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 : Dynamic Claims Team Leader with over 10 years of experience in optimizing claims operations and driving team performance. Proven expertise in mentoring staff, enhancing quality standards, and fostering a culture of continuous improvement. Committed to delivering exceptional service while meeting critical performance metrics and ensuring compliance with industry regulations.
Supervised daily operations of the claims team, setting priorities, scheduling work, and coaching staff to ensure compliance with Claims Quality Standards.
Developed a high-performing team through strategic hiring, onboarding, and continuous professional development initiatives.
Promoted a culture of continuous improvement by leveraging the Liberty Management System for problem-solving and standard work development.
Built and maintained strong relationships with internal and external stakeholders to enhance service delivery.
Acted as the primary liaison for agents, brokers, and policyholders, ensuring effective communication and issue resolution.
Facilitated regular claim reviews to ensure compliance with Special Service Instructions and quality standards.
Conducted management oversight of claims files, performing quality assurance reviews and identifying training needs for team members.
Experience
10+ Years
Level
Senior
Education
BBA
Claims Team Leader Resume
Objective : Accomplished Claims Team Leader with 5 years of expertise in enhancing claims processes and driving operational excellence. Skilled in leading diverse teams, implementing strategic improvements, and ensuring adherence to compliance standards. Dedicated to fostering a high-performance culture while achieving service quality and efficiency goals.
Skills : Claims Risk Assessment, Team Leadership And Development, Claims Management, Regulatory Compliance, Risk Assessment
Description :
Managed and developed a high-performing team of seven in a client-focused personal injury claims environment.
Implemented coaching strategies that resulted in a 75% promotion rate for team members within their first year.
Trained staff on operational procedures and client engagement, enhancing overall team performance.
Analyzed performance metrics to identify areas for improvement and develop personalized coaching plans.
Recognized as the leader of the top-performing representative in New York, closing 86 accounts in 90 days.
Proactively addressed client satisfaction issues, exceeding Net Promoter Score expectations by 8% year-to-date.
Executed a consultative customer service approach, leading to 89 successful claim closures within 30 days.
Experience
2-5 Years
Level
Junior
Education
B.B.A.
Claims Team Leader Resume
Headline : Results-oriented Claims Team Leader with 7 years of experience in optimizing claims management and enhancing team productivity. Adept at mentoring staff, streamlining processes, and ensuring compliance with regulatory standards. Passionate about driving high-quality service delivery while achieving key performance indicators and fostering a culture of continuous improvement.
Oversaw daily claims operations, ensuring timely and accurate processing.
Conducted thorough investigations to determine liability and validate claims.
Reviewed and resolved insurance policy coverage issues, ensuring compliance.
Estimated and negotiated property damage costs with repair facilities and claimants.
Facilitated negotiations for bodily injury settlements with claimants and attorneys.
Collaborated with the Special Investigative Unit to address fraud cases.
Developed and implemented training programs for new staff to enhance quality assurance.
Experience
5-7 Years
Level
Executive
Education
B.S. in BA
Claims Team Leader Resume
Objective : Proficient Claims Team Leader with 5 years of experience in managing claims operations and enhancing team performance. Expertise in coaching personnel, optimizing workflows, and ensuring compliance with industry standards. Focused on delivering superior service and achieving key performance indicators while fostering a collaborative team environment.
Skills : Microsoft Office Suite, Performance Management, Mitchell Claims Management, Team Leadership, Communication Skills
Description :
Increased productivity by 15% while achieving top regional customer service scores.
Coached and developed team members across four regional offices, enhancing overall team performance.
Designed and executed a claims assignment pilot program, significantly improving efficiency.
Provided daily feedback to struggling associates, enhancing productivity and job satisfaction.
Conducted regional diagnostics to identify improvement areas, implementing best practices.
Boosted branch work quality by 18% compared to the previous year.
Experience
2-5 Years
Level
Executive
Education
B.S. in BA
Claims Team Leader Resume
Objective : Accomplished Claims Team Leader with 5 years of experience in managing high-performing teams and enhancing claims operations. Expertise in strategic process improvements, compliance management, and mentorship. Driven to deliver exceptional client service while consistently achieving operational goals and fostering a collaborative team environment.
Oversaw a team of 6 claims specialists, managing an average of 200 active claims per specialist across 26 states.
Executed hiring, training, and performance management processes to develop team competencies.
Managed complex professional liability claims, ensuring timely and equitable resolutions.
Supervised litigation processes with outside counsel, maintaining oversight of legal strategies.
Provided expert consultation to Underwriters and executives regarding policy language and claims issues.
Developed and implemented standardized guidelines for claims processing and vendor interactions.
Enhanced operational efficiency by revising workflows related to claims setup and deductible collection.
Experience
2-5 Years
Level
Junior
Education
BBA
Claims Team Leader Resume
Objective : Seasoned Claims Team Leader with 5 years of proven experience in managing high-volume claims operations and driving team success. Expertise in enhancing operational processes, ensuring regulatory compliance, and fostering staff development. Passionate about delivering exceptional service and optimizing performance metrics for sustained organizational growth.
Coordinated with 25 behavioral health facilities to reconcile claims efficiently.
Utilized online portals and direct communication with insurers to track claim statuses.
Successfully appealed denied claims, securing thousands in reimbursements for clients.
Applied strong problem-solving skills to resolve complex issues effectively.
Enhanced company relationships with insurance providers, improving claim processing times.
Led the implementation of document imaging projects, optimizing workflow.
Reduced associate turnover to zero over two years through effective team engagement strategies.
Experience
2-5 Years
Level
Executive
Education
B.S. in B.A.
Claims Team Leader Resume
Objective : Innovative Claims Team Leader with 5 years of experience in transforming claims operations and enhancing team dynamics. Expertise in process optimization, staff training, and compliance management, ensuring high-quality service delivery. A results-focused leader dedicated to achieving operational excellence while fostering a collaborative and motivated work environment.
Skills : Conflict Resolution, Data Analysis Tools, Motivational Skills, Sales Skills, Market Research
Description :
Conducted comprehensive training sessions for staff on claims procedures and compliance.
Reviewed and analyzed customer complaints to recommend appropriate disciplinary actions.
Implemented operational improvements following the multi-state task force settlement.
Analyzed complex claims cases, ensuring compliance with regulatory standards.
Maintained high-quality service delivery through effective claims oversight.
Received recognition for outstanding contributions to claims operations.
Facilitated staff development programs to enhance team capabilities.
Experience
2-5 Years
Level
Executive
Education
B.S.B.A.
Claims Team Leader Resume
Summary : Accomplished Claims Team Leader with a decade of experience in streamlining claims management and enhancing team efficiency. Demonstrated ability to develop high-performing teams, implement effective strategies, and maintain compliance with industry regulations. Passionate about driving operational success while delivering outstanding service and fostering a culture of continuous improvement.
Skills : Process Improvement, Decision Making, Interpersonal Skills, Adaptability, Training & Development
Description :
Provided technical assistance and supervised the daily activities of a team of Senior Claims Examiners to ensure optimal performance.
Developed and implemented programs to meet claims goals and objectives, enhancing team efficiency through product knowledge and customer insights.
Created and managed training initiatives for entry-level benefit analysts, fostering career development within the team.
Successfully transitioned a line of business from California to Richmond, ensuring seamless operations.
Established a new team and executed related projects to improve claims processing.
Supervised the accuracy and timely adjudication of all claims, ensuring compliance with industry standards.
Investigated and resolved complex claims issues, enhancing communication between providers, clients, and team members.
Experience
10+ Years
Level
Senior
Education
B.S. in BA
Claims Team Leader Resume
Objective : Results-driven Claims Team Leader with over 7 years of experience in managing claims processing and team performance. Proven track record in improving operational efficiency and enhancing customer satisfaction. Skilled in training and mentoring staff, implementing best practices, and ensuring compliance with industry regulations. Adept at analyzing claims data to identify trends and drive strategic improvements.
Analyzed EDI transmissions to verify electronic claims submissions and compliance.
Reviewed claims against provider contracts and guidelines, ensuring adherence to standards.
Managed, trained, and developed a team of Claims Representatives to enhance performance.
Monitored key metrics to ensure service level agreements were consistently met.
Authored and revised controlled documents including SOPs and work instructions.
Addressed and resolved customer complaints to improve satisfaction.
Utilized KPIs to drive operational accuracy and efficiency, enhancing customer service quality.
Experience
2-5 Years
Level
Junior
Education
B.S.B.A.
Claims Team Leader Resume
Summary : Accomplished Claims Team Leader with a decade of experience in driving operational excellence and enhancing claims processing efficiency. Expertise in mentoring teams, implementing strategic improvements, and ensuring compliance with industry standards. Passionate about fostering a high-performance culture and consistently exceeding service quality metrics while delivering exceptional client satisfaction.
Skills : Sap Software Expertise, Advanced Excel Proficiency, Microsoft Word Proficiency, Customer Relationship Management, Problem Solving
Description :
Promoted from High-Cost Claims Adjustor to Claims Team Leader based on performance and leadership abilities.
Implemented project management strategies to enhance claims processing efficiency.
Monitored team performance and provided actionable feedback to drive improvement.
Conducted claim adjustments for high-cost claims, ensuring accuracy and compliance.
Streamlined claims processing for skilled nursing facilities, focusing on pre-existing condition policies.
Participated in system migration and testing, recognized for strong communication and attention to detail.
Led and mentored a high-performing claims operations team, achieving departmental objectives.
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