Claims Support Resume Samples

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HS
H Skiles
Hildegard
Skiles
8473 Maggio Via
New York
NY
+1 (555) 195 2371
8473 Maggio Via
New York
NY
Phone
p +1 (555) 195 2371
Experience Experience
New York, NY
Claims Support Specialist
New York, NY
Koelpin, Ferry and Johnston
New York, NY
Claims Support Specialist
  • Performing support functions including email, calendar management, and word processing with a strong emphasis in excel
  • Works on simple tasks using established procedures
  • Contacting or receiving communication from customers or additional claim related third parties to obtain and/or provide necessary claim information
  • Work is typically reviewed by others
  • Processing total loss claim files and payments
  • Complying with quality and process standards
  • Retrieving, prints, faxes, or mail supporting documentation to vendors or others as directed
San Francisco, CA
STD Claims Support Specialist
San Francisco, CA
O'Conner, Rolfson and Klein
San Francisco, CA
STD Claims Support Specialist
  • Provides feedback to unit managers on individuals' performance
  • Partners with the STD Unit Leader to analyze, identify and implement strategies to enhance claim management, customer centricity and efficiency of their team while monitoring strategy effectiveness
  • Expertise knowledge of system and tools, ie…MDG, DPA, Intellis and how to leverage tools to improve claim management effectiveness
  • Provides candid and specific feedback to team members in order to support their growth and development
  • Coaches, coordinates, and develops claims specialists
  • Conducts weekly quality audits; assists with training; resolves escalated phone calls
  • Basic knowledge of medical conditions, treatments, prognosis
present
Boston, MA
Senior Claims Support Coordinator
Boston, MA
Veum, Lowe and Feest
present
Boston, MA
Senior Claims Support Coordinator
present
  • Working with other team members to coordinate the management of the shared email box
  • Monitor claims within a workflow system
  • Determines claim eligibility based on established criteria. Administration of all waiver claims, determining eligibility for continued benefits and offering conversion options for clients whose benefits are reducing or terminating
  • Maintain excellent working relationships
  • Responsible for performing all tasks within department quality and service level agreement standards
  • Other duties as assigned
  • Microsoft Office Suite
Education Education
Associate’s Degree in Business
Associate’s Degree in Business
Drexel University
Associate’s Degree in Business
Skills Skills
  • 3 to 5 years of claims or related administrative experience
  • Proven customer service and follow up skills
  • Intermediate to advanced computer skills (Word, Excel, Claims Station)
  • Strong written and verbal communication skills
  • Attention to detail
  • Strong organizational skills
  • Ability to work independently or in a team
  • Gainshare bonus of up to 16% of salary (Our annual Gainshare bonus program rewards employees based on the company's achievement of annual performance objectives)
  • Ongoing training, tuition assistance and opportunities for career advancement
  • Award winning, supportive environment including Employee Resource Groups
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13 Claims Support resume templates

1

Advertising Claims Support Manager Resume Examples & Samples

  • Bachelor's Degree (or equivalent life experience)
  • 5+ years in fields related to advertising, marketing (CPG or Pharma), regulatory or R&D
  • Excellent teamwork and problem-solving skills
  • Proficiency in Microsoft Office programs
  • Strong time management and task prioritization skills
  • Strong analytical/quantitative skills
  • Ability to work in a dynamic, fast-paced environment
2

Senior Claims Support Service Specialist Resume Examples & Samples

  • Receives, screens and routes incoming telephone calls and other electronic correspondence
  • Generates and sends appropriate forms to insured/claimant for completion
  • High School Diploma/General Education Diploma (GED) required
  • One year of customer service experience in an office environment
  • Experience with data entry on a 10 key pad preferred
3

Claims Support Specialist Resume Examples & Samples

  • Retrieving, prints, faxes, or mail supporting documentation to vendors or others as directed
  • Contacting or receiving communication from customers or additional claim related third parties to obtain and/or provide necessary claim information
  • Complying with quality and process standards
  • High School Diploma or Associate’s degree
  • Prior customer service experience in an office environment
  • Good organization skills with timely follow-up skills
4

Claims Support Specialist Resume Examples & Samples

  • Sort and file prescriptions/patient demographic forms (may include lifting up to 30 lbs.)
  • Locate and retrieve prescriptions/patient demographic forms when requested
  • Label older prescription file boxes for off site storage
  • Cross train and work in all processes when needed
  • Repetitive movements including: sit, stand kneel, reach, and climb ladder
  • Service center environment with Representatives, computers, printers, floor activity
  • Ability to stay organized, focused and prioritize in order to complete tasks Limited work experience
  • Works on simple tasks using established procedures
  • Depends on others for guidance
  • Experience in a support role in either an office environment or a service center environment
  • Experience with computers and Windows PC applications (this includes the ability to learn new and complex computer system applications)
  • Experience in a Medical Office
  • Experience in the Healthcare Industry
5

Claims Support Associate Resume Examples & Samples

  • High School Diploma/General Education Diploma (GED), plus one year of customer service experience in an office environment
  • Excellent customer service skills and a passion to help others
  • Strong computer, typing and grammar skills - Microsoft Office
6

Claims Support Associate Resume Examples & Samples

  • Retrieves, prints and faxes, or mails supporting documentation to vendors or others as directed
  • Process, sort, index and route incoming and outgoing communications related to claim operations
  • Receive, screen and route telephone calls and other electronic correspondence
  • Maintain internal and external customer relationships and deliver outstanding customer service
  • Strong computer, typing and grammar skills
7

Associate, Claims Support Resume Examples & Samples

  • Analyzes and processes claims by investigating, gathering and obtaining information to make basic claim determinations
  • Analyzes claimants coverage contracts to determine basic payment eligibility is met
  • Collaborates with appropriate internal stakeholders to determine basic claim eligibility
  • Conducts basic interviews with external stakeholders (e.g. physicians, claimants, and/or lawyers)
  • Evaluates and makes recommendations regarding basic claim eligibility determinations to management
  • Makes claim determinations for his /her assigned claims
  • Reviews and provides assessments to facilitate settlement of claims up to designated authority level and makes claims payments
  • Interpret a variety of policy provisions and apply the interpretations to complex claim situations, which require a broad understanding of insurance products as well as other insurance functions outside the Claims department
  • 0 - 1+ Years Experience in claims that directly aligns with the specific responsibilities for this position(Required)
  • 2-3 Years Long Term Care claims experience preferred
  • 4 Year/Bachelors Degree or equivalent work experience (4 years of experience in lieu of Bachelors) in Business or Finance (Minimum Required)
8

Claims Support & Process Consultant Resume Examples & Samples

  • Bachelor's Degree or Finance, Mathematics, Industrial Engineering or related field
  • Experience in data acquisition and manipulation applications (MS Access, Business Objects, Excel)
  • Experience organizing hypotheses, results and analysis into an effective communication package (PowerPoint, Tableau)
  • Ability to thrive in both structured and project-oriented work environments
  • Prior experience or knowledge in 1st Party medical claim handling a plus
9

STD Claims Support Specialist Resume Examples & Samples

  • Coaches, coordinates, and develops claims specialists
  • Acts as resources for claim-related and technical issues
  • Monitors case managers' work queues to ensure claims team is meeting expectations and applicable performance guarantees
  • Conducts weekly quality audits; assists with training; resolves escalated phone calls
  • Provides feedback to unit managers on individuals' performance
  • 3+ years insurance claims experience
10

Dir, Claims Support Resume Examples & Samples

  • Responsible for the day to day operations of the department including the establishment of acceptable performance standards to ensure compliance and regulatory requirements are achieved
  • Assure performance standards are achieved by daily monitoring of inventory, conducting quality audits of the team’s work product and surveying customer’s as appropriate
  • Produce trending and analysis reporting of the team’s performance as requested
  • Participate in the implementation of claim operational strategies, policies, workflow processes and standards. Ensure effective utilization of these strategies and policies
  • Seek out and propose more cost efficient means to support the claims department within the scope of these administrative services
  • Responsible for the training, supervision and performance of the associates supporting the administrative functions of the department
  • Support sales in the training of claim processes
  • Manage vendor relationship supporting financial transactions post claim decisions
  • 5-7 years of management responsibility within a customer service focused organization
  • 3 - 5 years experience in process flow re-engineering and optimization (people, process and systems)
  • Understand greater vision for the company, and is able to translate changes in business environment to opportunities outside of the department for overall organizational effectiveness
  • Able to promote a culture of performance, teamwork, customer focus and integrity
  • Has full managerial and staffing responsibilities for area
  • Communicates and interfaces with all levels of management
  • Develops and maintains close agent and customer ties, articulates customer needs, keeps priorities in focus with the desires and expectations of the customer
  • Experience in analyzing trends; developing and interpreting reports; and designing solutions to operational challenges is required
11

Administrative Claims Support Specialist Resume Examples & Samples

  • 2+ years of administrative - clerical support experience
  • Professional communication skills with speaking ability to be clear and patient while providing phone support
  • Good business judgment and professional demeanor
  • Commitment to providing excellent customer service support
  • Proven ability to work with sensitive information and deadlines
  • Strong proficiency with Microsoft Office software, specifically strong tying and data entry skills
12

Offshore Claims Support Manager Resume Examples & Samples

  • Assist the Offshore Manager with performance management utilising valid MI to identify opportunities for improvement to contribute to the profitability of Direct Line Group
  • Support the optimising of performance within the offshore operation across multiple sites 400+ Fte ensuring service standards are met in line with the resource/capacity plans
  • Develop in depth knowledge of offshore governance, supporting the Offshore Manager to ensure adherence to process and procedure across multiple Claims processes including Customer Voice & back office activity
  • Support the Offshore Manager with engaging with all key stakeholders for offshore projects across both DLG & strategic out-source partner
  • Collaborate with Offshore Manager and UK stakeholders to identify off shoring opportunities
  • Act as a Deputy to the Offshore Manager as and when required
  • Have an in depth knowledge of Quality Assurance Testing ensuring controls are fit for offshore environment and align 1LOD governance
  • Demonstrable offshore and/or Customer operations experience
  • Effective stakeholder management skills
  • Ability to embrace and drive change
  • Commercial acumen
  • A diverse outlook, in line with the DLG Values and organisational culture
  • Flexibility in your approach and demonstrate and maintain a high level of professionalism at all times
  • A customer centric approach
  • Attractive holiday entitlement
  • Free Travel insurance
13

Claims Support Coordinator Resume Examples & Samples

  • High school degree, 1-2 years of secondary education is preferred
  • Microsoft Office Suite – {Excel – Advanced (Stop Loss)}
  • Ability to multi-task and prioritize workload in a workflow environment
  • Critical Thinking: Thoughtful process of analyzing data and problem solving data to reach a well-reasoned solution
14

Claims Support Analyst Resume Examples & Samples

  • Index claims related documents for various lines of businesses
  • Create first notice of loss & setup incident only claims in our claims systems
  • Reconcile coinsurance bordereau and enter payments/reserves in our claims systems
  • Work together with onshore teams to resolve complex scenarios and ask for additional information when needed
  • Maintain proper documentation of all the procedures and updates
  • Be part of the process meetings and participate in monthly/quarterly audio & video conference calls
  • Make sure to achieve service level agreements and meet set quality standards at all times
  • Proven experience in insurance industry preferably in (re)insurance claims area (ability to read and interpret insurance data) will be an asset
  • Excellent data processing skills
  • Fluent English and German, both spoken and written are a must
  • Inquisitive mind with strong analytical thinking skills
  • Excellent people skills; communicative and open to new challenges
15

Administrative Claims Support Resume Examples & Samples

  • 2+ years administrative or clerical support experience - desired
  • Ability to type and enter data with accuracy and proficient with MS Office
  • Understanding and ability to work with confidential information with accuracy
  • Commitment and interest in learning new skills and contributing to company success
16

Senior Claims Support Coordinator Resume Examples & Samples

  • New claim setup , correspondence , and coverage eligibility
  • Analyze and determine claims eligibility meeting compliance requirements
  • Generate internal and external customer correspondence
  • Monitor claims within a workflow system
  • Maintain excellent working relationships
  • Participate in problem solving activities in a team environment
  • 1+ years insurance experience
  • Proven analytical and problem solving skills and attention to detail
  • Excellent Data Entry skills maintaining top quality
  • High level of compassion and commitment to customer service
17

Claims Support Frontline Leader Resume Examples & Samples

  • Provide guidance and leadership to associates and serve as a mentor for their day-to-day activities
  • Identify reasons for variation in individual performance and take appropriate actions that will result in improved production and quality performance
  • Analyze data to guarantee key performance measures are met, while aiding in the removal of barriers to success of organizational goals
  • Conduct deeper dives into what is causing claims rework
  • Review projects and tasks submitted and identify gaps and opportunities
  • Conduct meetings with Network or other departments to present findings with recommendations
  • Maintain proactive communication and collaboration with other departments to ensure efficient, accurate and timely responses to internal/external customer needs
  • Ensure timely trainings on errors identified from internal or external customers with hands on experience to support team success
  • Accountable for managing workflows, policies, and inventory meeting all Service level agreements (SLAs)
  • Two years of previous leadership experience
  • Experience managing 7 or more associates
  • Must have two years of medical claims experience in a production based environment
  • Intermediate in Microsoft Office Programs Word and Excel
  • Ability to build and run complex queries in Microsoft Access or SQL
  • Knowledge of PowerPoint
  • Prior work experience in an operational setting
18

Manager, Claims Support Resume Examples & Samples

  • Minimum 3-5 years experience in Managed Care claims payment in IPA, Medical Group, MSO or health plan setting
  • Comprehensive knowledge of CPT, ICD-10, inpatient procedure coding, HCPCS, Revenue Codes, medical terminology and COB Required
  • Comprehensive knowledge of various fee schedule for professional, facility, and ancillary claims—CMS pricers, DRG, APC, ASC, SNF-RUG and other CMS fee schedules
  • Knowledge of enrollment and eligibility processes and requirements
  • Working knowledge of Claims information systems
  • Microsoft Excel, Work, and Access skills
  • Detail oriented with excellent verbal and written communication skills
  • Demonstrated effective communication, interpersonal, and organization skills
  • Ability to plan and identify opportunity to effectively utilize resources
19

Claims Support Specialist Resume Examples & Samples

  • Three or more years HMO claims and Claims Correspondence processing experience required in a managed care environment, preferably PMG/IPA setting within the last three years or any combination of education and/or experience which produces an equivalency
  • Knowledge of medical terminology and coding
  • Familiar with CMS and Department of Managed Care mandates
  • Ability to type 35 WPM uses a ten‑key adding machine, perform data entry and make mathematical calculations
  • Effective communication and follow-through skills
  • Spanish bilingual
20

Claims Support Unit Team Leader Resume Examples & Samples

  • Meet department targets, objectives and SLA’s through managing department workloads. Complete allocation by 4pm
  • To assist and work collaboratively with the wider leadership group regarding ad-hoc requests as required
  • To ensure suitable and sufficient cover by team is in place in the event of absence
  • Manage work queues, ensuring effective processes and controls are in place that will deliver a consistent, high quality claims to a handler
  • Review distribution of Rebalancing work queues daily
  • Ensure personal and team compliance with the provisions of CSU Best Practice
  • Building & implementing training programs and ensure all staff have sufficient knowledge of all processes
  • Understanding of MI to ensure effective reporting and production of CSU specific data to support management of the team and allocation across BI Pro-Active
  • Proactively identifying trends and using relevant data / information to understand emerging issues
  • People management of team, specifically conducting one to ones and monitoring and assessing team performance
  • Role modelling, through positive behaviours,
  • Manage pay view hierarchy and cost centre
  • Escalation for HR issues - Understand and apply the relevant people processes and procedures e.g. disciplinary, absence, timekeeping, dress code and conduct
  • Ensure active staff records are managed and maintained as well as carrying out quarterly & annual reviews and agreeing training and development plans
  • Deal sensitively with highly confidential information
  • Unlocking the full potential of your people through engagement, identifying and arranging learning and development, coaching, feedback , both individually and collectively
  • Resource plan department recruitment needs
  • Manage workday account as required in terms of business requirements
  • To possess sound working knowledge of MOJ Portal, and claims handling and Best Practice processes
  • Develop self in order to maximise personal contribution to your role. Possess a sound working knowledge of MOJ Portal, claims handling process and Litigation process. Keep an up to date comprehensive business rules document relating to workload management for the entire BI function
21

Claims Support Analyst Resume Examples & Samples

  • Have excellent communication, grammatical, research and analytical skills
  • Exhibit attention to detail
  • Have ability to solve problems logically and creatively
  • Learn complex procedures quickly and adapt to new/changed procedures with ease
  • Establish and maintain effective working relationships with co-workers, company personnel, and the general public
  • Type at least 40 words per minute with a high degree of accuracy
  • Proficient computer experience in PC, Windows, Excel, Access and Word
  • At least two (2) year’s experience working in an office environment; OR Any equivalent combination of experience and training that provides the required knowledge, skills and abilities
22

Receptionist Claims Support Resume Examples & Samples

  • High school diploma (or equivalent)
  • Knowledge of medical terminology, CPT coding and physician reimbursement methodologies such as RBRVS
  • Strong computer experience (minimum 1 year experience with EZ-Cap preferred)
  • Experience with computer programs (Windows, Word, Excel, Mail Merge, Fax Blast, PowerPoint)
  • Excellent communication and assessment skills
  • Willingness to learn new tasks
23

LTD Claims Support Specialist Resume Examples & Samples

  • Provides coaching, mentoring, and direction to associates
  • Identifies issues and works with associates to increase individual and organizational capabilities
  • Works in tandem with Unit Leader to resolve all claimant escalations
  • Performs EA and Claim reviews on decisional and financial elements as needed
  • Provides real-time coaching to ensure associates are making the right decision in a timely manner supported by proper documentation and with effective communication
  • Identifies performance issues and/or trends and provides Unit Leader with feedback on individual’s progress, performance and opportunities
  • Responsible for inventory control and/or load balancing. Assists Unit Leader with control reports. Acts as team and office resource for claim related and technical issues
  • Resource for implementation of new accounts from a technical and process perspective, as needed
  • Partners with Learning & Development and Documentation team on work instruction and office training as deemed appropriate
  • Embraces and promotes change initiatives within team and office-wide
  • Performs other related duties as assigned or required
  • 5+ years Disability claims and/or clinical experience
  • Must be able to communicate clearly and effectively, both written and verbal
24

STD Claims Support Specialist Resume Examples & Samples

  • Partners with the STD Unit Leader to analyze, identify and implement strategies to enhance claim management, customer centricity and efficiency of their team while monitoring strategy effectiveness
  • Drives Claim Management Accuracy and Customer Centricity through the QQA program by auditing claim file reviews including monthly call monitoring for Claims Specialist to identify improvement opportunities, skillset gaps, trends for quality, service and/or compliance
  • Fully engages in customer focused training; model learned behaviors
  • Supports and guides assigned team member(s) to ensure that they have the knowledge, skills, tools, and resources to be successful in achieving expectations
  • Supports team to meet or exceed regulatory and compliance requirements, and performance guarantee commitments
  • Coaches and mentors new hires to enhance their skills, knowledge, and effectiveness as Claim Specialists. Assesses new hire readiness or independent work
  • Reviews and approves key decisions made by team member(s) within authority limit
  • Assesses and provides information, trends, and observed behaviors of assigned team members to the STD Unit Leader. Partners with the STD Unit Leader as appropriate to enhance the performance of those team members
  • Identifies and facilitates claim discussions on highly complex claims with the appropriate resources including STD Unit Leader, Clinical Resources and Vocational Rehabilitation Consultants
  • Supports team members to ensure that team members are effectively transitioning claims to LTD (as appropriate)
  • Mentors team members to ensure they are identifying and facilitating Return to Work opportunities through their own efforts or by engaging the appropriate resources
  • Provides candid and specific feedback to team members in order to support their growth and development
  • A comprehensive understanding of the disability contractual provisions, especially the definition of disability
  • Strong communication skills, including the ability to coach Case Specialist to interview claimants dynamically with the goal of setting claimant expectations and obtaining information necessary to administer the claim
  • Basic knowledge of medical conditions, treatments, prognosis
  • Expertise knowledge of system and tools, ie…MDG, DPA, Intellis and how to leverage tools to improve claim management effectiveness
  • Strong Coaching/Mentoring skills
  • Ability to give and receive feedback using specific measurements and observed behaviors
  • Openness to receiving feedback
  • Strategic-thinking skills
  • Prioritization skills. Ability to balance quantity and quality
  • 2 - 5 years of insurance claims experience
25

Claims Support Associate Resume Examples & Samples

  • This position is part of a job family. Placement will be determined by skills and qualifications of the candidate
  • Reviews, evaluates, and ensures accuracy of incoming claims by navigating multiple computer systems and platforms for efficiently making claims assignments and reassignments to appropriate units. Completes all data entry required on a daily basis to document and communicate extensively with supervisors and adjusters regarding reporting requirements, adjustments, and reassignment of claim files
  • Accesses systems (i.e. Siebel Passport, Internet, vendor database) to support general claims processing including: verification of coverage, draft data entry, ordering of claims related reports, and preparing letters, forms, and correspondence required for the claim
  • Provides administrative assistance to multiple claims departments including the generation of claims support documents, assist with mail and imaging, answers phone calls and emails, backs-up other CSR's during high service times, compiles claims specific data for supervisor reports, and provides back-up assistance during peak periods, storm situations, leaves, etc
  • At least 1 year of customer service experience in the insurance industry
  • Excellent oral and written communication skills (including telephone etiquette)
  • Ability to work with a wide variety of staff, management, claims personnel and external contacts
  • Good personal computing skills, including basic knowledge of Microsoft Office Word and Excel (or their equivalents)
  • At least 4 years customer service experience in the insurance industry
  • Knowledge of property/casualty claims operations and experience working with Claims reporting systems
  • Can perform Claims Support functions in an independent manner and serve as a resource to others
  • Demonstrates strong relationship-building skills, initiative, and work prioritization and organizational skills
26

Temporary No-fault Claims Support Resume Examples & Samples

  • Promptly and accurately type claims form, file jackets and documents, including timely maintenance of these forms and documents
  • Data entry, including claims related information for vendors, legal and finance
  • Photocopy, print and mail correspondence when necessary
  • Print and distribute diary to examiners
  • Compiling claims information for statistical purposes
  • Record and file retrieval
  • Ability to adapt to new situations and learn quickly
  • Must perform well in high-energy, dynamic and team-oriented environments
  • Expected minimum typing speed of 40 words per minute
  • Proficient in Microsoft Office (Word, Excel, Outlook)
  • Prior insurance or office support experience
27

Claims Support Technician Resume Examples & Samples

  • File Review and Document Redaction; includes printing, mailing and faxing documents
  • Ordering ISO, Police, Fire, Weather, Duplicate Policies, and Medical Records
  • Prepare packages for Worker's Compensation Board
  • Research files provide lists/photocopy of documents, attorney, vendors, etc
  • Successful candidate will be asked to cross-train in other processes in order to achieve individual goals and organizational needs
28

Claims Support Resume Examples & Samples

  • Data entry of claim payments for both Indemnity & ALAE into the appropriate operating system
  • Filing, scanning and maintaining claim files, mail and mailing records
  • Collect and distribute fax correspondence
  • Conform to internal workflow standards
  • High School Diploma or general education degree (GED)
29

Senior Claims Support Coordinator Resume Examples & Samples

  • PC skills, to include word processing
  • Previous experience with Microsoft Excel and Outlook; to include Pivot Tables and Macros
  • Previous Insurance experience is highly preferred