakeholders. Passionate about driving innovation and delivering exceptional customer service in a fast-paced environment.
Skills : Claims Management Software, Risk Assessment, Claims Analysis, Team Leadership, Regulatory Compliance
Description :
- Oversaw the planning, coordination, and execution of claims processing for Wal-Mart product claims, ensuring timely and accurate payments.
- Conducted thorough investigations into claims, analyzed product records, and prepared detailed reports to facilitate negotiations and settlements.
- Collaborated with internal teams to perform inventory and production analysis, utilizing data to enhance claims management procedures.
- Managed financial documentation, including accounting and bookkeeping for claims, to ensure accuracy in billing and record-keeping.
- Developed and maintained a comprehensive claims database to streamline information retrieval and reporting.
- Provided mentorship and training to claims assistants and sales associates, enhancing team performance and operational efficiency.
Experience
10+ Years
Level
Senior
Education
B.S. in BA
Jr. Claims Manager Resume
Objective : Proactive Claims Manager with over 5 years of specialized experience in claims management within the insurance sector. Proven ability to streamline operations and enhance claims processing efficiency while ensuring adherence to regulatory standards. Skilled in leading teams and cultivating strong partnerships with stakeholders to drive organizational success. Focused on delivering top-notch customer service and maintaining the integrity of operational practices.
Skills : Claims Analysis, Claims Processing, Regulatory Compliance, Data Management, Risk Assessment
Description :
- Oversaw the Claims Department, managing a team of five claims adjusters for commercial losses in the cargo transportation sector.
- Assigned new claims to staff adjusters while supervising all ongoing claims processing and maintaining an accurate claims database.
- Achieved high departmental efficiency, leading to exceptional independent audits by primary insurers.
- Handled large and complex claims for high-profile clients, ensuring thorough investigation and resolution.
- Authorized settlements up to $100,000, reviewing and approving all claims exceeding staff adjuster authority.
- Evaluated all claim declinations, ensuring compliance with company policies and regulations.
- Acted as a mediator on challenging claims, fostering a positive reputation for customer service within the industry.
Experience
2-5 Years
Level
Junior
Education
B.S.B.A.
Claims Manager Resume
Summary : Accomplished Claims Manager with a robust track record of over 10 years in the insurance industry, specializing in optimizing claims operations and enhancing team performance. Proven expertise in developing and implementing strategic initiatives that drive efficiency, reduce operational costs, and ensure compliance with regulatory standards. Strong communicator and relationship builder who leads diverse teams to exceed performance targets while maintaining a commitment to exceptional customer service and operational integrity.
Skills : Regulatory Compliance, Team Leadership, Process Improvement, Add New, Add New
Description :
- Oversaw a team of eight direct reports and 40 indirect reports, driving process evaluation and change management initiatives across the claims business unit.
- Ensured efficient claims processing from initial notice to closure, enhancing operational workflows and compliance.
- Developed and executed strategic initiatives to optimize resource allocation and reduce operational expenses.
- Identified and corrected transaction errors following a significant catastrophic event, saving the organization from inflated claims costs.
- Initiated a comprehensive review of suspect claims, implementing corrective actions to mitigate processing errors.
- Designed a performance audit model that improved documentation quality and established audit standards for employee evaluations.
- Implemented key performance indicators to track and enhance operational effectiveness across the claims department.
Experience
10+ Years
Level
Senior
Education
B.S.B.A.
Regional Claims Manager Resume
Objective : With over five years of experience in claims management, I excel in leading teams to optimize claims processing while ensuring compliance with industry regulations. My strategic approach has consistently improved operational efficiency and reduced costs, positioning the organization for success. I am dedicated to fostering strong relationships with stakeholders and enhancing customer satisfaction through exceptional service and effective claims resolution.
Skills : Team Leadership, Claims Process Optimization, Effective Communication, Strategic Planning, Claims Analysis
Description :
- Supervised a team of 13 claims adjusters, overseeing property, automobile, and general liability claims to ensure high-quality outcomes.
- Provided comprehensive technical guidance throughout the claims process, ensuring compliance with regulations and established standards.
- Enhanced team performance through targeted coaching and constructive feedback, fostering a culture of continuous improvement.
- Managed employee performance metrics, optimizing operational results through effective expense management.
- Conducted training sessions and team meetings to align strategies with company objectives and improve service delivery.
- Facilitated the recruitment process for new claims adjusters, successfully participating in job fairs and interviews.
- Implemented performance improvement action plans that resulted in consistently meeting and exceeding company goals.
Experience
2-5 Years
Level
Junior
Education
B.S. in BA
Claims Manager Resume
Summary : Seasoned Claims Manager with a decade of proven expertise in leading claims operations and driving strategic initiatives within the insurance industry. Recognized for implementing innovative solutions that streamline processes, enhance operational efficiency, and ensure compliance with regulatory standards. A collaborative leader who excels in nurturing relationships with stakeholders and guiding teams toward achieving organizational goals while delivering exemplary customer service.
Skills : Proficient in Microsoft Office Suite, Skilled in navigating multiple claims management systems, Claims Analysis, Regulatory Compliance
Description :
- Recommended and implemented corrective actions to enhance team performance and operational efficiency.
- Coordinated employee engagement initiatives to promote open communication and boost team morale.
- Monitored performance metrics using management tools to ensure standardization and consistency across claims processing.
- Provided coaching and counseling to staff, fostering accountability and professionalism within the team.
- Delivered comprehensive claims support to customers and dealers, managing daily accounts payable and receivable duties.
- Acted as a critical point of escalation, resolving denied or pending claims swiftly and effectively.
- Collaborated with cross-functional departments to address and resolve customer and business-related issues in a timely manner.
Experience
10+ Years
Level
Senior
Education
B.S. in BA
Claims Manager II Resume
Summary : Strategic Claims Manager with a decade of proven experience in overseeing claims operations within the insurance industry. Recognized for developing and implementing innovative strategies that drive operational efficiency and compliance while significantly reducing costs. Skilled in fostering robust relationships with stakeholders and leading diverse teams to achieve exceptional results. Passionate about enhancing customer satisfaction through effective claims resolution and service excellence.
Skills : Claims Reporting Software, Data Analysis, Presentation Skills, Add New, Add New
Description :
- Established claim strategies in collaboration with AVPs, risk managers, legal partners, and stakeholders to enhance the overall Risk Management Strategy.
- Managed all reported Workers Compensation, General Liability, Property, Builders Risk, Mold, and Environmental claims, ensuring timely notifications to insurance companies and brokers.
- Worked closely with internal operations teams to gather critical information on individual claims, facilitating efficient claims resolution.
- Oversaw the litigation process, including negotiating rates with external defense attorneys and developing cost-effective strategies for file resolution.
- Coordinated Workers Compensation managed care and Return To Work initiatives involving various stakeholders.
- Conducted thorough internal accident investigations and collaborated with Safety Coordinators to implement procedures aimed at mitigating workplace risks.
- Analyzed claim data to identify trends and root causes, presenting findings to field operations for improved decision-making.
Experience
7-10 Years
Level
Management
Education
B.S.B.A.
Claims Manager Resume
Summary : Accomplished Claims Manager with 10 years of comprehensive experience in the insurance industry, adept at leading claims management initiatives that drive operational efficiency and compliance. Proven track record in implementing innovative strategies that reduce costs and enhance service quality. A dedicated leader skilled in building and nurturing relationships with stakeholders while guiding teams to exceed performance benchmarks. Eager to leverage expertise in claims operations to contribute to organizational success and customer satisfaction.
Skills : Claims Operations Management, Risk Assessment, Regulatory Compliance, Team Leadership, Process Improvement
Description :
- Directed all claims activities to limit exposure and enhance profitability through strategic oversight.
- Proactively managed claims and liability cases, ensuring optimal outcomes for clients and stakeholders.
- Oversaw daily operations of Personal Auto Insurance Departments, prioritizing exceptional service quality.
- Acted as a liaison between the Department of Insurance and the organization, ensuring compliance with regulations.
- Supervised all aspects of the claims process, focusing on Property and Casualty claims management.
- Identified and analyzed key performance indicators to measure claims effectiveness and operational metrics.
- Monitored and improved processes to empower claims staff and enhance service delivery standards.
Experience
10+ Years
Level
Senior
Education
B.S. in Bus. Admin.
Claims Manager/Analyst Resume
Summary : Accomplished Claims Manager with a decade of expertise in overseeing complex claims processes within the insurance sector. Renowned for implementing strategic initiatives that enhance operational efficiency, minimize claim costs, and ensure compliance with industry regulations. Proven ability to foster collaborative relationships with stakeholders and lead diverse teams to achieve organizational goals while maintaining a strong commitment to exceptional customer service.
Skills : Claims Management Software, Data Analysis and Reporting, Risk Assessment, Team Leadership, Negotiation Skills
Description :
- Managed claims for self-insured clients across workers' compensation and liability sectors, ensuring compliance with state regulations.
- Processed and submitted all necessary state filings for TN and VA, adhering strictly to legal requirements.
- Organized and maintained over 1,700 claimant files for accuracy and efficient authorized disclosures.
- Successfully transitioned historical claims data into new reporting software, ensuring continuity of service during client acquisitions.
- Developed and maintained a custom electronic data interchange system to streamline data exchange.
- Created a client-accessible website for real-time reporting and updates on claims status.
- Collaborated with attorneys, state representatives, and healthcare providers to facilitate effective claim resolutions.
Experience
10+ Years
Level
Senior
Education
B.S.B.A.
Lead Claims Manager Resume
Summary : With a decade of dedicated experience in claims management, I excel in driving operational excellence within the insurance industry. My expertise lies in crafting and executing innovative strategies that streamline claims processing, enhance compliance, and significantly reduce costs. I am committed to fostering collaborative relationships with stakeholders and leading high-performing teams to achieve ambitious organizational goals. My passion for customer service and process improvement positions me as a leader poised to make a meaningful impact.
Skills : Claims Data Analysis, Cross-Functional Team Leadership, Financial Risk Assessment, Client Relations Management
Description :
- Accountable for team performance metrics, including associate development and monthly scorecard assessments, ensuring alignment with organizational goals.
- Managed claims quality assurance to ensure compliance with industry standards and guidelines.
- Led recruitment efforts to build a high-performance claims team, focusing on talent development and retention.
- Oversaw comprehensive claims operations, including processing new claims, handling appeals, and managing correspondence effectively.
- Authorized security access levels for the claims department, safeguarding sensitive information.
- Collaborated with account managers and health plans to resolve complex claims issues, including fraud detection and management.
- Analyzed claims reports to identify trends and areas for improvement, enhancing operational efficiency.
Experience
7-10 Years
Level
Management
Education
B.S. in BA
Claims Manager Resume
Objective : Innovative Claims Manager with over 5 years of experience in the insurance industry, specializing in optimizing claims processes and enhancing operational performance. Proven ability to lead teams in the resolution of complex claims while ensuring strict adherence to regulatory standards. Adept at implementing strategic initiatives that drive efficiency, reduce costs, and improve customer satisfaction. Passionate about building collaborative relationships with stakeholders and fostering a team-oriented environment that prioritizes exceptional service delivery.
Skills : Claims Management Software, Data Analysis and Reporting, Presentation and Communication Skills, Team Leadership, Regulatory Compliance
Description :
- Collected and analyzed documentation and evidence from retailers for warranty claims, presenting findings to manufacturers for resolution.
- Collaborated with customers and suppliers to mitigate risks and provide effective solutions while maintaining a customer-centric approach.
- Conducted informative presentations to the sales team to communicate new processes and departmental objectives.
- Reduced the average outstanding claims from 140 to 60 per month through process improvements.
- Implemented strategies that resulted in either prompt credit issuance or claim denial, ensuring timely communication.
- Minimized the average balance of the prepaid claims account, reducing the company's monthly liability.
Experience
2-5 Years
Level
Junior
Education
B.S.B.A.
Claims Manager Resume
Summary : With a decade of specialized experience in claims management, I excel in directing high-impact operations within the insurance industry. My expertise encompasses not only optimizing claims processes for enhanced efficiency but also ensuring strict compliance with regulatory standards. I have a proven ability to develop strategic initiatives that drive cost reductions while maintaining exceptional service quality. A strong leader, I prioritize relationship building with stakeholders and team empowerment, fostering a culture of excellence that consistently meets organizational objectives.
Skills : Effective Communication, Risk Assessment, Claims Processing, Data Analysis
Description :
- Managed comprehensive training for claims staff, improving service delivery and operational performance.
- Designed and implemented a training budget that aligned with organizational goals, ensuring efficient resource allocation.
- Conducted needs assessments to identify and develop targeted training programs, enhancing employee skills and knowledge.
- Monitored and evaluated training effectiveness, providing actionable feedback to instructors and management.
- Facilitated ongoing professional development workshops to keep staff updated on industry best practices.
- Collaborated with management to identify training needs based on emerging trends and operational changes.
- Led initiatives to improve customer service standards through effective training and support.
Experience
10+ Years
Level
Senior
Education
B.A.
