Claim Manager Resume Samples

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FD
F Deckow
Fredrick
Deckow
7709 Wyman Ville
Dallas
TX
+1 (555) 764 2973
7709 Wyman Ville
Dallas
TX
Phone
p +1 (555) 764 2973
Experience Experience
04/2015 present
Phoenix, AZ
PIP Regional Claim Manager
Phoenix, AZ
PIP Regional Claim Manager
04/2015 present
Phoenix, AZ
PIP Regional Claim Manager
04/2015 present
  • Coach and counsel others on strengths and areas of opportunity by providing feedback and valuing other perspectives
  • Monitor and manage expenses
  • Interview and make hiring recommendations
  • Collaborate with other RCMs to review and improve processes
  • Audit files and calibrate with front line manager audit results
  • Monitor and drive metric results
  • Listen to recorded calls for customer service and process opportunities
02/2010 10/2014
Houston, TX
Msla-claim Manager
Houston, TX
Msla-claim Manager
02/2010 10/2014
Houston, TX
Msla-claim Manager
02/2010 10/2014
  • Develop and monitor goals for staff and the department, providing regular on-going feedback and coaching
  • Provide leadership and directly supervise team members to ensure performance expectations and milestones are achieved
  • Conduct regular self-audits of department results, processes and workflows. Analyze the information to improve outcomes and maximize productivity
  • Work with business leaders and technology team to improve process and system support
  • Identify opportunities and implement process improvements to optimize outcomes and mitigate costs
  • Lead and/or participate in workgroups and committees
  • Assist on RFP’s
09/2004 08/2009
Houston, TX
Claim Manager
Houston, TX
Claim Manager
09/2004 08/2009
Houston, TX
Claim Manager
09/2004 08/2009
  • Contributes to the development and enhancement of claim training/curriculum
  • Makes recommendations on claim policy and procedures and drives claim initiatives
  • Report overpayments, underpayments, and other irregularities to management
  • Prepare reports to be submitted to management for additional authority or coverage issues
  • Management and coordination of award process
  • Conduct detailed bill reviews to implement litigation management and expense control
  • Management of Owner approval process
Education Education
Bachelor’s Degree in Technical Complexity
Bachelor’s Degree in Technical Complexity
University of Illinois at Chicago
Bachelor’s Degree in Technical Complexity
Skills Skills
  • Ability to effectively identify, lead, coach, develop and retain talented claim professionals
  • Ability to drive for superior results in business goals and objectives
  • Technical expertise, claims resolution skills and knowledge of insurance and claims principles, practices and
  • Ability to effectively collaborate with CNA's internal and external business partners, possessing excellent
  • Advanced analytical and problem solving skills, with the ability to prioritize and effectively manage multiple priorities
  • Ability to effectively deal with ambiguous situations and business issues
  • Ability to embrace change and value diverse ideas and opinions
  • Creativity in resolving unique and challenging business problems
  • Knowledge of Microsoft Office Suite and other business-related software
  • LI-AM1
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13 Claim Manager resume templates

1

Scientific Claim Manager Resume Examples & Samples

  • Sets up and manages the multifunctional team that will deliver the evidence development plan in collaboration with R&D Operations (CMC, Med Experts, Research, Evaluation)
  • Submits the Evidence Development Plan to Global Brand Managers/ Steering committee
  • Defines & consolidates budget, resources according to launch marketing plans, ensure Management is in line with recommendations
  • Implements recommendations of the Global Brand Managers/ Steering committee and develops with the project team the operational plan for the execution of the evidence Development plan
  • Follows up on the execution of the operational plan with relevant Clinical Operations and coordinate actions to adapt or correct when necessary
  • Provides updates on project progress to management
  • Evaluates obtained evidence against target product profile specifications and suggests appropriate actions in case of deviations (in collaboration with MD and project team)
  • Obtains approvals for corrective actions (if needed) and implements actions in collaborations with project team and relevant competence pillars
  • Compiles the obtained evidence in a systematic way that allows for easy consultation and communication and contribute to the preparation of claim submission files as needed
  • Liaises with the communication department for the development of internal and external communication
2

Excess / High Cost Claim Manager Resume Examples & Samples

  • Direct technical staff of DIIT and Office of Revenue Operations (ORO) in the preparation and update of computer programs and ensure that necessary technical modifications are compatible with New York State Education Department (SED) and ORO requirements for collecting data used in the preparation and submission of excess cost and high excess cost claims of over $1.3 billion in revenue
  • Assess and identify metrics on critical student demographics that impact claims. Create and maintain reports for analyzing special education placement and determine the impact on state aid
  • Manage analytical review of State excess and high cost claims. Create or modify business rules as per the requirement by Education Law in maintaining proper claim data
  • Utilizing advanced computer tools such as pivots and macros, manage the preparation and submission of thousands of student-specific claim reports as mandated by the State
  • With support from the Director, represent the Department in response to the State Education Department review of the year end data. Research, analyze, and report on supporting backup documentation. Coordinate and report on all backup documentation as requested by State Education Department. Compile and provide backup documentation as requested by the SED
  • Explain variances noted on the claim as identified by the State. Recommend revisions to algorithms and business rules as necessary
  • Prepare modules to construct program costs related to the claim. Coordinate with various program and budget offices with the Department to compile unit cost accounting components for all special education placements
  • Prepare and update projections as needed for submission to the SED
  • Develop and maintain computer models of excess and high cost claims to generate projections and simulations that reflect changes in state aid, based on potential/projected changes in student demographics and/or State law
  • Research current Education Law and assess impact of changes on State excess and high cost aid
  • Process the Medicaid revenue per Medicaid claims and apply revenue to appropriate revenue codes
  • A baccalaureate degree from an accredited college and four (4) years of satisfactory full-time professional experience as described in "1" above, including the 18 months of executive, managerial, administrative or supervisory experience described in "1" above
3

Claim Restriction Manager Resume Examples & Samples

  • Fluent English 
  • XLS practice, knowledge necessary 
  • Medium database administration skills 
  • Communication skills in a remote team environment 
  • Mature behavior as communication with senior professionals and FLMs is required. 
  • Logical thinking and flexibility 
  • Basic corporate finance understanding
  • Preferred Technical and Professional Experience
4

Assistant Manager, Claim Resume Examples & Samples

  • Medical University Degree
  • Insurance or financial qualifications is an advantage
  • Min 3 years work experience in a life insurance or financial services environment
  • Fast learner and hard working
  • Leadership and good communication skills
  • Independent and has the ability to work under pressure
  • Customer Service Orientation,
5

Regional Workers Comp Claim Manager Resume Examples & Samples

  • Works with business units and TPA to reduce Lost Time Days due to WC injuries by providing training, coaching & motivating techniques to mitigate claim costs, i.e. optimal Return To Work
  • Oversees claims from injury through settlement, intervening when necessary to ensure claim follows clear strategic direction that reflects SHC business initiatives
  • Develops & implements loss cost reduction strategies by improving processes & financial results
  • Integrate negotiation piece
  • Confers with defense attorneys to ensure optimal outcomes. (What does this involve?)
  • Provides leadership to internal claims professionals, third party administrators, and vendors in the execution of claim service instructions and strategies to maximize Sears' profitability
  • Identifies claims ripe for settlement & develops strategy to obtain timely, cost effective resolution
  • Works closely with TPA to manage the Medical component, facilitating Return To Work as soon as medically feasible
  • Approves settlement evaluation & maintains grant authority as delegated to Director, Workers Compensation
  • Effective oral & written communication skills
6

Claim Manager Resume Examples & Samples

  • Developing and administering all contract documents from the tender process through to contract closeout including variations and issue resolution for design, construction and other project related contracts
  • Advise the Client on any potential variation to the Design Consultant / Contractor’s Scope of Work that may generate cost or time impact and present PMC assessment
  • Lead PMC staff in assessing variations, claims, and reports to Client’s representative the position of the proposed variation
  • Monitor the permanent materials procurement activities by others providing consultation when requested
  • Evaluate potential risks to the client and to the project and thereafter suggest measures to reduce risks to levels acceptable by the Client
  • Prepares Progress Report Summaries of overall claims and variations
  • Supervises specific contracting activities of a project
  • Management and coordination of award process
  • Development of contract documents including tender documents
  • Management of Owner approval process
  • Monitor contract correspondence
  • Management of claims avoidance activities/measures
  • Claims verification of Entitlement and responses
  • Coordination of contract execution
  • Contract administration including
  • Schedule administration
  • Variation or change administration
  • Risk management administration
  • Proper operation of the Project Execution Plan
  • Periodic preparation and processing of site reports
  • Assistance to the Coordination Engineer for project reporting requirements
  • Maintenance of contract documents
  • Processing of contractor documents
7

Life Claim Case Manager Resume Examples & Samples

  • Bachelor’s Degree and 6 or more years of experience in the Claims Area
  • OR High School Diploma or Equivalent and 8 or more years of experience in Group Life claims area
  • AND 10 or more years of direct line claims management experience
  • Knowledge of Life, Disability and Absence Management
  • Ability to collaborate effectively within a matrix environment
  • Demonstrate effective research skills
  • Strong proficiency with MS Office Products
  • Secures information and reviews coverages to determine liability for life claims
  • Applies claims and target market knowledge to identify how individually and the wider organization can meet and exceed our customer claim service
  • Recommend and implement changes to processes, systems
  • Ensure that appropriate documentation, implementation and communication of established policy, procedures and operating standards is completed for area of responsibility
  • Document claims file by accurately capturing and updating claims data/information in compliance with best practices
  • Exercise judgment to determine liability by gathering and analyzing relevant facts
  • Work to have a timely resolution to claims by developing case strategy; developing a case evaluation; escalating issues as appropriate
  • Meet quality standards by following best practices
  • Ensure customer service by proactively communicating information, responding to inquiries and follow customer protocols
  • Ensure legal compliance by following state and federal laws and regulations and internal control requirements
  • Serve as a technical resource by mentoring lower level claims professionals and sharing technical knowledge related to specific Line of Business expertise
  • Protect Zurich’s reputation by keeping claims information confidential
  • Business Travel, as required
  • Model behaviors that demonstrate commitment to corporate values
  • Provide input into performance management discussions of project team members
  • Educate team members and business partners on area of technical expertise
  • Provide guidance and support for team members
  • Take action to manage own personal development and encourage others to do the same
8

Claim Manager Resume Examples & Samples

  • Manages the work activities and staff of the functional area and has full management responsibility for the performance and development of subordinate staff in accordance with corporate strategic direction. Manages team metrics by analyzing claim reports and driving for superior results
  • Contributes to organizational profitability by ensuring that claims are effectively managed in accordance with company guidelines and standards. Effectively manages loss costs and claim expenses
  • Engages with Claim leadership to identify areas of best practice execution and improvement opportunities in assigned line of business. Recommends training and process improvements and works with Field and line of business leaders to determine implementation strategy when process improvements are required. Leads implementation efforts
  • Builds and maintains collaborative relationships with both internal and external business, such as underwriting, risk control, quality assurance team, staff counsel and actuarial partners
  • Makes recommendations on claim policy and procedures and drives claim initiatives
  • Reviews and manages investigation of claim liability and damages, exposure identification, development of action plans for claim resolution
  • Manages the negotiation of claims settlement packages including setting reserves and authorizing payment or timely refers claims to appropriate location for continued claim handling
  • Remains current on state/territory regulations and issues, industry activity and trends. May participate in industry trade groups
  • Contributes to the development and enhancement of claim training/curriculum
  • Leads project teams and may be accountable for special projects and presentations
  • Works with claim leadership to assure sound and consistent approach to the investigation, evaluation, reserving and resolution of claims
  • Works closely with leadership to design and implement training to address identified trends
  • Ability to effectively identify, lead, coach, develop and retain talented claim professionals
  • Ability to drive for superior results in business goals and objectives
  • Technical expertise, claims resolution skills and knowledge of insurance and claims principles, practices and
  • Advanced analytical and problem solving skills, with the ability to prioritize and effectively manage multiple priorities
  • Ability to effectively deal with ambiguous situations and business issues
  • Ability to embrace change and value diverse ideas and opinions
  • Creativity in resolving unique and challenging business problems
  • Knowledge of Microsoft Office Suite and other business-related software
  • Management Experience preferred
  • Adjusting licensure with potential reciprocity and professional designations preferred
  • Typically a minimum eight years claims experience with extensive auto physical damage experience preferred
9

Msla-claim Manager Resume Examples & Samples

  • Responsible for overall production, performance and quality of the IME Business
  • Provide leadership and directly supervise team members to ensure performance expectations and milestones are achieved
  • Work as a point of contact to effectively understand the unique client needs; Manage new client onboarding process; Interacts with clients to strengthen/expand existing relationships and to ensure appropriate and timely resolution of service issues; Recommends solutions for meeting these needs through process mapping analysis, resource allocation, and division of labor
  • Identify potential new clients and new lines of business; participate in prospective and current client meetings
  • Work with business leaders and technology team to improve process and system support
  • Sets team direction, resolves problems and provides guidance to the team members
  • Develop and monitor goals for staff and the department, providing regular on-going feedback and coaching
  • Conduct regular self-audits of department results, processes and workflows. Analyze the information to improve outcomes and maximize productivity
  • Identify opportunities and implement process improvements to optimize outcomes and mitigate costs
  • Accountable for maintaining effective internal controls over the processes and transactions
  • Adapts departmental plans and standard operating procedures to address business needs
  • Influence and/or provides input into forecasting and planning activities
  • Responsible for managing doctor utilization to ensure they are meeting contractual expectations and timelines
  • Assist on RFP’s
  • Lead and/or participate in workgroups and committees
  • Perform other duties as assigned or required by operational need, or as assigned by Management
  • Operations Management with specific IME Industry knowledge; Knowledge and Experience working with Independent Medical Exams (IME) and Peer Reviews
  • Knowledge and understanding of Claim Processes and Workflows
  • Bachelor’s Degree in Business Administration or Healthcare Administration
  • 5+ years of experience in managing employees
  • Strong Business and Operations Leader
10

Manager, Claim Services Resume Examples & Samples

  • Support account management and client needs by various levels of interaction including conference calls, emails, visits, presentations, and investigative reporting/issue resolution to ensure client retention/satisfaction
  • Provide timely and professional communication to clients, account managers, direct reports and senior management to effectively support team and company goals
  • Support the implementation of company directives and processes to meet internal/external client needs such as retention and satisfaction related to the success of the unemployment claims process
  • Implement and maintain process improvement initiatives as related to system and employee development through the monitoring/streamlining of current operating procedures
  • Provide leadership, direction and supervision to a team of Unemployment Insurance Consultants (UIC’s), Unemployment Claim Specialists (USC’s), Unemployment Hearing Consultants (UHC’s), Unemployment State Consultants (USC’s), associated Team Leads and/or other supporting claims personnel
  • Conduct annual evaluations of team members and provide feedback and monitor departmental performance; address performance issues
  • Evaluate ongoing staffing requirements by reviewing productivity reports, claims and client accounts and hiring and training new employees to meet these requirements
  • Coach and mentor team members including the facilitation of on-the-job training to develop job skills and effectively address client concerns and meet client needs
  • Ability to perform multiple tasks at the same time
  • Ability to respond quickly to unexpected changes
  • Ability to deal with people in a professional and courteous manner
  • Ability to communicate and motivate individuals in the department
  • Creativity and optimism
  • Ability to interact in written and oral form with clients, state agencies, and all levels of company personnel
  • Ability to gather, coordinate and present technical data in verbal and written form
  • Ability to handle high volume of work and work under deadlines
  • Excellent analytical skills, problem solving and decision making abilities
  • Ability to work well within a team
  • Ability to follow policies and procedures; complete administrative tasks correctly and on time
  • High level of organization and multi-tasking abilities
  • Ability to handle a high volume of work and work under deadlines
  • Self-motivated with high level of initiative
  • HS Diploma or Assoc. Degree. Bachelors Degree preferred
  • Preferred supervisory or lead experience with a strong emphasis on customer service preferred. Industry knowledge of the unemployment process preferred
  • Understanding of PC functions, including Windows-based applications and ability to learn/understand internal UCM technology/systems
11

Claim Manager Resume Examples & Samples

  • Manage the day to day operations with the Partner Support Center teams
  • Track and improve the performance of your agents using the daily performance report and regularly assess your agents’ skills using the QA scorecard
  • Ensure procedures and regulations are enforced
  • Provide regular, transparent feedback and reporting on team performance to your agents as well as to your manager
  • Manage and make decision on or escalated complicated case for your team members
  • Continuously improve the key performance indicators (KPIs) of your team on productivity, quality, service level, and seller satisfaction
  • Review and improve internal claim and returns processes
  • Meeting with sellers when necessary to discuss claims and dispute topics and complaints
  • Thai Nationality only
  • Bachelor’s Degree or higher in related fields
  • Team management skills
  • Results and KPI driven, highly detailed oriented
  • Ability to prioritize tasks and manage multiple tasks under pressure
  • Fluent in EN and in TH (speaking, writing and reading skills)
  • Good technical skills and proficiency in Excel
12

Msla-claim Manager Resume Examples & Samples

  • Operations Management with specific IME Industry knowledge; Knowledge and Experience working with Independent Medical Exams (IME)
  • Bachelor’s Degree in Business Administration or Healthcare Administration or equivalent work experience
  • 3+ years of experience in managing employees
13

Eso-casualty Claim Manager Resume Examples & Samples

  • Applications will be accepted for this position through midnight on (internally3/29 and externally 4/5 )
  • Offer to selected candidate will be made contingent on the results of applicable background checks
  • Demonstrated experience handling complex casualty claims
  • Solid knowledge and understanding of each phase of the claim handling processes
  • Solid knowledge and understanding of casualty policy language, coverages and underwriting intent
14

Claim Manager Resume Examples & Samples

  • Builds and maintains collaborative relationships with both internal and external business, such as underwriting, risk control, staff counsel and actuarial partners
  • Reviews and manages investigations of claims, liability and damages, and works with senior management to determine if major claims should be settled or litigated
  • Manages the negotiation of claims settlement packages including setting reserves and authorizing payment or refers claims to appropriate location for adjudication
  • Technical expertise, claims resolution skills and knowledge of insurance and claims principles, practices and procedures
  • Ability to effectively collaborate with CNA's internal and external business partners, possessing excellent communications, negotiations and presentations skills
  • Bachelor's degree or equivalent experience. Professional designations preferred
  • Typically a minimum eight years claims experience
15

Claim Manager Resume Examples & Samples

  • Manages the work activities and staff of the functional area and has full management responsibility for the performance and development of subordinate staff in accordance with corporate strategic direction. Manages team and metrics by analyzing recovery/claim reports and delivering desired results
  • Manages the negotiation of claims settlement, including setting reserves and authorizing payment
  • Ability to effectively identify, lead, coach, develop and retain talented recovery/claim professionals
  • Ability to effectively collaborate with CNA's internal and external business partners, possessing excellent communication, negotiation and presentations skills
  • Typically a minimum eight years commercial claims/recovery experience
16

OPC Claim Manager Resume Examples & Samples

  • Provide supervision, leadership, direction and coordination of operational day-to-day activities within the Employees Compensation Claims Team
  • Manage the claims function to ensure operational efficiency, efficient claims settlement and equitable solution to claims dispute in accordance with company claims philosophy
  • Support the implementation of claims management strategies and objectives for the region/branch
  • Initiate new ideas and recommend changes to department policy and procedures as needed
  • Contribute to the refinement of processes and procedures to improve Claims systems and procedures
  • Approve substantial claims within appropriate authority levels
  • Maintain current knowledge of insurance guidelines, policy changes and modifications
  • Work with key stakeholders/business managers to develop sustainable Claims products and services to attract and retain customers and increase profitability
  • Quickly respond to and resolve complaints within the agreed service standards. Take immediate corrective actions when necessary
  • Lead the team to respond to critical issues and exceptions appropriately
  • Ensure legitimate claims are paid in accordance with policy conditions by providing technical expertise and leadership
  • Supervise the medical, return to work management, investigation and settlement of all claims within the team
  • Motivate and develop the team by demonstrating good leadership behaviours and through the use of management best practice, to enable development of staff to support the achievement of business goals
17

Claim Manager Resume Examples & Samples

  • Adjust reserves and provide recommendations to ensure reserving activities are consistent with corporate policies
  • Communicate promptly and professionally with all parties when answering questions and gathering claim information
  • Conduct detailed bill reviews to implement litigation management and expense control
  • Confer and direct legal counsel on claims requiring litigation and attend mediations, arbitrations and/or trials when necessary
  • Contact and/or interview insureds, claimants, witnesses, doctors, medical specialists and/or employers to obtain additional information to mitigate claims
  • Enter claim payments, reserves and new claims into computer system by inputting concise yet sufficient file documentation
  • Examine claims investigated by outside insurance adjusters and further investigate questionable claims to determine whether to authorize payments or refer the claim to SIU
  • Investigate, evaluate and settle claims applying technical knowledge and human relations skills to effect fair and prompt disposal of cases which will result in a reduced loss ratio
  • Maintain claim files with professional notes and detailed analysis
  • Pay and process claims within designated authority level
  • Prepare reports to be submitted to management for additional authority or coverage issues
  • Present cases and participate in their discussion at monthly claim committee meetings
  • Report overpayments, underpayments, and other irregularities to management
  • Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures
  • Perform other duties as assigned by management and mentor less experienced staff
  • A thorough technical understanding of insurance coverage and claim procedures
  • A strong team player with initiative and ability to effectively multi-task
  • Must communicate professionally with excellent verbal and written skills
  • Computer skills with working knowledge of company software programs
  • English (Reading, speaking and writing 70%)
  • Travelling: 40% of time (National and international) *American VISA desirable (but not a MUST requirement)
  • Candidate willing to relocate to Mexico City, CDMX
18

Crop Claim Manager Resume Examples & Samples

  • Manages assigned staff. Maintains proper personnel practices including hiring, performance evaluation, salary administration, promotion, transfer, and termination. Trains and develops staff
  • Ensures that claims are adjusted and processed correctly according to established loss adjustment guidelines. Adheres to file documentation standards, and Crop Division reserving methodologies and practices
  • Improves productivity through constant analysis of workflow and procedures while adhering to established L.A.E. goals
  • Establishes appropriate performance and productivity standards for the efficient processing of all claim-related transactions
  • Establishes appropriate quality measures; monitors results to ensure high quality service delivery while upholding claim integrity standards
  • Provides feedback to marketing, underwriting and management staff regarding the quality of business and/or policy files
  • Manages the field and internal claim staff to ensure timely, accurate and professional service to all agents and policyholders
  • Participates in the establishment of regional goals, plans, strategies and operating methodologies
  • Insight and monitoring of adequate reserves
  • Systematic evaluation of risk to accurately forecast loss ratio projections
  • Candidates must have a Bachelor’s degree or equivalent business/work experience
  • 5+ years of crop claim experience and 5+ years management/supervisor experience is required
19

Msla-claim Manager Resume Examples & Samples

  • Work as a point of contact to effectively understand the unique client needs; Manage new client onboarding process; Interacts with clients to strengthen / expand existing relationships and to ensure appropriate and timely resolution of service issues; Recommends solutions for meeting these needs through process mapping analysis, resource allocation, and division of labor
  • Operations Management experience
  • Business and Operations Leader experience
  • Proficient in general computer use and Microsoft Office Suite
  • Experience / Knowledge of Peer Reviews
  • 3rd Party Administrator or Insurance Company experience
  • IME Industry knowledge; Knowledge and Experience working with Independent Medical Exams (IME)
  • Medical Disability Exam Experience
  • Knowledge of relevant State and Federal Compliance Guidelines
  • Prior experience partnering with Sales to identify and on-board new clients
20

Claim Manager Resume Examples & Samples

  • Coach and manage the work activities and staff of the functional area and has full management responsibility for the performance and development of staff in accordance with corporate strategic direction. Utilizes team metrics to ensure that behaviors are driving superior results and identifying areas of opportunity
  • Ensures the team delivers industry-leading levels of service and excellent claim outcomes for our customers
  • Builds and maintains collaborative relationships with both internal and external business partners, such as Underwriting, Risk Control, Litigation Counsel, and Actuary
  • Reviews and manages reserving, investigations, liability and damages, and settlements, partnering with Legal and other business partners to achieve optimal results
  • Ability to effectively identify, lead, coach, develop, and retain talented claim professionals
21

Specialty Branch Claim Manager Resume Examples & Samples

  • Demonstrated experience in a leadership role
  • Solid knowledge and understanding of claim handling procedures
  • Solid knowledge and understanding of claims concepts and strategies
22

PIP Regional Claim Manager Resume Examples & Samples

  • Monitor and drive metric results
  • Interview and make hiring recommendations
  • Evaluate performance making recommendations for merit/bonus increases, promotions and performance improvement when needed
  • Coach and counsel others on strengths and areas of opportunity by providing feedback and valuing other perspectives
  • Monitor and address customer service issues as needed
  • Monitor workplace culture and environment, taking action when needed
  • Review complex files and grant authority for coverage and indemnity when needed
  • Audit files and calibrate with front line manager audit results
  • Listen to recorded calls for customer service and process opportunities
  • Remain aware of changes which impact claims handling in region (internal and external changes)
  • Collaborate with other RCMs to review and improve processes
  • Work with Product Managers to gain mutual understanding of what may impact products, pricing and claims handling
  • Ability to listen and diffuse customer concerns through explanation of our position
  • Monitor and manage expenses
  • Maintain and build agent relationships with others
  • Prior FL PIP claims handling and Management experience
  • Understanding FL PIP Litigation landscape and how it impacts claims handling
  • Ability to analyze and interpret data to drive improvement
  • Solid understanding of compliance knowledge, policy and legal, and how to apply in decision making
  • Understand the importance of being available and approachable as a leader
  • Proficient in Microsoft Office (Word, Outlook, Excel, PowerPoint)
  • Effective organizational and management skills with the ability to work under pressure, multi-task, adhere to project deadlines and successfully adapt to a changing environment
  • About National General Holdings
23

Claim Case Manager, SMD Resume Examples & Samples

  • Strong math aptitude skills
  • Ability to multi-task and meet turnaround times
  • Demonstrate independent problem solving and decision making ability
  • Ability to clearly communicate claim decisions and contract language verbally and in written correspondence
  • Excellent analytical, problem solving, and communication skills (verbal & written) essential
  • Ability to multi-task, balance goals and priorities a must
  • Ability to work independently and within a highly collaborative team environment
  • Group Disability claim experience or product knowledge strongly preferred
  • Regulatory and Compliance experience a plus
  • Understanding of medical terminology and medical conditions helpful
  • Strong math aptitude skills and PC skills (e.g., Microsoft Word & Excel)
  • Ability to adapt to change
  • Minimum 1-2 years of disability claim / case management, or other previous group insurance experience preferred