Claims Manager Resume Samples

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ES
E Strosin
Eden
Strosin
1683 Larson Skyway
Los Angeles
CA
+1 (555) 556 6805
1683 Larson Skyway
Los Angeles
CA
Phone
p +1 (555) 556 6805
Experience Experience
San Francisco, CA
Claims Manager
San Francisco, CA
Ritchie LLC
San Francisco, CA
Claims Manager
  • Providing developmental feedback, coaching, and direction on work management
  • Interviews, hires and establishes colleague performance development plans; conducts colleague performance discussions
  • Provides Claims management by meeting with brokers, Risk Managers and reinsurers to both implement and maintain claim management programs
  • Establishes and executes controls to assure that the quality of the work meets or exceeds standards
  • Assists with preparations of executive-ready management reports including claims administration performance and cost savings
  • Collaborate with peers to meet Key Performance Indicators and develop strategic initiatives to consistently improve throughout the business
  • Assist in developing and implementing improvement processes
Phoenix, AZ
Bodily Injury Claims Manager
Phoenix, AZ
Block-Roberts
Phoenix, AZ
Bodily Injury Claims Manager
  • Analyze budget variances and assist Regional Claims Manager with development of annual budget process
  • Coordinate internal communication to establish new field offices and manage the daily operations of field offices
  • Summarizes results, identifies opportunities for efficiencies and improvements in order to make recommendations and communicate key messages to branch team and senior management
  • For all duties and responsibilities, manager will take ownership of any issue, problem, or error that could potentially impact the policyholder and/or loss participant
  • Supervises, evaluates performance and recommends salary changes for personnel. Responsible for recommending promotions or disciplinary action of direct report. Primary responsibility for interviewing and selection of new personnel. Will also assist with other staffing decisions
  • Oversee and manage the entire claims handling process working independently and through special projects to direct the branch's activities in this area
  • Provides continuous training and support to personnel
present
Dallas, TX
Senior Claims Manager
Dallas, TX
Breitenberg and Sons
present
Dallas, TX
Senior Claims Manager
present
  • Work closely with Manager of Network Services and Medical Delivery Coordinator in expanding provider network
  • Keep senior management abreast of developments within the operation and provide support for management on special projects
  • Partners with Team Leader to evaluate employee performance and support performance management plans for under-performing staff
  • Provide assistance and oversight of workers' compensation panel development and utilization
  • Provide Management Oversight and direction to the claim units in the adjudication of workers compensation claims
  • Provide training on claims to project management and contract management community
  • Support on claim management, dispute settlement and other contract management and legal issues arising during the course of performing contracts
Education Education
Bachelor’s Degree in Initiative
Bachelor’s Degree in Initiative
University of California, Los Angeles
Bachelor’s Degree in Initiative
Skills Skills
  • Strong attention to detail and organization
  • The ability to build and maintain excellent relationships
  • Ethical approach: Have an impeccable reputation for ethics, integrity and the highest standards of professionalism
  • Basic knowledge of claims systems and estimating software
  • Strong interpersonal skills and the ability to work effectively with a wide range of constituencies
  • Excellent interpersonal skills – able to work within a team
  • Excellent organization skills – able to prioritize work and meet deadlines
  • Knowledge of basic contractual concepts
  • Knowledgeable of project control policies and procedures
  • Works within highly complex assignments requiring specialized knowledge in breadth and/or depth in area of expertise
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15 Claims Manager resume templates

1

Senior Claims Manager, Liability Resume Examples & Samples

  • Process improvement
  • 10+ years Retail General Liability Program Management
  • Litigation and Catastrophic Management Experience
  • Program and Project Management experience
  • Claim Measurement and Analysis experience
2

Claims Manager Resume Examples & Samples

  • Handle and coordinate litigated and non-litigated general liability and auto claims
  • Liaise with company Operations, Legal, other internal departments, TPAs, carriers, defense counsel, and related third parties to facilitate claim management and effective resolutions
  • Collect and review relevant contracts and documents for tender/subrogation opportunities
  • Evaluate claims, provide support information and authorize decisions with the VP Risk Management
  • Monitor and direct TPA and defense counsel activity from claim inception through closure
  • Track claim timelines and key dates such as filing deadlines, mediations, trials, etc
  • Compile data such as loss runs from the TPA’s risk system, company information and other sources for quarterly and ad hoc Risk Management status reports
3

Claims Manager Reinsurance Miami Resume Examples & Samples

  • Minimum of 6 years experience in a Claim or Risk Control related position with some prior experience working at an insurance carrier or third party administrator preferred
  • Minimum of 3 years in a position leading a team
  • WC and Liability experience a must
  • Must have appropriate licenses in resident state
  • Analyze data and provide concise conclusions
  • Communicate orally and in writing at executive level
  • Evaluate information against a set of standards to verify compliance
  • Analyze and report financial data
  • Communicate technical information orally and in writing
  • Evaluate information against a set of standards to verify correctness
  • Manage, lead and motivate others
  • Perform annual performance reviews for staff
  • Understand impact of losses on a corporation’s financial performance
  • Write annual business plans
  • Computer skills relevant to Microsoft Office, Outlook, and web-based applications
  • Interpersonal relationship skills with internal and external executives
4

Claims Manager Resume Examples & Samples

  • Communicates effectively with injured workers, medical professionals, insurers, brokers, internal/external counsel, corporate management, and various related regulatory agencies
  • Develops and maintains project-specific Workers’ Compensation claims manual and related processes and procedures. Implements improvements based on lessons learned, legislative changes or Court decisions, and client operating imperatives
  • Assists with subcontractor CCIP enrollment and provides workers’ compensation orientation to subcontractors
  • Develops and provides onsite training related to workers’ compensation
  • Under the guidance of the Workers’ Compensation Risk Manager, develops and prepares regular reports outlining project claims performance. Monitors claims activity to identify early negative claim trends or other issues that may negatively impact project performance
  • Is the project principal administrator for supervision and processing of workers compensation claims
5

Claims Manager Resume Examples & Samples

  • Analysis of claim, review of potential coverage/applicable section of policy
  • Holding coverage discussions with client throughout the lifetime of a claim
  • Conducting briefings and meetings with insureds’ legal advisors
  • Assisting the client in understanding, negotiation and presentation of difficult claims to insurers
  • Attending and running mediations and settlement meetings
  • Directing coverage and quantum negotiations with insurers
  • Escalating any complex or difficult claims/issues as appropriate
  • Conducting risk manager and insurance team training
  • Identify and implement ongoing customer service, productivity and quality enhancements in a fast-paced environment
  • Collaborate effectively with both internal and external key stakeholders, business partners and peers
  • Bachelor’s degree in insurance or relevant field preferred
  • Plus, seven year’s experience in claims reporting, monitoring and advocacy for property, automobile, general liability, professional and workers compensation claims
  • Must have and preserve required licenses
6

Claims Manager Resume Examples & Samples

  • Prepare and analyze loss runs
  • Serve as a technical resource to company
  • Participate in claim reviews
  • Assist in directing and training of property associates for best claims practices
  • Become personally involved in claims when required
  • Respond to inquiries of agents, etc., regarding claim handling and decisions
  • Audit claim files to ensure proper handling, reserving and a satisfactory conclusion
  • Enforce company policies and procedures
  • At least 5 years management experience of claim operations
  • A thorough knowledge of commercial lines products and coverages
  • Strong background in adjusting / supervising claims
  • Supplemental insurance education / designations
  • Multi-line claim background with knowledge of CGL, Auto, Property and Workers’ compensation claims management experience
  • Litigation management experience
  • Risk management claim background
  • Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint)
7

Field Claims Manager Resume Examples & Samples

  • Provides leadership to a team of field claim representatives who conduct physical inspections of damaged automobiles. Responsible for ensuring team member compliance with state regulations. Through strong performance management practices, provides feedback, coaching and skill/knowledge development to respective team members
  • Ensure estimate quality through the review of estimates and/or re-inspections of vehicles
  • Accountable for the management/quality of all Field Staff, Preferred Shops, Independent Appraisers, Customer Shops, and Self Inspections in assigned territory
  • Oversee the appropriate distribution and manage workloads within the team to ensure customers/claimants are having their matters addressed within company and legal time frames
  • Assign the level of settlement authority for each team member; personally authorize settlements that exceed direct reports limits but within personal authority limits
  • Provide training for claim representatives in the use of estimating software and vehicle damage estimating
  • 5+ years of relevant experience
  • 2-3 years of experience in leading field claim representatives
  • Obtain state specific property casualty licenses as required
  • Strong leadership skills that include effective coaching and collaboration
  • Working knowledge of computerized estimating software such as Audatex, CCC, Mitchell
  • Ability to review and analyze policy language and make coverage determinations
  • Availability for limited out of town travel for catastrophe work
  • Valid driver's license and good driving record
  • ASE Certifications, I-CAR Coursework
8

Fsd Claims Manager Resume Examples & Samples

  • Assure that new employees are trained, interview applicants and make hiring recommendations
  • Resolve unique or high priority coverage/claim issues involving producers, clients or company personnel and process/monitor E&O claims
  • Prepare performance reviews in a timely and thorough manner, effectively address performance issues
  • Assist supervisor and claim reps. with coverage issues
  • Provide producers with claims support in making sells presentations, resolving claim problems and developing necessary claim management programs for select accounts
  • Maintain educational standards and posses CIC designation
9

Claims Manager Resume Examples & Samples

  • Reviews work in progress as well as provides training or assistance in processing to insure quality standards are met
  • Handles personnel actions including interviewing, hiring, firing, performance reviews, salary recommendations, and coordinates training and development. Enforce company rules fairly and impartially
  • Reviews more complex cases and settles or initiates further action within approved authority limits
  • Serves as a technical resource to subordinates and others in the organization
  • Monitors performance, progress, schedules, and costs
  • Involved in fraud identification and referral to appropriate team for investigation
  • In collaboration with Director and Vice President, establish overall department budget; allocate resources within department; manage department activities to budget. Involved in various projects as they occur specific to claims or corporate initiatives
  • Bachelors degree or equivalent related work experience
  • 5+ years of experience with Long Term Care (LTC) claims
  • 1+ years of supervisory experience and/or served as a team lead
  • Strong leadership skills to fosters an environment of respect, support, and growth within team and peers
  • Ability to research and interpret information for the completion of claims as well as projects; self-starter
10

Guest Claims Manager Resume Examples & Samples

  • Lead, support, and coach, and Guest Claims Cast Members
  • Review of claim files in accordance with department operating guidelines
  • Escalating incidents with potential excess coverage exposure
  • Help set, implement and achieve department goals and strategies
  • Review claim files for timeliness, accuracy, and action-planning that will bring files to successful and cost-effective resolution
  • 520 or 620 All-Lines Adjusters’ License with the State of Florida
  • Minimum five years experience handling auto and general liability claims
  • Florida 520 or 620 License in Good Standing
  • Demonstrated familiarity with automated claims administration systems
  • Demonstrated ability to handle confidential information appropriately
  • Ability to effectively prioritize multiple tasks in a fast-paced environment
  • Computer proficiency within a Windows environment; including Word, Outlook, Excel, and PowerPoint
  • Demonstrated knowledge and familiarity with Business Objects or related reporting software
11

Stop Loss Claims Manager Resume Examples & Samples

  • Plans and organizes the work of Examiners
  • Reviews work in progress as well as conducts audits to insure quality. Involved in State Insurance Dept. audits
  • Involved in fraud identification and training. Testifies at depositions, hearings, and trials
  • Assist and maintain claim loss and reserve records and report on claims in relationship to company business and industry standards
  • In collaboration with Vice President, establish overall department budget; allocate resources within department; manage department activities to budget. Involved in various projects involving the system, acquiring business, etc
  • Maintain positive, proactive relationships with our clients, agents and other internal departments to meet service objectives
  • Negotiate and monitor relationships with outside investigative firms and death claim payments through banks
12

Claims Manager Resume Examples & Samples

  • Assure quality claim handling for all files opened by claims associates through periodic file review and coaching. Assist, as necessary, in complex cases or claims, ensuring transfer of knowledge to supervisors and claims representatives
  • Provides leadership to the claims supervisors, that includes training/development and effective coaching/feedback through the performance management process; through effective leadership, builds highly effective claims team(s)
  • Incorporate compliant practices into claims procedures and coordinate adoption of proper state regulatory compliance across the entire division
  • Maintain and control proper technical authorities/experts throughout the division and personally handle escalated client complaint issues
  • Assist senior leader(s) in areas of development regarding system enhancements, technology enhancements, vendor selection and monitoring, staffing needs and departmental workflow
  • Strong leadership skills that includes effective coaching, collaboration and development
  • Strong negotiation and organization skills required
  • Ability to translate expert level claims and insurance industry knowledge into procedures
  • Solid understanding of regulatory environment and state statutes that affect the insurance industry
13

Field Claims Manager Resume Examples & Samples

  • Assure quality claim handling for all files opened by claims associates through periodic file review and coaching. Assist, as necessary, in complex cases or claims, ensuring transfer of knowledge to supervisors and associates. Oversee Catastrophe events to ensure events are handled in a timely and efficient manner
  • Provide leadership to Home CAT Claims Representatives including training/development and effective coaching/feedback through the performance management process; through effective leadership, builds highly effective Home Claims CAT team(s)
  • Assist senior leader(s) in areas of development regarding system enhancements, technology enhancements, vendor selection, and monitoring and departmental workflow
  • 2-3 years of experience in leading a claims processing unit
  • Presents issues in a highly professional manner; excellent communication skills - both verbal and written
  • Expected overnight travel on short notice for what could be extended periods of time in order to handle all assigned claim volume
14

Claims Manager Resume Examples & Samples

  • Life
  • Terminal illness
  • Accidental death and dismemberment and related benefits
  • Disability
  • Critical illness
  • Provide problem and complaint resolution on contentious claims for issues, co-ordinate response to claim appeals from customers, branches and regulatory bodies
15

Failed Claims Manager Resume Examples & Samples

  • Bachelor's Degree in Business or related field preferred
  • 3-5 Years Pharmacy Benefit Management (PBM) experience
  • 3-5 Years Managed Care experience
  • Working understanding of e-Pharmacy landscape and its influential partners
  • Ability to manage multiple tasks and deadlines with attention to detail
  • Ability to communicate effectively and deliver presentations to senior leaders of Humana
  • Pharmd
16

Claims Manager Resume Examples & Samples

  • Experience : Cosmetics or pharmaceutical regulatory
  • Language : Fluent in English
  • Other skills : Logical thinking
17

Claims Manager Resume Examples & Samples

  • Manage Claims Work Lead and Specialist
  • Facilitate periodic project tracking to management
  • Validate and ensure departments compliance to company requirements
  • Completion of department ILC and training
  • Assist risk management with annual compliance deliverables
  • Assist with Key Performance Indicator reporting and Internal Control testing
  • Analyze Key Performance Indicator I and other departmental data to identify and implement process improvements
  • Participate in new hiring process, including but not limited to screening applicants, coordinating the interview and participate in initial interviews with potential new hires
  • Completes special projects and ad hoc analyses as requested by management
  • Attention to Communication: The ability to ensure that information is available to others who should be kept informed
  • Building Collaborative Relationships: The ability to develop, maintain, and strengthen partnerships with others inside or outside the organization who can provide information, assistance, and support
  • Initiative: Identifying what needs to be done and employing self motivation to pioneer tasks in anticipation of the need or prior to being instructed
  • Managing Change: The ability to demonstrate support for innovation and for change needed to improve effectiveness; initiating, sponsoring, and implementing change
18

Supplemental Rent Claims Manager Resume Examples & Samples

  • Lead Supplemental Rent claims budgeting, processing and approval, ensuring timely and accurate settlement of all lessee claims within established time to payment targets
  • Drive proactive customer engagement through customer conference presentations and one-on-one engagements
  • Ensure timely review of maintenance & modification cost data to ensure deal pricing estimation accuracy and supplemental rent rates are reflective of the current market
  • Identify and lead process improvement projects to deliver claims processing efficiency and management information
  • Focal point for aircraft maintenance programme evaluation, ensuring GECAS interests understood and protected trough contractual language to support aircraft placement and Supplemental Rent claims
  • Centrally manage customer on-lease contribution claims, provide technical assessment and raise budgets as required
  • Technical Liaison & Support for operations teams as part of the claims process
  • Proactive engagement in increasing GECAS services available to customers
  • Professional Engineering or relevant management qualification, or
  • Airframe & Powerplant (A&P) qualification or equivalent, with proven years of maintenance and engineering experience in commercial aviation
  • Strong computer skills with proficiency in general business and web based applications
  • Demonstrated experience of developing and maintaining good working relationships with key players at all functional levels within customer airlines
  • Aircraft and /or maintenance planning experience
  • Ability to maintain a high level of engineering integrity while working in a high-pressure commercial environment
  • Working to knowledge of operating lease structures
  • Outstanding negotiating skills
19

Claims Manager Resume Examples & Samples

  • Is responsible for overall direction, management, coordination, and evaluation of the claims department
  • Provides technical consulting and assistance to clients and employees
  • Calculate and assign timely and appropriate reserves to claims and manage reserve adequacy throughout the life of the claim
  • Assigns and controls work load distribution of claims department
  • Ensures professional and timely claims coordination and reporting for clients
  • Develop and manage claims through well-developed action plans; continues to work the action plan to bring the claim to an appropriate and timely resolution
  • Review and submit new claims to insurers or adjusters as required
  • Counsel clients on claims presentations and process
  • Analyzes policy wordings and negotiates with insurers to secure broadest interpretations and provide maximum claim settlements for insureds
  • Maintain accurate claims data and files
  • As required, work with legal counsel to resolve complex claims issues
  • Establishes and maintains positive relations with insurance claim professionals and Third Party adjusters
  • Update staff and insureds on legislative changes and industry trends
  • Provide training and professional development to staff
  • Participate in quarterly claims reviews for national clients
  • Prepare quarterly claims bordereaux for clients (as required)
  • Other miscellaneous, administrative and clerical functions as required
  • University degree and insurance designations preferred
  • Ontario (RIBO) Brokers license is mandatory
  • Minimum 10 years insurance industry experience, at least 2 years in a supervisory role
  • Must have strong technical knowledge of claims, loss control and the insurance industry
  • Writes clearly, concisely and effectively
  • Communicates verbally effectively and with impact
  • Ability to multi-task - Manages time effectively
  • Committed to superior customer service
  • Ability to work well with others and provide assistance cooperatively and courteously
20

Claims Manager Resume Examples & Samples

  • At least two years related experience in a management role or equivalent combination of education and experience
  • At least two years of experience with mortgage servicing or similar financial industry
  • At least one year of project management experience
21

Injury & Claims Manager, Melbourne CBD Resume Examples & Samples

  • Extensive experience in Injury Management or advanced knowledge of injury management practices
  • High level of understanding of regulatory requirements pertinent to the role
  • Well-developed network of Injury Management and Rehabilitation Providers
  • Tertiary qualification in Health related discipline is a plus
22

Claims Manager Resume Examples & Samples

  • Knowledge of (Claim or Risk Control) Handling & (Claim or Risk Control) processes and procedures
  • Communicate orally and in writing
  • Display versatility in working with different personalities
  • Handle complaints, arbitrate disputes and negotiate settlements
  • Obtain relevant information
  • Effectively communicate with senior management
  • Handle complaints, arbitrate disputes, and negotiate alternative solutions
  • Obtain relevant technical information to support decision making or selling risk improvement programs
  • Understand company products, services, global network, and industry practices
  • Understand the process and value of basic data analytics and benchmarking
23

Claims Manager Resume Examples & Samples

  • Leads the claims management across a wide range of transit projects
  • Works with the Contract Administration team and accountable to the Program Commercial Manager
  • Serve as a subject matter expert in all aspects of claims management
  • Successfully coordinate the relationships between the Client management team, the Project team, internal legal counsel and the Project Controls functions including, estimating, planning/scheduling, cost control, and risk management Provide input on claims mitigation techniques in other functional disciplines (scheduling practices, risk management, contract administration, etc.)
  • Proactively Manage and maintain comprehensive claims documentation within the contract administration software
  • Investigate, evaluate, and provide recommendations for the negotiated settlement of claims
  • Provide position papers to recommend solutions to contractual issues and claims settlement
  • Provide detailed evaluation of potential claim impact to the Project Management team
  • Provide summary reports to Executive Management
  • Liaison with client legal team
  • Understanding and experience of alternative dispute resolution techniques
  • Project delivery using AFP, P3, or design/build methodology
  • Familiar with contractor delivery methods and pros / cons of each
  • Highly responsive and ability to act quickly under changing circumstances
  • Commercially astute with excellent negotiation skills
  • Highly organized and ability to process and efficiently manage numerous claims
  • Effectively and positively influence Client and Stakeholder team members to comply with claims process as set out in the Project Agreement
  • Ability to anticipate multiple claim paths and investigate client impacts, to keep ahead of the claimant
  • Minimum of 15 years’ experience of major project claims management with demonstrable successful resolution in favor of the Client
  • Comprehensive experience of the administration of major construction contracts
24

Assistant Claims Manager Resume Examples & Samples

  • Bachelor degree/diploma in translation (or related field) and/or medical knowledge
  • Experience in translating financial/legal/insurance/medical and other types of documents from Chinese to English and vice versa
  • Extensive relevant experience in life insurance industry
  • Minimum of 1-2 years of claims experience in either life or medical insurance
  • Knowledge in insurance principles and familiar with insurance policy wordings
  • Good command of English and Chinese, both spoken and written
  • Excellent command of both English and Chinese (Mandarin)
  • Alert, meticulous and attentive to amendments and documents
25

Absence Claims Manager Resume Examples & Samples

  • 5 + yrs progressively increasing experience in disability insurance claims including managerial, supervisory and/or demonstrated leadership experience
  • 2 + yrs of supervisory or management experience
  • Educational experience and/or proficiency in disability insurance, medical terminology, contracts and leadership experienc
26

Claims Manager Resume Examples & Samples

  • Responsible for management and oversight of the Claims Department to ensure timely adjudication of claims for health care services, received from contracted and non-contracted providers and to ensure all Federal, State and Client requirements are met timely and efficiently in accordance with regulations and client guidelines
  • Associate or Bachelor degree preferred
  • Extensive experience in health insurance claims processing with a minimum of 3 to 5 years management experience
  • HMO Claims or managed care environment preferred
  • In-depth knowledge of medical billing and coding
  • Knowledge of health insurance, HMO and managed care principles
  • Define and manage staffing needs including recruitment
  • Critical thinking skills to build efficiencies
  • Create and manage productivity reports
  • Create and maintain policy and procedures
  • Manage and execute projects
  • Able to work independently; strong analytic skills
27

Claims Manager Resume Examples & Samples

  • Oversees the resolution of highly complex customer conflicts or issues
  • Oversees the negotiation of highly complex claim settlements
  • Oversees response to highly complex arbitrations contentions
  • Manages and oversees performance of vendors
  • Leads training sessions for the team
  • Frequently participates in special projects as a subject matter expert
  • Ability to interact effectively, and coach others on interacting effectively, with internal or external customers and act with empathy
  • Advanced industry knowledge to discipline practices, including best practices, to support the business unit
  • Advanced knowledge of analytical procedures to reconcile, manipulate, and recognize patterns of data
  • Highly advanced conflict management and problem resolution skills in managing internal and external customer relationships
  • Applies highly advanced problem solving skills to continuously improve business outcomes
  • Works within highly complex assignments requiring specialized knowledge in breadth and/or depth in area of expertise
28

Regional Claims Manager, Northern Region Resume Examples & Samples

  • Collaborates with CRS Compliance to ensure compliance within RMA guidelines as well as coordination of claims over $500,000
  • Provides a weekly recap report to CRS leadership outlining progress made and problems encountered
  • Accompany sales representatives on agency visits as needed
  • Complete expense audits in a timely manner
  • Train and/or coach individual supervisors to ensure compliance with ADM policies and programs
  • Follow up with agents to ensure positive, proactive customer service
  • Attend and provide leadership update at agent training meetings in the region
  • Weekly communication with sales managers in the region
  • Plan and execute regional adjuster training meetings
  • Ability to lead and encourage a high performing culture of service and teamwork for a growing and diverse workforce
  • Promote ADM core values
  • Understand and promote IT innovation and integration
29

Claims Manager Resume Examples & Samples

  • Plan and direct the work of the Claims unit including regular review & assessment of team progress and performance
  • Communicate verbally and in writing with customers, agents, vendors and internal resources including senior management, in response to all inquiries including claimant or case specific statuses, escalated calls or departmental process and performance queries
  • Liaise with other departments to maintain effective and relevant processes in support of the organization's sales objectives and customer service goals
30

Senior Claims Manager Resume Examples & Samples

  • Support on claim management, dispute settlement and other contract management and legal issues arising during the course of performing contracts
  • Advice on specific issues and claims activities
  • Reviewing of claims files from or against the company
  • Preparing claims files
  • Reporting on claims activity to top management
  • Provide training on claims to project management and contract management community
  • Experience of at least 15 years in the above area gained with a corporation Familiar with international contracts and negotiation of claims
31

Global Claims Manager Resume Examples & Samples

  • Manages the corporate global insurance renewal process for all property and casualty insurance placements; negotiates and manages global risk broker contracts; ensures that all accounting and cross-charges for placements are consistently and accurately entered
  • Manages the corporate global insurance renewal process for all property and casualty insurance placements; compiles loss file, risk profile, and applications; markets global Cummins property and casualty insurance placements; analyzes quotes and proposals and makes recommendations for binding instructions; prepares and manages premium payments; ensures that all payment information is captured in risk systems
  • Manages global insurance premium budgets and annual operating plan; manages cross-charges of premiums for all Cummins offices; leads communications with global controllers regarding annual corporate premium charges and local fronting insurance policy premium payment coordination; liaises with global in-country risk manager on a monthly basis to review global broker/local broker issues, claims reporting, and loss mitigation; liaises with Enterprise Risk Management and coordinates vendor support of their efforts
  • Negotiates and manages multi-year global risk insurance broker contracts; manages and owns the review and maintenance of annual Statements of Work; manages the annual statement of work/purchase order and payment process; manages and leads routine open items and issues logs and monthly and annual reviews of insurance brokers’ contract fulfillment
  • Monitors and coordinates global insurance broker network communications with local broker offices and regional hub-support offices to support all local Cummins offices requiring local insurance placements; supports on-going insurance carrier relationship management efforts and communications with worldwide insurance markets; reports downgrades below corporate minimum standards of an insurer’s financial strength/credit rating to leadership
  • Supports and participates in the development of short and long-term global risk insurance strategies for improving Cummins’ risk management profile; identifies global, strategic risk mitigation strategies and assist with the implementation of those strategies; reviews existing policies for gaps and improvement opportunities; manages the Cummins Risk Management Information System Risk Console to support insurance purchasing decisions
  • Actively participates in the risk insurance community associations; participates in facilitation and coordination of student internship mentoring and development program between Cummins and representative from Indiana universities supporting risk insurance curriculums
  • Recruits, selects, develops, manages, motivates, coaches, and mentors Risk Console coordinators; provides guidance and direction on problems and issues; delegates work assignments considering project demands, employee skills and development needs
  • Demonstrated experience in administration of international insurance programs with knowledge of Control Master Programs and focus on tax compliance in foreign placements
  • Understanding of usual and customary policy provisions in different lines of insurance coverage
  • Experience with captive insurers and evaluating the risks it should accept
  • Experience managing third party insurance broker/risk consulting vendor contracts and performance
  • Experience managing global insurance premium allocation
  • Understanding of the risk management process
  • Experience developing and delivering global, on-site risk mitigation and risk transfer strategies and related communications for all levels of the organization
  • Development, management and oversight of US Workers Compensation claims and WC TPA claims vendor management. Administration and management of regulatory compliance for state and federal regulation and support and maintain all audit and controls requirements for US WC; state filings and actuary accrual development management and monitoring
  • Participates in the management and oversight of global P&C claims for lines including but not limited to: global property, cargo marine & inland, US automobile, primary domestic casualty and umbrella excess liability; annual policy renewal budget process support through actuary loss run extract and reporting required for renewal submissions and budget funding
  • Corporate resource to support global internal business owner/leader through claim submission, adjustment, settlement and reserve compliance process, coordinating and supporting internal legal and external vendor recommendations on claim settlement
  • Logistics, HSE & Fleet, Legal, Benefits & HR, Medical, etc
  • Support integration and on-going management of merger/acquisition entity’s historic and future claims administration : claim management oversight and TPA/insurer/supporting vendor contract management associated with each historical coverage line
  • 5 years workers compensation experience in multiple jurisdictions, 10 to 15 years claims experience
  • At least one year experience in management of a US Work Comp Program
  • At least one year experience in supervision of a claims adjuster team
  • Experience in training of a worker compensation program
  • Experience in Mod projections and verification
  • Experience with US State Filings for Self-Insurance
32

Claims Manager Resume Examples & Samples

  • The position requires a strong understanding of claim management, the ability to analyze data and formulate action plans
  • Minimum of five years of claim management experience in a corporate risk management department, insurance broker or insurer with a demonstrated ability to act as a liaison and to improve performance
  • Self-motivated individual who requires little or no direct supervision
  • Strong teamwork skills  
  • Minimum of five years of experience in a corporate risk management department, insurance broker or insurer
  • Must be authorized to work in the U.S. without further sponsorship
33

Claims Manager Resume Examples & Samples

  • Responsible for the oversight of the claims department and directs and monitor department work flow
  • Generate reports and perform claims analysis to monitor the claims operations
  • Generate weekly claims check runs
  • Oversee and monitor the claims internal audits
  • Oversee and monitor the claims process including claims adjudication, denial and dispute process
  • Assists in developing and implementing claims operations policies and procedures
  • Participate in on-site meetings with internal and external customers
  • Resolve claim issues with internal and external customers
  • Promote and contribute to a fair, positive and professional work environment through both management style and personal example
  • Identify problems that may cause claims non-compliance
  • Technical – strong knowledge in claims operation, claims system and general knowledge of regulatory requirements as it pertains to claims processing, timely and accurate payment requirements
  • Communication skills – communicates clearly, professionally and respectfully to peers, superiors, subordinates and customers
  • Reliability – demonstrates responsibility through a positive attendance record and punctuality
  • Organization skills – ability to organize work assignments and work independently prioritizing task assigned
  • Work quality – consistently produces high quality work product, demonstrates a clear understanding of the functions of the department
  • Productivity – ability to meet deadlines and complete tasks assigned in a timely and efficient manner
  • 5 years of experience in claims operations in a managed care setting that includes managing personnel in a claims processing environment
  • Familiar with regulatory and reporting standards with DMHC, AB 1455, and CMS requiremetns
  • Strong working experience with provider reimbursement methodologies
  • Degree in Healthcare, Business, Administration or related field
34

Claims Manager Resume Examples & Samples

  • Works within the Contract Administration team and accountable to the Project Agreement Manager
  • Successfully manage the relationships between Project Co, the Project Team, and Project Controls functions including, estimating, planning/scheduling, cost control, and risk management
  • Manage and maintain comprehensive claims documentation within the contract administration software
  • Investigate, evaluate, and provide recommendations for the settlement of claims
  • Provide position papers to recommend solutions to contractual issues
  • Commercially astute
  • Highly organized and ability to process and efficiently manage numerous claim
35

Claims Manager Resume Examples & Samples

  • Coordinates investigation firm and/or attorneys in their investigation of PCR’s claims and lawsuits
  • Attends staff/physician interview with investigation firm
  • Sequesters all evidence on PCR’s, claims, and lawsuits
  • Obtains information relative to Answers to interrogatories, Requests for Admissions, Motions to compel, Requests for Production, subpoenas, and any other legal documentation regarding PCE’s, claims and/or lawsuits
  • Work closely with attorneys defending lawsuits
  • Works closely with Director relating to communication with patients, families, visitors, etc. to negotiate early resolution of PCR’s within the direction of HCII
  • Review medical records and/or any hospital documentation relative to a request by a third party and review the request for legal authenticity with Director’s approval
  • Daily Review of Patient, Non-Patient Notifications; refers to appropriate party and follows up on referrals and completion of follow-up required
  • Attend and report on interviews with staff/physicians to Director
  • Participation in meetings and committees, including, but not limited to, Safety sub-committees, Safety committee, Falls Committee, Patient Rights/Ethics/IRB, Continuum of Care, Medical Staff peer review, and Care of the Patient
  • Daily update on computer based loss run information (RMLOSSRUN)
  • Accumulate and maintain legal research to assist all departments with legal issues
  • Obtain and maintain good relationship with physicians/staff
  • Interviews, telephones, or corresponds with claimant and witnesses; consult police and hospital records within the direction of the Director
  • Communicates with Director regarding any problems in compliance with all mandatory and voluntary standards relating to patient and visitor safety
  • Demonstrate Customer Service/Service Plus principles and behaviors consistent with Las Palmas Medical Center vision and values
  • Collect and prepare data for reports relative to needs of the department and requests of the Director on timely basis
  • Analyzing loss control data to determine appropriate loss prevention where applicable and report to Director
  • Provide Risk Management education to all employees and specific topics for department specific issues when requested by the Director
  • Greet patients/visitors in a professional, prompt and courteous manner. Follow up with patients/visitors in a timely manner following all rules of ethics
  • Assist Director in coordinating an ongoing program to educate employees and the medical staff in risk management, loss control matters, including orientation of new employees, risk management issues, and any legal implications
  • Communicates with the employee health/injury coordinator and other appropriate individuals within the facility for follow-up and action on worker’s compensation claims and employee safety issues. Works with the employee health/injury coordinator to coordinate identification, evaluation and trending of risk exposures
  • Assures the appropriate, timely review of medical records for lawsuits, criteria outcome data, ER Risk Initiative, Perinatal Risk Initiative, Premium Credit Initiatives and the incident reporting program
  • Acts as the IRB Coordinator to develop, implement and document orientation and ongoing education of IRB members in the protection of human subjects participating in biomedical research in compliance with federal and local regulations. Assures the implementation and adherence to institutional policies, procedures and federal regulations for IRB studies
  • Customer Service: Demonstrates customer service skills with both internal and external customers. Treats patients/visitors as individuals with unique values, beliefs and practices
  • Educator: Identifies, implements, and/or evaluates opportunities for patient/family education
  • Safety: Demonstrates safety practices consistent with policies and procedures
  • Information Management: Demonstrates adherence to information management policies and procedures, maintaining confidentiality at all times
  • Practices Professionalism: Performs, participates, implements and evaluates personal performance
  • Time Keeping/Attendance: Demonstrates accountability to the facility and healthcare team by adhering to the time and attendance policies and procedures
  • Ethics/Compliance: Performs all duties ethically, complying with all policies and procedures, federal, state, and local laws
  • Job Specific: Claims Manager
36

Global Claims Manager Resume Examples & Samples

  • Development, management and oversight of US Workers Compensation claims and WC TPA claims vendor management
  • Administration and management of regulatory compliance for state and federal regulation and support and maintain all audit and controls requirements for US WC; state filings and actuary accrual development management and monitoring
  • Develop and deploy communication plans and training programs by line of coverage to worldwide CMI organizations: Procurement, Logistics, HSE & Fleet, Legal, Benefits & HR, Medical, etc
  • Support integration and on-going management of merger/acquisition entity’s historic and future claims administration: claim management oversight and TPA/insurer/supporting vendor contract management associated with each historical coverage line
  • Significant level of relevant work experience required, including supervisory experience
37

Claims Manager / Specialist Resume Examples & Samples

  • Extension of time claims evaluation and calculation of prolongation costs
  • Is able to effectively author contractual commitment documents, as well as internal and external communications, proposals and reports
  • Well organised in terms of physical and online filing and data management
  • Numeracy, monetary analysis and analytical skills
  • BOQ analysis
  • Customer and Client relations
  • Knowledge of FIDIC and modified forms of Contract
  • Ability to manage staff and multiple assignments
  • Good people and team working skills
38

Group Claims Manager Resume Examples & Samples

  • Experience processing and adjudicating claims (preferred)
  • French speaking ability (required)
  • Integrity and objectivity
  • Self motivation and ability to work independently
  • Multi tasking (the ability to manage time and prioritize)
  • Team oriented; ability to effectively partner with team members in remote locations in order to achieve team, office and network goals
  • Math skills at intermediate level
  • Personal accountability
39

Assistant Claims Manager Resume Examples & Samples

  • Acquire and efficiently organise the relevant evidence and information necessary to accurately assess whether or not there is a fraudulent aspect to individual claims
  • Conduct desktop investigations either internally or externally to facilitate collation of evidence of suspected cases
  • Identify cases which need to be escalated to the senior staff
  • Adhere to local regulatory and governance requirements throughout the investigative process
  • Collect accurate fraud data in the fraud database and provide information for internal communications in order to support ongoing promotion of and adherence to the claims fraud strategy
  • Adhere to the Global and Local Claims Vendor Management Best Practise
  • Responsible for managing or sourcing Claims Vendors within the agreed authority levels
  • Continuously monitor the performance of Claims Vendors to ensure adequate performance against agreed SLAs and engages, communicates with all stakeholders and seeks resolution on Claims Vendor performance issues
  • Conduct analysis and monitor the Claims Vendor relationship value including operational risks and escalate where appropriate
  • Promote and communicate Claims Vendor policy, procedures and guidelines across the Claims Operations
  • Collaborate with Claims Operations to ensure seamless delivery of the Claims Vendor Strategy
  • Any additional tasks as assigned
  • Tertiary education with significant experience in insurance claims investigation or professional investigative experience with an external agency required
  • Holder of Insurance qualification is preferred
  • Knowledge of insurance fraud and understand legal and contractual framework
  • Recognize the benefit of providing excellent customer service
  • Able to manage cases proactively to achieve best outcome
  • Desire to learn and be flexible to business change
  • Field investigation skills including interviewing and statement taking etc
  • Claim investigation Experience in EC, Liability and Motor Third Party Liability is preferred
  • Candidate with less experience will be considered as Senior Officer
40

Claims Manager, No Fault Resume Examples & Samples

  • Maintain overall management responsibility for the Unit Managers and Claims Managers within assigned Branch locations
  • Conduct on-going inspections of operations to ensure compliance with applicable legislation; technical and administrative objectives i.e., accepted claims handling practices
  • Communicate new and revised policies and procedures to branch office personnel
  • Perform personnel functions within the Regional claims operations
  • Oversight of recruitment, interviewing, and selection of claims personnel; ensure personnel receive orientation initial and on going technical training
  • Conduct performance appraisals, identify performance problems and approve disciplinary actions. Establish work standards and monitor personnel progress
  • Manage salary (and non-salary) budgets, make recommendations to region management concerning promotions, terminations and staffing authorizations
  • Function as the Department liaison with regulatory agencies in the assigned states of responsibility
  • Advise subordinates on technically involved cases (high exposure, questionable coverage situations, suspected fraud, exposures that exceed policy limits, etc.) and extends settlement authority after reviewing claim files. Resolve complaints and problems which can not be dealt with by subordinates
  • Implement new and revised policies and procedures; keeps subordinates informed of current company goals and objectives
  • Ability to manage and direct claims operations of offices within the region and to effectively communicate operational procedures to a work staff
  • Advanced knowledge of principles and methods pertaining to the claims field; knowledge of claims management practices, company operations (i.e., other staff & line departments) and policies
  • Bachelors Degree plus 7-10 years of relevant and progressively more responsible work experience required, plus proven claims management experience
  • Advanced insurance related designations/CPCU preferred
41

Claims Manager Resume Examples & Samples

  • Manages day to day operation of the claims management office, monitoring the consistent application of departmental standards, policies and procedures
  • Establishes claim handling standards and monitors performance and adherence to these standards
  • Utilizes data to analyze workers’ compensation and general liability claim costs, trends and cost savings resulting from claim management processes and services. Designs or modifies cost management initiatives in response to data results
  • Assists with preparations of executive-ready management reports including claims administration performance and cost savings
  • Establishes interface guidelines and communication channels between all parties, including the claims office, Third Party Administrators (TPA) adjusters, outside counsel, managed care nurses, operations and supervisors
  • Ensure compliance with state regulations
  • Conducts staff training and provides technical assistance as needed
  • Facilitates quarterly TPA performance audit
  • Develops of claims handling instructions or special account instructions
  • Partner with safety and risk control to help identify adverse trends, mitigate exposures and educate management
  • Partners with corporate employment attorneys and Human Resources to secure global releases, ADA interactive processes to ensure return to work is in accordance to ADA, leave, EEOC, and other policies
  • Ensures excess carrier reports are timely processed by TPA
  • Ensure proper Medicare reporting on behalf of organization
  • Participate in department budget planning
  • Ensures policies and procedures are in compliance of changing regulations as they pertain to our business
  • Controls costs through design, implementation and oversight of a medical cost containment program as it pertains to initial treatment facilities, physical therapy, durable medical equipment, diagnostics and pharmacy benefits
  • MSJA
42

Assistant Claims Manager Resume Examples & Samples

  • With moderate supervision to manage medium standard (moderate severity / complexity) litigated claims in the most effective and efficient way
  • Take responsibility to resolve all enquiries from both customer and external contacts to ensure delivery of a focused, quality and professional claims service
  • Meet with clients for claims review meeting
  • Work with our healthcare specialist in minimizing claims duration
  • Report to claims manager on adverse trend of development of claims and clients with adverse claims experience
  • Assist Claims Manager to monitor and conduct assessment of the performance of external loss adjuster whose services form part of claims services
  • Supervise and coach junior staff on claims management, including reserve and settlement amount approval of junior staff with lower authority
  • Assist Claims manager in departmental ad hoc tasks and projects
  • Minimum 4 years’ of Employees’ Compensation claims management experience is a must with supervision experience preferred
  • Currently undertaking or have completed Legal Executive qualification or LLB degree
43

Claims Manager, Liability Resume Examples & Samples

  • Monitors changes and proposed changes in laws that could impact Ryder's Liability program and recommends to Director new processes that will ensure compliance and mitigates exposure
  • Interacts with field and operations management, legal counsel, safety managers, customers, insurance carriers, and third party claimants
  • Participates in large claim review calls and updates field operations personnel on claim status
  • Ensures claims are being handled appropriately according to the applicable jurisdiction
  • Prepares files and coordinates audits for primary and excess insurance carriers, re-insurers, and financial auditors
  • Participates with Director in the selection and management of outside vendors for investigation, cost containment, audit functions, expert witnesses, and Litigation Management
  • Works directly with various State Departments of Insurance on inquiries and complaints
  • Monitors staff's technical work and develops and implements action plans if deficiencies are noted
  • Reviews reserves and trends on individual cases to ensure the reserves represent the probable ultimate payout based on documented file developments
  • Monitors staff's workflow to ensure accurate processing of claims and timely establishment of reserves
  • Manages the efforts of Ryder's national liability staff to ensure both technical expertise and a high level of customer service are attained
  • Responsible for coaching, education and performance appraisals of assigned staff
44

Senior Claims Manager Resume Examples & Samples

  • Supports past and future EoT and cost claims of the BACS consortium against the Employer in accordance with agreed schedule. Provides and contributes to inputs of TS to (BACS) CJV , verifies drafts and inputs supplied by CJV to TS, discusses and challenges these inputs in regular interaction with CJV claims team. The Claims Manager is the representative of TS towards the Head of the BACS Claims Team. He is also a member of the TS team which includes TS Project Director, Legal who form, with corresponding personnel from the CJV, the consortium claims strategy Group who are responsible to steering committee
  • Prepares defense against claims received from the employer
  • Leads and manages his team like a project within the project running daily routines as required. Provides the necessary reporting internally for Business Unit / Division reviews etc. Is also focused on claim strategy, management and operation of the claims process and the efficient production of the sustainable claims documentation
  • Together with the Project Director he represents the TS element of the BACS consortium towards the Engineer and the Employer
45

Subrogation Claims Manager Resume Examples & Samples

  • Coordinating the subrogation claim support for multiple business segments. This will include (a) acting as the main point of contact between Claims, TPA’s and vendors, (b) directly handling subrogation claims as needed, (c) directing TPAs retained to service the segment’s business and (d) managing the subrogation team
  • Evaluates subrogation files for proper liability investigation, verification of damages, and legal implements
  • Effectively applies best claims and recovery practices
  • Provides direction on further investigation strategies in the core areas of evaluation and negotiations
  • Determines and resolves workload and assignment issues to ensure effective claims subrogation processing, expense management, and claims disposition
  • Auditing of external subrogation vendors and TPA’s
  • Managing ALAE through advanced litigation management
  • Develops and implements appropriate training initiatives and trains other company personnel on recovery processes as needed to ensure that the proper level of expertise exists in the unit
  • The ideal candidate will have 10 to 15 years of subrogation experience and current working knowledge of jurisdictional laws and regulations
  • Experience with multi-line claims is preferable
  • Extensive experience with subrogation and recovery techniques, procedures, planning, and administration
  • Extensive interacting with all levels of internal customers, investigative agencies, and field sales and claims personnel
  • Ability to develop and analyze advanced claim metrics is required
  • Ability to influence others and demonstrate leadership skills
46

Claims Manager Resume Examples & Samples

  • Managing contractors claims
  • Making formal recommendation reports
  • Integrating with Planners to analyse programme implications
  • Attending and Chairing meetings with Client and Contractors in connection with claims
  • Working to tight deadlines
  • Providing contractual guidance to project staff and supporting the Programme Director and Commercial Director
  • Carrying out detailed analysis of the project, and reporting on the issues and findings from a commercial perspective
  • BSc. Quantity Surveying is preferable, however other related degrees may be acceptable subject to Client approval
  • A post graduate law qualification would be beneficial
  • Must be chartered, either MRICS or MCIOB
47

Msla-claims Manager Resume Examples & Samples

  • Provide leadership and direct staff 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
  • Develop and monitor goals for staff and the department, providing regular on-going feedback and coaching
  • 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
  • Interacts with clients to strengthen/expand existing relationships and to ensure appropriate and timely resolution of service issues
  • Sets team direction, resolves problems and provides guidance to the team members
  • Responsible for managing doctor utilization to ensure they are meeting contractual expectations and timelines
  • Lead and/or participate in workgroups and committees
  • Perform other duties as assigned or required by operational need
  • Assist on RFP’s
  • Insurance Industry Experience and/or Medical Disability Exam Experience
48

Senior Claims Manager Resume Examples & Samples

  • A minimum of 10 years claims adjusting and management experience
  • Broad expertise in managing, operational and technical claims performance across both commercial classes of business and volume personal lines
  • Proven record covers strategic, conduct, Risk, operational, technical, due diligence on acquisition targets and relationship management roles
  • Experience of managing Shared Services and/or Third Party Administrators via Service Level Agreements
  • Experience of interaction with Insurance Regulators an advantage
  • A thorough functional knowledge and skill of Insurance loss adjusting and claims management
  • Broad understanding of claims, operations and underwriting processes
  • Understanding of legal statues and procedures
  • Insurance coverage and issues related thereto
  • Negotiation and settlement
  • Knowledge of actuarial reserving techniques and processes an advantage
  • Life Insurance knowledge a plus
  • Exposure to various carriers claims systems and a working knowledge of MS Excel and PowerPoint
  • Good understanding of Reinsurance Contracts, (Facultative / Treaty and Pro-rata / Excess of Loss)
  • Achieve best practices by reviewing claims files, identifying trends and recommending improvements
  • Provide advice and instructions to ensure the claims are managed pro-actively, reserved accurately and the potential risk of adverse development is understood
  • Prepare and present Management Information (“MI”) to allow ZLS to monitor and analyze historical, real time and forecast performance, and to facilitate oversight and timely decision-making
  • Interpret and interrogate various sources of data and information to drive portfolio strategy and deliver focused solutions that contribute to improvements in business performance
  • Prepare internal management reports on portfolio performance
  • Work with claims, actuarial and finance functions to ensure that the portfolio operates effectively in advance of an exit
  • Prepare claims, operational and underwriting information to support the execution of ZLS’s exit strategies
  • Identify opportunities and risks associated with changes in the external environment that may impact ZLS’s portfolios
  • Resolve reinsurance or claims disputes including commuting or buying-back policies
  • Share professional and technical knowledge by participating in industry conferences or associations or has other involvement in industry events
  • Assist in development of claims expertise by mentoring ZLS staff
49

Msla-claims Manager Resume Examples & Samples

  • Bachelor’s Degree Business Administration Healthcare Administration
  • 5+ years of experience in managing employees
  • Knowledge and understanding of claim processes and workflows
  • Strong Business and Operations Leader
50

Claims Manager Resume Examples & Samples

  • Develop claims management goals, objectives and strategic plans based on business impact, available resources and budget
  • Effectively collaborate with additional claims team members
  • Oversee claims management internal and external activities, including but not limited to claim processing and assessment, settlement evaluation and negotiation, vendor management, and other functional responsibilities
  • Recommend metrics, programs and processes to effectively manage continuous improvement of post-loss claims management
  • Establish and maintain vendor relationships and measure performance of third party service providers
  • Support development, analysis, management of the casualty reserve, working with external vendors and internal teams
  • Act as liaison with internal field operations management to
  • Advanced working knowledge of Workers’ Compensation statutory requirements, with strong experience preferred with California Workers’ Compensation claims management; working knowledge of other coverage lines, including but not limited to, general liability, auto liability, property, crime and management liability
  • Ability to analyze data and formulate action plans
  • Experienced in claim negotiations and settlement practices
  • Advanced working knowledge of Risk Management Information Systems (RMIS) systems and reporting
  • Experience working with and ability to negotiate terms of third party service agreements with TPA, Carriers, and other Service Providers
  • Strong teamwork skills  
  • Excellent customer service skills supporting field operations organization
  • Commitment to continuous improvement
  • Bachelor’s Degree required, Risk Management or Finance degree preferred
  • CPCU, ARM, or AIC preferred
  • Georgia Adjuster License preferred
  • Minimum of 5-8 years multi-lines claims management with multi-jurisdictional experience in a corporate risk management department, insurance broker or insurer
51

Senior Product Claims Manager Resume Examples & Samples

  • Be responsible for all claims, methods, testing and evidence for one or more Dyson product categories
  • Build expertise in those categories, know the technology. Develop the claim substantiation strategy for each project from early product stages
  • Assist local markets in designing region-specific research with local partner organisations to facilitate new product endorsement
  • Attend product launches to present new Dyson technology to the media, conduct interviews and train local marketing teams on product detail and claims
  • Identify and commission external test houses capable of running standard tests and bespoke methods as new product categories come online
  • Attend regular James Dyson reviews
  • Ideally degree qualified in a relevant engineering or science discipline
  • Experience gained from a similar role
  • Good numeracy skills and can demonstrable ability to analyse data
  • Can devise creative ways to deliver potentially ‘dull’ or ‘complicated’ technical detail to a broad range of customers
  • Working knowledge and experience of consumer electronic goods, medical devices or similar would be ideal
  • Demonstrated knowledge and interest in science and engineering
52

Claims Manager Resume Examples & Samples

  • At least 7-10 years of work experience with at least 7 years previous insurance or financial services experience and 3+ years of experience in leadership or change management
  • Excellent organization skills – able to prioritize work and meet deadlines
  • Excellent interpersonal skills – able to work within a team
  • Comfortable and experience working with technology (solutions)
  • Proficient in Microsoft Office tools (or equivalent) – Outlook, Word and Excel
  • Insurance/ claims handling knowledge
  • Relevant industry practice or Line of Business experience
  • Insurance market, clients and claims management skills related to area of expertise
  • Proven experience of effective resource and cost management
  • Strong networking skills
  • Ability to handle complex and difficult negotiations and influence stakeholders Ability to handle very complex and difficult negotiations and influence multiple stakeholders
53

Claims Manager Resume Examples & Samples

  • Manage day to day site operations, supervisor leadership (internal and external to organization), and accountability for financial and non-financial results (budgets and actuals)
  • Lead project management and implementation initiatives
  • Impact of work is most often at the local level
  • 3+ years of supervisory/managerial experience in claims adjudication or customer service
  • 2+ years of experience managing relationships with clients and/or vendors
  • 2+ years of experience managing budgets, process improvement and quality assurance
  • Intermediate Microsoft Office skills (Word to create documents, and performance management, with Excel to create Pivot Tables; PowerPoint to create presentations)
  • 5+ years of healthcare claims leadership experience
  • Experience with Data Analysis
54

Claims Manager Resume Examples & Samples

  • Providing developmental feedback, coaching, and direction on work management
  • Ability to coach and develop direct and indirect reports
  • Ability to implement process improvements
  • Ability to influence and mentor
55

Group Claims Manager Resume Examples & Samples

  • Methodical and systematic
  • Good Management skills
  • Previous Claims Management Experience necessary
  • Skilled communicator
56

Claims Manager Resume Examples & Samples

  • Lead the claims team with responsibility and accountability for the successful closure of workers compensation, general liability and auto liability claims focusing on productivity, quality, technology innovation and customer service
  • Communicate and collaborate with subsidiaries, outside counsel and TPAs/insurers to provide efficient claims handling and quality customer service
  • Review, update and implement processes and procedures within the claims department focusing on best practices
  • Organize and lead claims meetings including quarterly claims reviews with the TPAs/insurers and monthly safety calls
  • Manage and monitor all high-exposure and complex files
  • Daily management of the claims department and the various TPAs and insurers
  • Manage, motivate and provide coaching to team to meet departmental goals and performance standards
  • Act as liaison between internal management, subsidiaries and TPAs/insurers
  • Manage all subrogation and defense and indemnity activities either directly or through outside counsel or insurer/TPA
57

Claims Manager Total Loss Resume Examples & Samples

  • Responsible for proper assignments of claims
  • Provide continuous training to personnel
  • Assist and or direct special projects and request
  • Analyze budget variances and assist Regional Claims Manager with development of annual budget process
  • Must possess effective verbal and written communication skills
58

Claims Manager Resume Examples & Samples

  • Minimum Bachelor’s Degree or equivalent experience
  • 3+ years Supervisory experience required
  • 10+ years’ experience in an environment that requires strong analytical and communication skills
  • Previous experience working in a Claims department
  • Previous experience in process or system improvement projects
  • Ability to manage people in a team environment
  • Expert knowledge in Microsoft Office Suite
59

Claims Manager Resume Examples & Samples

  • A thorough knowledge and understanding of pre-tax benefits, federal spending account (FSA) benefits and health spending accounting benefits to be able to base determinations of claim eligibility is required. Additionally, a solid knowledge and understanding of bank reconciliation, debit or credit card operations is required
  • A high level of analytical skills is necessary. The ability to uncover facts and use that information to effectively solve issues is also required. An attention to detail is essential
  • Incumbents must have the ability to effectively handle multiple tasks and priorities and the ability to work under specific time constraints. Excellent organizational skills and time management skills are essential
  • Strong oral, written and interpersonal skills are required. Demonstrated strong interpersonal skills in a team-based environment are also necessary to manage the team as described
  • Previous coaching experience is required. The ability to manage performance is required
60

Claims Manager Resume Examples & Samples

  • Monitoring and directing a portfolio of casualty losses and potential exposures, promoting best claim handling practices and providing compliance with early warning and loss protocols across Asia Pacific as well as acting as a point of referral and coordination for casualty claims matters across Asia Pacific
  • Acting as a point of coordination and referral for Casualty Claims matters across Asia Pacific
  • Providing oversight regarding processes related to coverage analysis, investigation, evaluation, reserving and resolution of a book of product-specific claims, in accordance with established guidelines, service standards, and regulations, while respecting local culture and marketplace differences
  • Ensuring that XL Catlin makes consistent technical claims decisions within Region and in line with Global Guidance – driving technical excellence across Asia Pacific Casualty Claims
  • Assessing potential complex claims across multiple jurisdictions including providing guidance on case strategies and action plans with local teams in the Region for Casualty lines
  • Providing/ driving technical guidance and training for Casualty Claims resources across the Region, leveraging available global resources and knowledge
  • Collaborating with Country/ Regional Claims Management to drive superior claims service and ensure effective and appropriate resourcing approach given the claims portfolio for casualty in the Region
  • Providing ongoing insights and advice to stakeholders on our large losses as well as material market developments and emerging risks
  • Continually reviewing and embedding global and regional best practices by collaborating with clients, claims resources and other internal and external stakeholders
  • Establishing a strong internal and external presence with line of business underwriters, producers and clients and supporting Underwriting on acquisition, wording and product development and participating in industry events including providing thought leadership
  • Coordinating communication and providing insights to actuarial/reinsurance/underwriting regarding any changes to claims exposure, emerging exposure trends and issues that may impact IBNR determination
  • Leading Claims response to catastrophe/ major events/ emerging risks for casualty in the Region and coordinating reporting to key stakeholders for Asia Pacific Casualty
  • In conjunction with Country Management, managing and developing a team, ensuring robust succession planning, and creating a culture of continuous improvement. Assisting in attracting, retaining and developing high performing claims talent
  • Leading and/or supporting internal projects to assess and implement improvement opportunities
  • Claims Experience: Minimum of 5 years of casualty claims experience – with experience in portfolio management as well as more complex claims experience. Specialized product-specific experience required as well as litigation management, field case management and pertinent regulatory issues
  • Legal & Regulatory Knowledge: Strong knowledge of multi-jurisdictional insurance coverage law and claim regulations in Asia Pacific. High dedication to customer service including professionalism and diplomacy in broker and insured relations
  • Leadership and Management: Lead by example with performance, engagement and commitment. Experienced leading a team of experts across various locations. Takes initiative
  • Strong Collaborator: Develop and maintain productive working relationships with insured, brokers, claim handlers, underwriters and legal counsel. Provide guidance and seek input from others as needed to achieve the best result possible
  • Strong Communicator: Proven verbal and written communication, collaboration, presentation and influencing skills. Able to communicate effectively with internal and external stakeholders across cultures
  • Results Oriented: Approach tasks proactively, prioritize. Strong analytical and sound judgment skills with the ability to take initiative and to work independently
  • Ability to travel occasionally and be flexible at time to lead across the Region as well as connecting with our Casualty Practice outside the Region
  • Customer Service: High dedication to client, team and vendor relations evidencing professionalism and diplomacy in all situations
  • Ethical approach: Have an impeccable reputation for ethics, integrity and the highest standards of professionalism
  • Education: Bachelor’s degree or equivalent required. Legal or Claim Handling qualification desired
61

Claims Manager Resume Examples & Samples

  • Handling/management & processing liability and finex claim
  • Administering and servicing own portfolio of clients’ claims
  • Working with broking staff to draft loss report/claims procedure and protocol
  • Participate in renewal and/or new business meeting to promote claims proposition
  • Provide technical support for broking and claims team, policy gap analysis where appropriate
  • Preparation of claims statistics/loss ratio and claim analysis
  • Engage with Insurers/loss adjuster to monitor claims progress and ensure timely settlement of claims
  • Mentoring and guiding claims executives on complex 1st party claims when escalated
  • Conduct claims training
  • Minimum 5 years’ experience in handling claims. With legal or insurance background
  • Sound IT Skills and experience with claims IT Systems
  • Ability to work effectively within a team environment to proactively share knowledge and work collaboratively to support colleagues and deliver required business outcomes
62

Claims Manager Resume Examples & Samples

  • Responsible for balancing workload within the area of responsibility
  • Provides continuous training and support to personnel
  • Assists in monitoring and controlling allocated/unallocated expenses and payment severity
63

Claims Manager Resume Examples & Samples

  • Hires, supervises, develops and evaluates claims team and manages performance, salary planning and administration, training and development and disciplinary actions
  • Meets with and provides technical feedback to the claims team on a quarterly basis to discuss positive and negative trends on the technical handling of claims
  • Communicates and resolves complaints via telephone and e-mail from customers or their representatives, agents, adjusters, examiners, contractors, etc
  • Responsible for providing claim file approvals and/or rejections with appropriate reasoning for all types of losses submitted by the claims team
  • Performs daily review of claim payments within your individual assigned authority level
  • Performs closed file audit monthly/quarterly to ensure acceptable margin of error, as well as to remain SOX compliant
  • Performs closed file audit on sample checks under $2,500 monthly/quarterly to ensure acceptable margin of error and to remain SOX compliant
  • Performs review of written correspondence developed by claims team for approval or rejection
  • Monitors the active pending claims of claims team to identify and provide feedback on aged or erroneous claims
  • Work extended hours or weekends during high volume periods or after catastrophic events, as needed
  • Assist with statutory or corporate reporting, as needed
  • Assist with the training and development of claims team
  • Bachelor’s degree in related field from an accredited institution preferred
  • 5-7 years of experience in claims settlement, supervisory, training and/or claims consulting experience preferred
  • In-depth knowledge of claims files handling, investigation and settlement processes and procedures; average knowledge of property insurance policies
  • Legal issues/litigation process as it relates to claims
  • Ability to discern problem areas, implement/coordinate resolution and follow up as needed to bring to conclusion
  • Must have current and valid adjuster’s license in all states that claims are assigned
  • Ability to empathize with customers and agents
  • Ability to operate PC and related software applications efficiently
64

Claims Manager Resume Examples & Samples

  • A proven track record of working in an operational leadership role
  • The ability to build and maintain excellent relationships
  • Be very good with numbers
  • Strong communication skills relevant to our industry
  • The ability to lead and motivate a team
  • Current knowledge of insurance market issues
  • Excellent teamwork skills
65

Senior Claims Manager Resume Examples & Samples

  • A real passion for team management and demonstrable experience of managing and developing a high performing team to deliver excellent results
  • Demonstrable experience implementing/designing strategy as part of a previous role
  • A relevant legal qualification (Solicitor/Legal Executive/GCilex essential)
  • Intermediate Excel capabilities (pivot tables, vlookups) and the ability to interpret large sets of data (e.g. from a Management Information and monthly reporting perspective)
  • Strong communication and business partnering skills and confidence in presenting to senior business leaders to train and engage in the importance of claims recovery activity
  • Ability to occasionally travel to support teams in the wider business
66

Specialty Claims Manager Resume Examples & Samples

  • Accountable for monitoring and assessing employee performance through spot checks, file reviews, ad hoc reports and other methods. Provide feedback and coaching and take appropriate action
  • Oversee the operational and technical work of the team and implement claim handling best practices to coordinate consistent handling of our company’s largest exposure claims
  • Process large quantities of file material, quickly discern key issues and create a plan for quickest claim evaluation
  • Direct outside counsel to most efficiently manage the litigation
  • May be involved in direct handling of extraordinary claims or losses
  • Monitor and control expenses related to claim handling activities
  • Manage according to established expense, reserve and settlement authority levels
  • Interpret and execute policies of higher level management
  • May lead quality file review teams
  • Bachelor’s degree with related 10+ years’ Specialty Claims experience
  • Juris Doctor preferred
  • Commercial litigation experience
  • Effective problem solver, who anticipates issues, seeks out and analyzes information collaboratively to propose solutions. Takes ownership for a successful resolution
  • Anticipates needs of the customer and takes a proactive approach to ensure they are met
  • Hires and develops the right people in the right place at the right time to deliver exceptional claim handling results and quality service
  • Able to multi-task and reprioritize
  • Effectively and creatively utilizes all resources (systems, people, etc.) to manage daily operations
  • Strong people management skills, effective at coaching and motivating staff. Serves as a role model in building effective relationships
  • Possess advanced claims technical knowledge combined with the ability to teach
  • Excellent communicator; communicates frequently in a clear, concise manner
  • Able to understand and articulate claims operations in a way that drives and achieves team(s) results
  • Supervisory experience preferred but not required
  • Proficient using MS Word and Excel and have good typing ability
  • Recognized as one of America’s Best Employers by Forbes,The Hanover is proud to be among the top property and casualty insurers in the United States. The Hanover offers a collaborative environment where you’ll gain new experiences and grow your career. The Hanover offers comprehensive benefits to help you stay healthy, build financial security, and maintain work/life balance. At The Hanover, you’ll enjoy what you do and have the support you need to succeed
67

Non-complex Bodily Injury Claims Manager Resume Examples & Samples

  • Owns the development and performance of the Core Bodily Injury operation or multiple smaller operations; applying functional operating principles to remove barriers to success. Continuously develops talent by creating opportunities for direct reports to grow and strengthen new skills
  • Champions claims customer service excellence by applying voice of the customer principles to build empathy and passion for the customer experience across the operation(s). Stays abreast of relevant industry best practices
  • Demonstrates a passion and vision towards a highly effective and engaged employee culture. Oversees the selection of top talent, delivers continuous coaching, understands and applies tools and processes to reinforce behaviors that ensure service excellence, and holds other managers accountable for the development of their people
  • Utilizes complex data to analyze and evaluate current processes and procedures. Monitors the performance of teams and claims managers, analyzing any problematic trends to identify root cause problems. Escalates issues or recommends solutions to operational leadership. Inspires a culture committed to identifying process efficiencies to continuously improve how work is completed
  • Sets and aligns the operation(s) on key success factors and goals, ensuring objectives align to broader claims functional goals
  • Function as the operation(s) liaison with regulatory agencies. Collaborates effectively with internal and external stakeholders and engages appropriate parties to resolve complaints, problems, and coverage questions that are escalated from teams, escalating further if needed to ensure compliance with regulatory and company standards
  • Owns results for multiple operations or one large operation, 80-120 total FTEs, with a scope of one geographic (e.g. region, zone) location within a sub-function
  • Continuously develops talent and holds others accountable for developing talent by selecting top talent, providing continuous coaching, and promoting a culture of claims customer service excellence
  • Manages salary (and non-salary) budgets
  • May coach and develop a team of 5-8 representatives/specialists in the most complex operations
  • Ability to lead and manage a claims operation within a geographic location and effectively communicate operational procedures
  • Advanced knowledge of principles and methods pertaining to the claims field; Advanced knowledge of claims management practices, company operations and policies. Advanced insurance related designations/CPCU preferred
  • Bachelor`s degree plus 7-10 years of relevant progressively more responsible work experience required, plus proven claims management experience
  • Bachelor`s degree plus 7-10 years of relevant and progressively more responsible work experience required, plus proven claims management experience
68

Claims Manager Resume Examples & Samples

  • Min. 4 years experience in healthcare claims review and/or provider dispute resolution
  • Knowledge of InterQual standards
  • Knowledge of CPT/HCPC/DRG and ICD10 coding, procedures and guidelines
  • Comprehensive knowledge of health care customer service, regulatory requirements and Provider Appeal process
  • Comprehensive knowledge of medical terminology
  • 6+ years experience in healthcare supervisory or management experience
  • 2+ years experience in management/supervisory role
69

Bodily Injury Claims Manager Resume Examples & Samples

  • For all duties and responsibilities, manager will take ownership of any issue, problem, or error that could potentially impact the policyholder and/or loss participant
  • Supervises, evaluates performance and recommends salary changes for personnel. Responsible for recommending promotions or disciplinary action of direct report. Primary responsibility for interviewing and selection of new personnel. Will also assist with other staffing decisions
  • Maintains service standards, reporting procedures, statutory compliance, and the efficient operation of the direct reporting group
  • Handles and directs resolution of problems, complaints and general public relation ("customer service") issues which arise concerning claims service
  • Extends coverage, reserve and settlement authority on losses which exceed individual levels
  • Maintains current knowledge of changes in state/area and helps develop and implement policies and procedures which impact claims processing
  • Assists and/or directs special projects or requests
  • Responsible for the communication , implementation and monitoring of procedural changes and company programs
70

ATM Claims Manager Resume Examples & Samples

  • Associate’s Degree in Accounting/other applicable field or 2 years of experience as an investigative analyst in a detail oriented operations environment is required
  • Experience in ATM operations, bank operations, retail banking or other banking capacity preferred
  • Practical knowledge of standard concepts, practices, and procedures for settlement processing, as well as basic knowledge of other Cash Connect functions, and the technology that supports those business lines is required
  • Must be proficient in using Windows and Microsoft software products and be able to develop an understanding of in-house applications
  • Must have excellent verbal, interpersonal and written communication skills
  • Incumbent will be required to stand for intermittent periods of time
  • Dexterity is mandatory as this job requires frequent use of hands and fingers
  • The incumbent will also be required to talk, hear, see, read and write
71

Claims Manager Resume Examples & Samples

  • Oversee daily operation of Specialty Department, including total responsibility for managing the department’s operating budget
  • Oversee all reconciliation associated with the payment process
  • Manage personnel in Specialty Department, including time worked, time off, and other operational functions related to managing personnel
  • Interviews and hires staff to meet departmental needs
  • Supervises staff, evaluates performance and terminates as necessary. Provides coaching and counseling when appropriate
  • Contribute to developing and maintaining necessary reports for the operation
  • Participates in organization decision making structure and process by attending meetings and actively participates in discussions. Participates in planning for new programs or initiatives
  • Works closely with Service Administration VP on quarterly business reporting in concert with Marketing Department
  • Work with IT and other departments as necessary to continually improve processes and procedures within the department
  • Ensure all client contractual SLA’s are met for reporting periods
  • Bachelor’s degree in business, finance or related field
  • 7+ years of related experience
  • 5+ years in a supervisory or management role within a call center environment
  • Experience with process improvement a plus
  • Ability to create reports from various systems and analyze data
  • Exceptional ability to manage multiple competing priorities
72

Claims Manager Resume Examples & Samples

  • High school diploma and 12 or more years related claim experience required
  • At least 3 of supervisor experience required
  • Knowledge of all team member related functions
73

Claims Manager Resume Examples & Samples

  • Process third party payments of damages to Company property or facilities and assure that the payment is to the proper invoice
  • Investigate either at the scene and/or through Company records, police and/or fire department reports, etc..the varied types of incidents/claims made against the Company
  • Assist the Legal Department in the preparation of a lawsuit for trial, including the drafting of a response to the petition/complaint and interrogatories and preparing Company employees and/or witnesses for deposition or trial
  • Prepare computer-aided reports, claim/investigative summaries, memorandums, etc. required by the department
  • Review, direct, investigate, and maintain a damage database and forward damage invoices to the appropriate operating department regarding .dig in. damages by the Company against other parties; settle, compromise, deny responsibility for said damage and successfully conclude the matter
  • Review all incoming mail and internal company reports for the appropriate handling and disposition
  • Develop and prepare comprehensive and understandable reports regarding the status of areas of responsibility in the business plan for senior management and other departments
  • Assign the appropriate Claims personnel the responsibility of handling a bodily injury, property damage, or other claims made against the Company and make recommendations and/or suggestions pertaining to further investigation, liability issues, potential settlement value, etc. until the matter is successfully concluded
  • Advise and assist other departments/operating divisions regarding the policy and procedures for reporting potential claims, record retention/recovery, completion of the mandatory state or federal report following a reportable incident, etc. and the appropriate disposition
  • Assist the Legal Department in miscellaneous matters as required
  • Advise and assist in the creation/implementation of new policies and procedures designed to reduce and/or eliminate legal exposure to the Company
  • Assist the department with the development, implementation, and presentation of various training/awareness programs within the Company
  • Respond to inquiries from collection attorneys regarding the explanation of the billing process, number of repair hours, reasons for the repair, settlements, etc. regarding damage repairs
  • Represent the Company in small claims court
  • Attend seminars and classes to maintain certification as a Missouri State Fire Investigator
  • Participate as a member of the Natural Gas Claims and Litigation Association and attend its annual meeting
  • Certification as a Fire Investigator through the Missouri State Fire Marshall's Office
  • Knowledge of Missouri statute/law of negligence, evidence, One Call program, etc
  • Extensive knowledge of Company policies, procedures, and operations
  • Knowledge of the Company's distribution system and customer-owned facilities
  • Ability to analyze and process a fire/incident scene within industry standards through diagrams, photography, retention of evidence, etc
  • Ability to evaluate and estimate the Company's potential liability exposure and the appropriate monetary reserve needed to settle any and all claims made against the Company
  • Ability to obtain recorded/written statements from Company employees or other individuals
  • Ability to evaluate and negotiate to a successful conclusion any and all claims made against the Company
  • Ability to obtain, review, and summarize medical records, court records, police and/or fire reports, and internal company records
  • Directly supervises two (2) non-supervisory management employee: Claims Supervisor
  • Assist in the supervision/development of departmental Administrative Assistant/Paralegal
74

Warranty Claims Manager Resume Examples & Samples

  • Manage warranty claims associated with NRG wind and solar assets
  • Develop and maintain detailed reports and presentations covering the current warranty status of wind and solar assets as well as company exposure to availability issues and lost revenue
  • Integrate warranty process in to SAP
  • Ensure appropriate reporting on claim processes to management
  • Ensure alignment of processes with internal and external stakeholders on warranty status
  • Conduct lessons learned and proactively initiate preventive actions
  • Responsible for internal warranty projects and strategies
  • Possess the ability to understand legal, commercial and technical issues in details and to negotiate with vendors in a trustworthy atmosphere
  • Bachelor's degree in engineering or equivalent experience
  • Successful Candidate with have a proven track record with warranty extension’s and have negotiated win/win terms and conditions
  • Ability to cooperate efficiently across multiple professional disciplines, while creating results though team work as well as independently
  • Excellent verbal and written communication skills and an honest open communication style
  • Proficiency in SAP, Microsoft Excel, Power Point, Project, Word and proven ability to learn new software programs
75

Branch Claims Manager Resume Examples & Samples

  • Has overall responsibility to organize and supervise claims-handling and clerical activities within Branch, allocating work loads and making work assignments
  • Responsible for selection of Branch Office employees, and schedules their attendance in company training schools, seminars and workshops
  • Implements Company policies and procedures for processing of claims and record keeping
  • Provides assistance to employees in policy interpretation, resolving underwriting concerns or problems regarding claims and participates personally in adjustment of claims, as situations or circumstances may require
  • Resolves problems and complaints concerning claims with Department of Insurance or individual claimants
  • Maintains communication and cooperation with Agents and Sales Managers, attending and participating in Marketing group meetings to inform or instruct on technical aspects of coverage and claims settlement, and any changes that occur
  • Responsible for implementation and control of Agents' draft authority program
  • Responsibility for maintenance and care of Branch Office facility and equipment and hires and coordinates projects with building contractors as needed and approved by upper management
  • Conducts performance and salary reviews for supervised personnel and makes recommendations for salary increases and promotions
  • Develops annual budget for assigned Branch Office, including all expenditures except Claims payments, and submits to Regional Claims Director for approval
  • Makes decisions concerning daily operations in accordance with procedures
  • Occasionally serves as instructor in Home Office and field Claims Seminars and training schools
  • Ability to accept supervision, follow instructions and work in a harmonious manner with co-workers and supervisors
  • Performs other duties and prepares special reports as requested by the Regional Claims Director
  • Excellent reading comprehension skills for study of insurance policies and claims laws
  • Ability to analyze and use management reports
  • Superior leadership skills
  • Thorough knowledge of insurance claims operations, and specifically of Shelter's policies and claims procedures
  • Minimum of five years successful experience in a claims environment, demonstrating superior skills for organization, communication, negotiation, and decision making, as well as thorough knowledge of claims procedures, insurance policies and coverages
  • Previous supervisory experience with demonstrated ability to supervise others effectively
  • Performs duties under the general supervision of the Regional Claims Director
  • Accountable for providing accurate, equitable and efficient claims service to Policyholders and Agents within assigned Branch Office area in accordance with established rules, procedures and policy coverages and applicable law
  • Responsible for prudent administration of budgetary allowance for the Branch, and for adequate explanation of variances on a quarterly basis
  • Accountable for ensuring employees hired possess basic skills for PC and software operation, and that staff receives training necessary to maintain strong level of technical skills in order to provide prompt and efficient claims handling
  • Responsible for maintaining safety awareness for Branch Office, including addressing ergonomic issues and other matters involving overall safety of employees' work areas
  • Accountable for overseeing upkeep and maintenance of Branch Office facility and equipment
76

Casualty Claims Manager Resume Examples & Samples

  • Leads, directs and has leadership accountability for a staff of Claims Adjusters. This includes ensuring that there are performance objectives and performance metrics in place to both support and meet department goals
  • Provide direction, leadership and training to in-house claims professionals
  • Partners with key Claims Management to develop strategic and operational plans aimed at achieving efficiencies so that the department can meet its Critical Success Goals and the business unit can meet both growth and profitability targets
  • Establish, refine and evolve best-in-class claim management program operating characteristics, measurement criteria, and meaningful metrics benchmarking
  • Provide advice and oversight into claim disposition strategies
  • Work closely with claims adjusters and outside counsel to ensure cost-effective and appropriate litigation management strategies are in place that will lead to the best overall outcome
  • Drives continuous improvement through initiatives involving the employees, processes and technology
  • Managing expenditures to budget / plan
  • Supports the professional claims selection process to retain claims professionals that consistently demonstrate appropriate technical expertise, maturity and a professional commitment to excellence and customer service
  • Ensures claims best practices are met in the support area for proper and consistent claims performance and achieving the appropriate financial outcomes
  • Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Group’s and our customers’ ability to be profitable)
  • Minimum 8 years claims experience, preferably with 3 years in a Claims Supervisory capacity
  • Bachelors degree and/or multiple industry designations required
  • Polished and professional written and verbal communication skills with the ability to build consensus both internally and externally. The ability to read and write English fluently is required
  • A strong focus on execution in getting things done right. Proven ability to consistently produce and deliver expected results to all stakeholders
  • Client focus – the ability to effectively determine specific client needs and to provide value added solutions
  • Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis
  • Intellectual curiosity. Consistently considers all options and is not governed by conventional thinking
  • Ability to build commitment both internally and externally. Ability to communicate corporate vision and to gain support for his/her views, opinions and decisions
  • Strong focus on selection – determined to have the right people who do the best job. Has a reputation for his/her ability to identify, attract and hire talented people
  • Dedicated to developing talent. Understands and is committed to developing people so that they realize their full potential
  • A team builder, someone who understands that success is dependent upon the performance of the team and not individual team members. Creates strong morale and spirit within the team: shares wins and celebrates success as a team
  • Ability to establish mentoring relationships with key employees and participates in the development of succession and training plans for critical positions
  • Ability to develop and communicate to claim management reports for accurate and timely reflection of support staff performance and impact on the claims department
  • Maintains productive relationships with clients, business partners and organizational peers with a focus on timely and meaningful exchanges of information
  • Measure his/her own success by performance in quickly identifying issues and bringing resolution to outstanding issues
77

Group Senior Claims Manager Resume Examples & Samples

  • Works directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
  • Manages both new claims and open claims equally and maintains decision times
  • Stays abreast of ongoing trainings associated with role and business unit objectives
  • Minimum of 2 years disability claim management experience
  • Strong math and calculation skills
  • Multilingual skills are highly desired
78

Claims Manager Resume Examples & Samples

  • Responsible for performance, development and coaching of staff (i.e. hiring, terminating, performance and salary management) Is a technical resource not only for Claims staff, but also Underwriting Staff
  • Determines liability, reviews coverages and settles claims
  • Provides Claims management by meeting with brokers, Risk Managers and reinsurers to both implement and maintain claim management programs
  • Establishes adequate reserves for both indemnity and expense and reviews reserves on a regular basis to ensure adequacy
  • Provides direction to external lawyers with respect to coverage, investigation and ultimate settlement, including, but not limited to direct participation in mediation and arbitration and active participation in settlement discussions
  • Actively pursues all avenues of recovery and manages subrogation activities including, but not limited to subrogation in Fidelity claims and timely recovery of deductibles from insureds
  • Provides regular reports to Claims management regarding losses either exceeding or likely to exceed the authority level or as prescribed by regulations within the Claims manual
  • Involved with new product development
  • Bachelors' degree or equivalent training; Law Degree preferred
  • A minimum of 10 years of relevant and progressively more responsible work experience required, including at least 5 years of performance management and employee supervisory experience
  • At least 7 years claims handling within a technical specialty
  • Requires advanced knowledge of claims handling concepts, practices, procedures and techniques, including, but not limited to coverage issues, product lines, marketing, computers and product competition within the marketplace
  • Requires advanced knowledge of a technical specialty
  • Knowledge of law and insurance regulations in various jurisdictions
  • The ability to effectively interact with brokers and internal departments is also required
  • Strong verbal and written communications and organizational skills
  • Strong negotiation, analytical and decision making skills also required
79

Claims Manager Resume Examples & Samples

  • Receive and investigate adverse occurrences and potential compensatory events, medical malpractice claims, patient complaints and highly sensitive billing dispute and analyze for risk liability exposure
  • Manage medical malpractice claims and collaborate with TPAs and defense attorneys on strategy recommendations
  • Collaborate with our Clinical Services Division and Chief Medical Officers with tracking/trending of adverse outcomes and medical malpractice claims in order to improve quality of care and advance patient safety
  • Prepare materials and participate in claims committee meeting, carrier meetings, and divisional meetings, as assigned
  • Evaluate medical malpractice claims history of healthcare professionals through the New Hire, Re-credentialing or Due Diligence process
  • Conduct Risk Management orientation training as needed. Develop and make recommendations for educational Risk Management programs based on needs assessment
  • 3-5 years risk management experience in a healthcare or large medical group practice or with medical malpractice claims and case management is required
  • LNC or prior medical malpractice claims adjusters will also be considered
  • Strong verbal/written communication skills required, along with proficiency with computer software systems
80

Claims Manager Resume Examples & Samples

  • Manages a comprehensive, integrated system for managing non-workers’ compensation claims for the Health System and its affiliates
  • Manages a caseload of assigned claims
  • Ensures reporting of claims to insurance carriers
  • Conducts insurance coverage analyses
  • Reviews and evaluates insurance carrier coverage responses including reservation or rights and coverage denials
  • Evaluates loss runs to ensure adequate reserving of claims at all layers of primary and excess coverage
  • Oversees Third Party Claims Administration (TPA) and defense counsel in the management of all aspects of assigned claims including day-to-day management, case reserves, expenses and motion practice
  • Maintain current claim information in the database
  • Ensures appropriate expert reviews
  • Evaluates claims focusing on exposure, severity, reserves and trial dates
  • Monitors cases on trial and attends trials, when necessary
  • Identifies cases requiring early/pre-trial resolution
  • Collects and reviews claims data to identify trends and opportunities for loss control
  • Collaborates with clinical risk management, and insurance / risk services teams to recommend loss control initiatives
  • Negotiates claim resolution as needed, including appearance at mediations and court conferences
  • Serves as a liaison between the Health System, Third Party Claims Administrator and Insurance Broker in all aspects of claims management
  • Monitors claims impacting on the Health System’s Insurance Captive Insurance company, Self Insurance Program and/or deductibles,
  • Reviews insurance and related provisions of written agreements
  • Bachelors Degree in Nursing, required. Masters Degree, preferred
81

Claims Manager Resume Examples & Samples

  • Establish and communicate clear performance objectives, evaluate work product and progress toward objectives, coach proactively, complete file quality reviews and write performance evaluations based on corporate standards; assist in determining salaries based on performance
  • Assist with the screening and hiring of staff
  • Serves as a resource to staff and others for information and guidance in using the claims system, and for making proper and timely claims decisions
  • Diary and track progress on large loss claims, guide claims handlers on large loss review process to include review of large loss forms and attendance at large loss reviews
  • Manage complex claims or claims involving coverage concerns
  • Lead and participate in committees or special projects as directed
  • Take on ad hoc assignments and distributes to team based on department driven need
  • Bachelor's Degree or in-lieu of degree equivalent education, training and work-related experience
  • 5+ years of experience in insurance claims
  • Strong interpersonal skills and the ability to work effectively with a wide range of constituencies
  • Ability to take initiative to provide solutions in a claims environment
  • Effective leadership skills
  • Ability to speak Spanish (Bi-lingual)
82

Claims Manager Resume Examples & Samples

  • Embracing opportunities
  • Doing the right thing at the right time for the right reasons
  • Manages workers compensation and general liability claims to reduce claim cost and improve outcomes
  • Partners with property managers to maximize opportunities for in-house handling of general liability claims and to negotiate settlements within authority or deny when appropriate
  • Investigates and analyzes general liability claims to determine exposure; manages claims through well-developed action plans to an appropriate and timely resolution
  • Evaluates and approves or denies Third Party Administrator (TPA) adjuster requests to increase reserves; provides settlement authority for non-self-handled general liability claims
  • Oversees the claim audit process to ensure TPA adherence to established minimum claim handling standards
  • Manages and reviews open workers compensation claims files for compliance with claims handling guidelines to include initial claims handling, investigation, medical management and overall file management
  • Provides guidance to property managers to ensure workers compensation claims are reported to insurance carrier in an accurate and timely manner
  • Conducts classroom training for new managers or other groups regarding claim procedures, policies and regulations
  • Analyzes claim data and trends in the context of ongoing management and programs aiming to enhance claim mitigation techniques
  • Performs other related duties as assigned to meet the needs of the business
  • Knowledge of risk management, claims management and workers compensation legal concepts
  • Knowledge of medical and occupational health topics and related terminology
  • Knowledge of basic contractual concepts
  • Skill in collecting and analyzing complex data to employ data-based conclusions
  • Skill in negotiation strategies and outcomes
  • Skill and ability to clearly and concisely communicate verbally and in writing with all levels of associates
  • Skill in developing training modules relevant to the company’s business operations
  • Proficiency with Microsoft Office applications (Word, Excel, Outlook and PowerPoint)
  • Some travel required (less than 25%)
  • Bachelor’s degree and three-to-five years of claims handling experience in one or more of the following areas: third party administration, insurance broker, carrier claims adjusting, claims management or corpo