The Claims Supervisor will manage and supervise insurance claims representative and also make sure the claims are accurately reported. To perform this core job task, the Claims Supervisor Resume mentions the associated tasks to be performed and such are – reviewing the claims relating to property, casualty, damages or personal; understanding fraudulent or illegal practices, reviewing claim file, investigating claims if necessary, promptly negotiating settlements, attending court hearings, ensuring the settlement made reflects the actual claimant losses, and making sure the insurer is protected from invalid claims.
A College education preferably in business administration or other suitable fields of study is required. Experience in risk management and insurance management is also needed. Strong communication skills, experience with MS Office is also needed. Employers prefer applicants who have extensive experience and skills with claims processing software. In addition, the ability to deal with people directly and fairly will also be required.
Summary : Looking for an opportunity in a reputed organization where I can complement and utilize my skills that will contribute in an effective manner. To be an asset and effective individual to serve and express my numerous skills, and form a long-term relationship in a career that I wish to pursue.
Skills : Microsoft, Leadership.
Description :
Responsible for Directing and overseeing the handling of Claims process functions and quality control to achieve optimal economic outcomes for the DPS and assures that claimants are treated fairly and with respect.
Meets with the Program Supervisor-Property and Liability and Executive Director as needed to discuss the activities of the unit along with any issues that may arise.
Attend the Liability/Legal claims roundtable to discuss open claim files, review settlement offerings, discuss denials and files closures File and track claims were insurance coverage applies.
Created a temporary data base to house of all non employees' claims within the District.
Denies, settles or authorizes payment of claims based on coverage, appraisal and verifiable damage.
Represents the District in Small Claims Court for mini tort recovery claims.
Review and provide recommendation for all student injury and theft reports.
Conduct claim investigations and evaluate the information to identify significant hazards and loss trends, and recommend preventive measured and corrective actions Analyze and trend District Losses Analyze and adjust reported claims to determine DPS' liability to ensure ongoing adjudication of claims within DPS claims standards and industry best practices.
Experience
10+ Years
Level
Senior
Education
Bachelor Of Business
Sr. Claims Supervisor Resume
Summary : Motivated individual with a successful work experience in processing reports, organization, customer service and retail. Seeking a position where I can merge my strong work ethic and organizational skills.
Skills : Microsoft Office, Coordintaing Skills.
Description :
Supervise and train report processors through the intricacies of insurance claim processing.
Manage the coordination and documentation of multiple field technicians' assessments of damage nationwide.
Maintain accurate records for reporting and audit purposes.
Utilize and manage Salesforce.com to track and update insurance adjuster's information to generate mass mailings.
Oversee report processors spreadsheets to ensure that they have all documentations and photos are accurate.
Research repair costs, replacement value, and depreciation assessments.
Convert spreadsheets and photos into PDF files for insurance adjusters to speed the resolution of pending claims, creating a more streamlined process.
Experience
10+ Years
Level
Senior
Education
Psychology
Jr. Claims Supervisor Resume
Summary : Results An inspirational leader with 25 years experience managing complex litigated, auto, general liability and construction defect claims. Excellent communication skills with strong emphasis on coverage analysis and interpretation. Creatively implemented methods to streamline workflow and drive down severity commensurate with the best interest of the company, insured's, brokers, staff, and the public.
Skills : Powerpoint, Leadership.
Description :
Responsible for performance and development of a general liability claim team handling claims throughout the United States with proficiency, adherence to best practices, focus on customer satisfaction, reduction in severity.
Spearheaded review of medical pay coverage claim handling, identified areas of lost economic opportunity, developed and administered adjuster training to reduce inappropriate claim payments.
Developed staff to handle complex litigated claims.
Leading the general liability operation in quality assurance best practices results, while maintaining current diaries, avoiding defaults, and facilitating use of structured settlements.
Held monthly team meetings for training purposes and also provide an open forum to discuss work flow, morale, improve claim processes and train.
Held monthly one on one with each team member to discuss performance, improvement needed and inspire engagement.
Managed team budgets for salaries, bonus and incentives and performed all needed performance reviews.
Participation on prestigious Employee Recognition Council which drives performance culture and selects winners of top award recognition in company.
Experience
10+ Years
Level
Consultant
Education
Bachelor Of Arts
Jr. Claims Supervisor Resume
Objective : To obtain a position, which utilizes my higher education, skills, talents and prior work experience, in a company in which I can grow and help contribute to its success. I enjoy working in challenging and evolving situations. I have the desire to use problem solving and analytical skills. Positive attitude allows me to be a great team leader, as well as mentor and inspire employees.
Skills : SQL, Microsoft Office, Cognos, Business Analysis, Analysis,.
Description :
Responsible for managing the development and activities of an organized team of claims processing specialists and support staff.
Supervised daily activities of teams ranging from 7 to 35 persons.
Provided leadership to a team of 7 claims specialists during a live system conversion from a paper claim system to an electronic pend resolution system while simultaneously managing another team of 7 Customer Service Representatives in a claims call center.
Managed claims inventory and workflow to meet Magellan's contractual performance guarantees.
Served as subject matter expert, product and procedure expert and knowledge resource for the team.
Monitored, examined, analyzed and reported on individual and team performance.
Implemented action plans as necessary to improve service levels and ensure that customer performance guarantees are consistently met.
Experience
2-5 Years
Level
Junior
Education
Associate Of Science
Claims Supervisor II Resume
Headline : Experienced healthcare leader, with significant experience in claim processing, compliance, worfklow implementation, operations and finance. Effective problem-solver, knowledgeable in government programs and products. Expert in managed care products in regards to billing and documentation requirements. Successful in team building and direct supervision, motivating and supporting staff professional development.
Skills : Microsoft Office, Planning Skills.
Description :
Monitor compliance with all departmental policies, procedures, and workflows as well as interface with Quality Assurance regarding procedure compliance.
Develop and implement system and operational changes to improve service and production efficiency of the department.
Ensure compliance with HIPAA regulations and requirements.
Supervise and research special projects as assigned by leadership.
Monitor departmental and individual performance metrics and take proactive action when necessary on a timely basis to maintain desired workflow outputs.
Recruit, hire, train, develop, motivate, and supervise, Claims staff assigned to claim processing functions including the review and approval of claims, data entry transactions, adjudication and adjustments, related reporting or other claims operations functions, to achieve successful functional performance.
Ensure that staff meet or exceed productivity and quality goals while adhering to applicable internal and external policies, procedures, rules and guidelines productivity and quality for assigned teams, identify trends and recommend improvements to processes, systems, etc.
Experience
5-7 Years
Level
Executive
Education
General Education
Claims Supervisor III Resume
Summary : Claims Supervisor professional within the healthcare and financial industries with extensive sales and collections experience. Easily adjustable to change regarding technology or regulations. Very experienced in training new employees and enhancing the abilities of established workers. Financial Services Banking Operation and Management Sales Management Training Collection Management Technical Support.
Skills : MS office, Customizing Skills.
Description :
Management of 9 direct reporting associates responsible for general liability bodily injury and property damage claims.
Required licensing and handling of claims in 48 states.
Responsible for inventory, analytics, locating trends, improving efficiencies to quantify re: investigation, handling, and claim inventory reduction.
Supervision of compliance, federal and state guidelines, and all aspects of claims handling for general and special damages.
Seek out and improve cross-divisional relationships and process improvement both locally and through support of field managers.
Improved communication and trended claim inventory down over 60% in one quarter via utilization of analytics via Retail Linkand local data mining to ensure handling with urgency and quality while providing superior leadership, customer service, and trend of reduction in inventory.
Claims Dispute Administrator Reporting directly to management and executives.
Responsible for data mining and analytics, queried via Retail Link to build custom reports and templates for Managers, Directors, and Executives in Operations management.
Experience
7-10 Years
Level
Management
Education
B.S. In Computer Science
Claims Supervisor I Resume
Objective : Responsible for Providing general assistance to department management in the implementation of quality improvement measures associated with audit results from regulatory agencies.
Skills : Microsoft Office Suite, Monitoring Skills.
Description :
Monitors and documents individual and team performance; provides timely feedback, coaches and counsels; writes and delivers performance evaluations.
Oversees daily operations and assigns work to staff members, including but not limited to the processing of specialty clinical claims / special circumstance claims and/or notification processes.
Informs manager of urgent issues, priorities, identified problems, and associated recommendations.
Evaluates staffing and resource needs to make recommendations, and actively participates in the recruitment process.
Maintains confidentiality of all members, practitioners, client and other proprietary and sensitive business information.
Ensures claims compliance with regulatory agencies, accreditation agencies, and health plan delegation requirements.
Provides general assistance to department management in the implementation of quality improvement measures associated with audit results from regulatory agencies.
Experience
2-5 Years
Level
Junior
Education
MBA In Marketing
Property Claims Supervisor Resume
Objective : More than 16 years working in insurance industry; which includes contract negotiations, accounts receivables, report writing, compliance, auditing, provider contracting, credentialing, and training. Able to multi-task, investigate, and resolve complicated issues.
Skills : Management, Retail Sales, inventory control, Retail Sales, home health care provider.
Description :
Monitors and documents individual and team performance; provides timely feedback, coaches and counsels; writes and delivers performance evaluations.
Oversees daily operations and assigns work to staff members, including but not limited to the processing of ASO/OOS/special circumstance claims and/or notification processes.
Informs manager of urgent issues, priorities, identified problems, and associated recommendations.
Evaluates staffing and resource need to make recommendations, and actively participates in the recruitment process.
Maintains confidentiality of all members, practitioners, client and other proprietary and sensitive business information.
Ensures claims compliance with regulatory agencies, accreditation agencies, and health plan delegation requirements.
Training and mentoring our new temps in order for them to become full-time employers faster than the time needed.
Experience
2-5 Years
Level
Junior
Education
MBA In Marketing
Supplemental Claims Supervisor Resume
Objective : A versatile and skilled professional with exceptional leadership qualities and significant hands-on experience in developing and driving operational metrics favorable to expectations. Absolutely fanatical about providing an extremely positive experience during all phases of interaction. An assertive individual with outstanding interpersonal, communications, negotiation, conflict management/resolution, presentation, project management and people management skills.
Managed claim inventories with an estimated 10k receipts daily.
Implemented new direction in management to focus on quality as well as quantity and more achievable expectations for telecommuting staff.
Continuously partnered with IT/Shared Services to implement and evaluate system enhancements on improving auto-adjudication rates.
Selected Contributions: Consistently and effectively managed claim inventory levels to 98% within 30 days of receipt for 10K+ claims by targeting specific days and effective workforce management.
Improved relations with existing telecommuting workforce by providing challenging, yet realistic production expectations.
Significantly improved in-house/telecommuter communication and team cohesiveness by establishing SharePoint site and in-house quarterly meetings and monthly WebEx meetings.
Reduced attrition to nearly 5% by my second year through a caring and understanding style of leadership that places accountability on the employee and consistent performance reviews.
Experience
2-5 Years
Level
Executive
Education
Business
Associate Claims Supervisor Resume
Summary : Compensation and risk management enthusiast whose experience includes adjudication of claims, management of both safety and risk management departments for $3B company as well as a developer of MMSEA/Section 111 program for a $4B multi-state and international service organization.
Supervised health claims department, overseeing team to ensure accurate and timely processing.
Headed employee recruitment and retention process, from interview and hire to training and performance management to ensure quality staff succession.
Provided human resource support in areas of hiring, coaching, attendance management, discipline, union contract interpretation, worker's compensation, family medical leave act (FMLA), and leave of absence (LOA) paperwork for direct reports.
Track employee production and manage labor hours using Time information management system.
Present one-on-one training and conduct staff performance evaluations and internal investigations.
Coordinated and liaised with broad cross-functional partners, including external providers, facility member services, call centers, and contracting and referral departments.
Addressed inquiries and issues for a range of stakeholders, from members and providers to attorneys and governmental agencies.
Facilitated and contributed to department-wide Labor Management Partnership (DLP) committees.
Experience
10+ Years
Level
Senior
Education
Bachelor Of Arts
Claims Supervisor I Resume
Objective : Over 10 years of extensive claims examining and auditing experience. Extensive management and supervisory experience. Proficient knowledge of CPT/HCPCS/ICD9-10/Revenue Codes. Thorough knowledge of staff training, development and team building . Analytical, dedicated and results-driven professional. Experienced in writing training manuals and policy and procedure manuals.
Responsible and accountable for the supervision and performance management of small claims team.
Oversee the day-to-day operations of the claims department and ensuring department compliance with City and County Medical Plan provisions.
Ensuring overall claims adjudication is in accordance with State, Federal and Health Plan regulatory requirements and guidelines.
Develop training programs, provide organization and a unified structure to the claims transaction review process, identify claims transaction inconsistencies, and implement controls and/or changes to systems and policies that support claims adjudication.
Responsible for accurate and timely adjudication of Clovis Unified School District, EAP, and PDR claims according to regulatory guidelines (AB1455).
Responds to incoming calls from providers of service and members in a timely and courteous manner as it relates to Claims and Provider/Member Disputes.
Analyze, process, research, adjustment of all provider reconsideration requests and correspondence in a timely and accurate manner.
Experience
2-5 Years
Level
Junior
Education
Diploma
Sr. Claims Supervisor Resume
Summary : Experienced health claims supervisor seeking new challenges. Organized, self-motivated, and able to work well under pressure. Detail and extensive customer service experience.
Skills : Microsoft Office, Mitchell Estimating Software.
Description :
Handled all aspects of Social Security Disability claims from initial application to processing of benefits.
Met with clients to explain the process of and qualifications of filing for disability benefits.
Handled multi-line phone system answering incoming calls and emails from potential clients and took detailed information for the attorney and scheduling of appointments.
Electronically filed disability claims with the Social Security Administration.
Filed appeals with the Social Security Administration and worked closely with the disability examiners and Social Security claims representatives to ensure that a fair decision was made.
Calendared and monitored all claims to ensure that all deadlines were met.
Handled all incoming mail and correspondence and distributed accordingly.
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