Supervisor Claims Resume Samples

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RK
R Koch
Ross
Koch
936 Lorenz Corners
Philadelphia
PA
+1 (555) 714 5634
936 Lorenz Corners
Philadelphia
PA
Phone
p +1 (555) 714 5634
Experience Experience
Phoenix, AZ
Supervisor Claims
Phoenix, AZ
Lemke, Ondricka and Swift
Phoenix, AZ
Supervisor Claims
  • Manage a team or provide guidance in absence of the leader to ensure assignments are completed and performance expectations are achieved
  • Establish departmental performance standards and coach individual employee performance to meet and exceed production and quality metrics
  • Conducts data entry and rework; analyzes and identifies trends and provides reports as necessary
  • Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary
  • Identify barriers in workflows, P&P's and bring new / fresh ideas to improve procedures
  • Manage inventory and performance to business metrics
  • Support team employee engagement and continually working to meet and/or improve vital signs results
Los Angeles, CA
Supervisor, Claims
Los Angeles, CA
Monahan, Conn and Franecki
Los Angeles, CA
Supervisor, Claims
  • Provide expertise and/or general claims support to teams in reviewing, researching, negotiating, investigating, processing and adjusting claims
  • Participate in interviewing, hiring, and training of team members
  • Supports claim processing functions including investigations, payments, research, analysis
  • Establish, refine and evolve best-in-class claim management program operating characteristics, measurement criteria, and meaningful metrics benchmarking
  • Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis
  • Attends management staff meetings as directed. Monitors management reports focusing on regulatory compliance timeframes
  • Provide direction, leadership and training to in-house claims professionals
present
Detroit, MI
Supervisor Claims CRT Telecommute
Detroit, MI
Romaguera, Friesen and Wehner
present
Detroit, MI
Supervisor Claims CRT Telecommute
present
  • Partner with Business Manager to recruit, develop and manage a high caliber workforce with minimal turnover
  • Coach employees to identify and develop career goals; assist employee development
  • Provide formal and informal performance feedback to individuals and the team; conduct annual performance reviews
  • Provide regular performance reports to the Business Manager
  • Use a balanced scorecard to manage the team's performance
  • Maintain a positive work environment that supports a quality driven team and identify any issues that may inhibit performance
  • Consistently meet established productivity, schedule conformance, and quality standards
Education Education
Bachelor’s Degree in Related Field
Bachelor’s Degree in Related Field
University of South Florida
Bachelor’s Degree in Related Field
Skills Skills
  • Excellent professional communication skills, both written and verbal
  • Ability to build professional relationships with your team while motivating them
  • Excellent attention to detail and time management skills
  • Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
  • Ability to delegate
  • Demonstrated ability to manage multiple priorities at the same time
  • Proven ability to build and maintain customer relationships through communication, collaboration and efficiency
  • Ability to navigate a computer while on the phone
  • Ability to work independently in remote environment
  • Strong reading comprehension, written and verbal communication skills
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15 Supervisor Claims resume templates

1

Supervisor Claims Manager Resume Examples & Samples

  • Supervises claims program administration to ensure proper claims practices and procedures
  • Supervises billing, claims and associated administrative activities to ensure compliance with laws, regulations, policies, agreements and contractual arrangements
  • Assists in implementing procedures to adjust claims when original demographic, sponsor or charge information is in error; monitors and controls resubmission of denials, rejections and appeals
  • Intercedes with third parties in unusual situations involving payment or adjustment of charges on accounts; consults with departments concerning services which affect collection of charges
  • Assists examiners in investigating claims and assists and/or performs settlement negotiations. Supervises claim settlement processing
  • Assumes supervisory responsibility for electronic and paper claims submissions; oversees analysis, correction and resubmission of registration and eligibility of edits and errors
  • Researches coding and reimbursement requirements for compliance with local, state and federal regulations
  • Bachelor's degree in business administration, insurance or related field preferred
  • Four or more years of claims experience
  • Two or more years of leadership experience included
  • Experience working with proper claims handling, policies and procedures
  • Experience working with computer based analysis tools
  • Experience working with insurance and/or medical terminology
  • Organizational skills to balance and prioritize work
  • Negotiation skills to interact with claimant
  • Ability to understand and convey applicable laws, regulations and practices regarding the insurance industry
  • Ability to work independently and lead group activities
2

Supervisor Claims Resume Examples & Samples

  • Supervise and direct the claims staff, including performance counseling and yearly performance evaluation. Ensure that regular feedback is provided to employees regarding performance particularly as related to productivity and quality
  • Supervise and support claims staff day-to-day activities to consistently meet established productivity, schedule adherence and quality standards
  • Responsible to ensure the proper training for employees
  • Monitor claim volumes and evaluate additional resource requirements
  • Oversee the recruiting process for new hires in conjunction with Human Resources to establish candidate requirements, overall recruiting strategy and conduct interviews
  • Establish departmental performance standards and coach individual employee performance to meet and exceed production and quality metrics
  • Participate in writing and updating manual claims procedures
  • Exhibit active support of five core values – Integrity, Compassion, Relationships, Innovation and Performance
  • Actively collaborate with management and staff to ensure that "best practices" are followed and continually seek efficient and innovative processes, technologies and approaches to optimize use of resources and enhance operations
  • Responsible for resolution of escalated issues, claims research and coordinating with Account Management, Customer Care and Benefit Administration teams as needed
  • Answer claim questions from within team, internal departments, clients and/or members
  • Bachelor’s Degree or 2+ years of supervisory experience within a pharmacy or medical claims department
  • Prior Supervisory and/or Team Lead experience
  • Experience with pharmacy or medical claims processing
  • Strong analytical skills to be able to evaluate claims and operational issues
  • Intermediate proficiency with Microsoft Word and Excel to create letters; create charts and graphs within Excel
  • Excellent professional communication skills, both written and verbal
3

Supervisor Claims CRT Telecommute Resume Examples & Samples

  • Maintain a positive work environment that supports a quality driven team and identify any issues that may inhibit performance
  • Facilitate daily meetings to communicate team performance goals/results
  • Partner with Training/QA team to identify skill development needs associated with performance and ensure employees receive appropriate coaching and training
  • Partner with Training/QA team to identify skill development needs associated with career development opportunities
  • Basic proficiency with MS Word and PowerPoint (Ability to create, edit, format docs in Word and presentations in PowerPoint independently)
  • Intermediate proficiency with MS Excel (ability to sort, filter, formulate and display data)
4

Supervisor Claims Resume Examples & Samples

  • 2+ years of experience as a Team Lead, Supervisor or Manager with coaching, mentoring and goal setting
  • 1+ years of experience analyzing data in a professional work office environment
  • Ability to use MS Excel to analyze data, formatting, and creating charts and tables
  • Ability to use MS Word to generate professional correspondence
  • Ability to use MS Outlook to manage multiple email boxes and calendars
  • Ability to use MS PowerPoint to creating and editing presentations
  • Associate’s Degree or Higher
  • 1+ years of Claims Processing experience within a Healthcare environment
  • 1+ years of experience with Human Resource Procedures
  • Supervisory experience within a Healthcare Claims role
  • Knowledge of Medical Terminology
5

Supervisor Claims Resume Examples & Samples

  • Respond to claims appeals and/or issues
  • Supervise, monitor, track and direct day to day operations for staff
  • Associate's Degree (or higher) or HS Diploma with 8+ years of experience in claims
  • 5+ years of experience analyzing and solving customer problems in an office setting environment
  • Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
6

Supervisor Claims Resume Examples & Samples

  • Respond to claims appeals
  • Create and/or present to peers and leadership
  • 5 + years of experience analyzing and solving customer's problems in an office setting environment
  • Intermediate/Advance with Excel: data analysis (pivot table, sorting/filtering, charting and grafting, etc.) basically manipulating data
  • Intermediate in PowerPoint: create presentation, (design, data, etc.)
  • Intermediate with Word and Outlook (or comparable email format): edit and create documents within an existing format in Word and have experience working within a corporate email system
7

Supervisor, Claims Quality / Claims Audit Resume Examples & Samples

  • Supports claim processing functions including investigations, payments, research analysis
  • Provide expertise and or general claims support to teams in reviewing, researching, negotiating, processing & adjusting claims
  • Authorize appropriate payment
  • Supervise, monitor, track and direct day to day operations of staff of up to 10 employees. Coordinates supervisors and is accountable for the daily activities of business support & auditing team
  • Research, identify and obtain data / information needed to help process claims or resolve claims issues
  • Identify and resolve claims processing errors / issues and trends, as needed (i.e., related to system configuration, network eligibility, data accuracy, vendor-related, provider) and provided reports as necessary
  • Communicate and collaborate with internal and external stakeholders
  • Document & communicate status of claims audits to stakeholders as needed, adhering to reporting requirements
  • Monitor performance metrics (i.e., productivity, quality, Turn Around Times)
  • Conducts traditional supervisory tasks such as singing off on employee time cards, regular 1:1 employee meetings, training, annual performance evaluations, performance management, Replacement Positions working directly with Talent Acquisition
  • Attends management meetings, offsite IPA office manager meetings
  • 3 years of experience as a medical claims examiner / auditor / biller with HMO knowledge
  • 1 year of experience as a Supervisor or Team Lead
  • Knowledge of Health Care and Medical Terminology
  • Understanding of Coding for ICD9, ICD10, CPT, HCPCS
  • Claim Form Knowledge: UB04 & CMS 1500
  • Understanding of lines of business with the HMO arena: Commercial HMO, Medicare Advantage, Point of Service, Medi-Medi
  • Provider & Facility / Hospital Contract knowledge: FFS, Capitation, PerDiems, StopLoss
  • Experience with State & Federal Regulations
  • Familiarity with Title 28
8

Supervisor Claims Resume Examples & Samples

  • Current verifiable Current Florida Residency
  • 1+ year of experience analyzing and solving customer or claim problems in an office setting environment
  • 1+ year of experience with Medicare and Medicaid claims ( MMA, MMA LTC, & CHIP products)
  • Ability to create, edit, save, & send documents utilizing Microsoft Word and Excel
  • 1+ year of experience managing or leading a team of 10-30 people to achieve high performance in process driven environment
  • 1+ year of experience managing or leading a team of 10-30 people in Business operations of Healthcare, manage care, or insurance industry
  • Understanding of UHC Claims processes and claim systems to process a claim to payment utilizing SOPs, 411s, and claims policies and procedures
9

Supervisor, Claims Resume Examples & Samples

  • Supports claim processing functions including investigations, payments, research, analysis
  • Provide expertise and/or general claims support to teams in reviewing, researching, negotiating, investigating, processing and adjusting claims
  • Authorize appropriate payment or refer claims to investigators for further review
  • Supervise, monitor, track and direct day - to - day operations of staff up to 15 employees. Coordinates, supervises and is accountable for the daily activities of business support & production team
  • Research, identify and obtain data/information needed to help process claims or resolve claims issues (e.g. verify pricing, prior authorizations, applicable benefits)
  • Identify and resolve claims processing errors/issues and trends, as needed (i.e., related to system configuration, network, eligibility, data accuracy, vendor - related, provider) and provides reports as necessary
  • Communicate and collaborate with external stakeholders (i.e., members, family members, providers, vendors) to resolve claims errors/issues, using clear, simple language to ensure understanding
  • Collaborate with internal business partners to resolve claims errors/issues (i.e., Subject Matter Experts, Network Management, IT/Systems staff, Compliance, vendor management teams, contract teams)
  • Document and communicate status of claims/investigations to stakeholders as needed, adhering to reporting requirements (i.e., status letters/reports)
  • Monitor performance metrics (i.e., productivity, quality, TAT)
  • Conducts traditional supervisory tasks such as signing -off on employee time cards, regular 1:1 employee meetings regularly, annual performance evaluations, working with an employee on any necessary CAPS (Corrective Action Plans), works with Talent Acquisition on any open positions
  • Attends management staff meetings as directed. Monitors management reports focusing on regulatory compliance timeframes
  • Conducts limited employee trainings for new employees and performance management needs
  • 3+ years of experience as medical claims examiner/auditor with HMO knowledge
  • 1+ year of experience as a Supervisor or Team Lead
  • Knowledge of Health Care and Medical terminology
  • Understand Coding for ICD9, ICD10, CPT, HCPCS
  • Claim Form Knowledge; UB04 & CMS 1500
  • Understanding of Line of Business within the HMO arena; Commercial HMO, Medicare Advantage, Point of Service, Medi Medi
  • Provider & Facility/Hospital Contract Knowledge; FFS, Capitation, Per Diems, Stop Loss
  • Experience with both State & Federal Regulations and Title 28
  • Medicare Billing Manual
10

Supervisor Claims Resume Examples & Samples

  • Lead a team of 25-30 claims adjusters
  • Dependable with strong work ethics, must be able to lead by example
  • 1+ years of experience leading a team of 15 or greater in an office setting
  • Experience with Microsoft Word basic document creation, PowerPoint including putting together a basic presentation and Excel including basic formulas, sorting, and navigating the application
  • Must be able to provide after hours, weekend, and holiday coverage on occasion, as business dictates
  • Bachelor’s Degree or Higher
  • 3+ years Leadership experience of 15+ employees
  • Prior Leadership experience in a metrics driven environment achieving quality and production goals
11

Supervisor Claims Resume Examples & Samples

  • Previous supervisor and customer facing experience preferable. This position will be responsible for managing the UMR-NRECA team as well as manage day-to-day operational duties for NRECA. In this role, the supervisor will be customer facing, NRECA's conduit to UMR support areas, troubleshooting on their behalf within UMR, identifying impact to NRECA and proactively managing. In this modified model, this supervisor will have customer specialists and customer first representatives reporting to them
  • Solid experience with MS Excel including: data entry, sorting, creating/modifying pivot tables, and formulas on spreadsheets
  • Ability to navigate a computer while on the phone
12

Supervisor Claims Resume Examples & Samples

  • The role of a supervisor has many responsibilities including but not limited to
  • Inventory management; meeting turnaround times and ensuring performance guarantees are met
  • Maintaining quality metrics monthly
  • Holding daily huddles, weekly team meetings and monthly one on ones with each staff member
  • Helping develop staff to meet production and quality goals
  • Monitor attendance
  • Identify barriers in workflows, P&P's and bring new / fresh ideas to improve procedures
  • Motivate and recognize good performance and overachievers
  • Yearly MAP reviews
  • Employee Scorecards completed on time (communication/writing skills key factors)
  • Accurately complete all Daily, Weekly Monthly Tasks within established timelines
  • Achieve/Exceed all PG Account Metrics
  • Demonstrates personal responsibility for achieving high quality results
  • Gets things done on time and within budget
  • Accepts responsibility for success and failures
  • Uses feedback to modify behavior when necessary
  • Demonstrate the ability to complete assignments timely and within departmental standards/expectations
  • Follows through on commitments
  • Represents information and data accurately
  • Attendance and punctuality conform to department and company needs
  • Changes course quickly and effectively when necessary
  • Remains open to new ideas, new approaches, new ways of doing things and dealing with people to achieve results
  • Demonstrates willingness to proactively address current and potential challenges and opportunities
  • Willingly accepts increased responsibilities
  • Seek new opportunities to improve a task or process
  • Demonstrates a sense of urgency to achieve results
  • Acts decisively to prioritize workload
  • Meet deadlines and achieve deliverables
  • Efficiently manages time, projects and resources across multiple priorities
  • 2+ years of experience with Inventory Control
  • 2+ years of experience in a Leadership role as a SME, Supervisor, or Manager
  • Experience with MS Word (document creation) and MS Excel (data entry, and sorting)
  • 1+ years of experience with FACETS Claims System
  • Effective communication skills, both written and verbal
  • Willingness and ability to develop team
  • Ability to place employees on corrective action as needed
13

Supervisor Claims Crt-telecommute Resume Examples & Samples

  • Supervise, monitor, track and direct day to day operations to staff
  • Motivate individuals and teams to process claims accurately, and in a timely manner
  • Assume accountability for ensuring individuals/team meet their performance metric goals, and support/adhere to improvement initiatives
  • Serve as first point of escalation for SME's on procedural and technical issues; coach staff regarding how to effectively resolve the issue(s)
  • Provide regular performance reports to the Business Manager
  • Provide coaching to associates based on quality results; develop improvement plans when needed
  • Coach employees to identify and develop career goals; assist employee development
  • Investigate trends, surface issues, identify root problem and collaboratively work with specific team/individuals, and other business areas to resolve issues
  • Identify high potential staff for succession planning Perform Human Resource administrative duties
  • Partner with Business Manager to recruit, develop and manage a high caliber workforce with minimal turnover
  • Impact of work is most often at the team level
  • 1+ years of Team Lead, Supervisory, or Managerial experience
  • Ability to use Microsoft Excel to sort, filter, formulate and display data
  • Previous healthcare industry experience
  • Previous claims processing experience within the healthcare industry
14

Supervisor Claims Resume Examples & Samples

  • Monitor performance and address opportunities as they arise
  • Support on going initiatives with the Heath Plans or internal projects and provide claims guidance
  • Manage a team or provide guidance in absence of the leader to ensure assignments are completed and performance expectations are achieved
  • Able to run macros as need and identify additional automation needs to increase the auto vs manual percentage of claim processing
  • 2+ years of experience analyzing and solving customer or claim problems in an office setting environment
  • Ability to use Microsoft PowerPoint to Develop Presentation of Data/Information to present to a group which might include management
  • Proficiency with computers and Windows PC applications (this includes the ability to learn new and complex computer system applications
  • Knowledge of CSP Facets Claims software usage
15

Supervisor Claims Resume Examples & Samples

  • Provide overall leadership to direct reports
  • Authorizes the appropriate payment or refers claims to investigators for further review
  • 5+ years of experience analyzing and solving customer's problems in an office setting environment
  • Moderate Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
  • Ability to multitask, this includes ability to understand multiple products and multiple levels of benefits within each product
  • 1+ years of Healthcare Claims background
16

Supervisor, Claims Client Resume Examples & Samples

  • Manages client accounts and meets with clients on a regular basis
  • Reviews outstanding and rejected claims
  • Ensures the submission of claimable events supported by completed service orders
  • Ensures that all efforts are made to recover revenue for submitted claims
  • Ensures the integrity and accuracy of work processes by auditing completed work
  • Learns all functional and technical aspects of the area(s) assigned
  • Ensures all process and procedure (SOP) documentation is updated in line with the BPO (off shore team) requirements
  • Identifies process improvement opportunities within assigned area(S) and within the Center as a whole and integrates relative
  • Information and define reasonable alternatives
  • Drives claims filing and reject recovery process improvement
  • Works closely with the field to obtain information and feedback results
  • Performs supervisory functions, including but not limited to, making employment decisions regarding hiring, promoting, demoting
  • And terminating, conducting performance appraisals and coaching and developing associates
  • 3-4 Years Home Services or Claims Management experience
  • Ability to make decisions based on company needs
  • Problem solving skills. Analysis skills are required
  • Balance long-term strategic goals with short term priorities
  • Good computer skills, including Excel experience to include formulas, pivot tables, v-lookups
  • Clear speaking voice, with a good command of the English language
  • Ability to perform multiple tasks with strong attention to detail
  • Ability to periodically work flexible schedules based on business needs
  • Ability to maintain a professional image at all times
  • Ability to prioritize and meet deadlines as required
  • Frequent sitting, some standing and walking and bending and reaching as necessary
  • Ability to communicate with customers and co-workers at various levels of the organization
  • Bachelor's Level Degree or Equivalent Work Experience
  • Home Services experience
  • Microsoft PowerPoint, Word
17

Supervisor Claims Resume Examples & Samples

  • Provide general claims support to teams in resolving and reviewing claim inventory
  • Analyze and identify trends and provide coaching and feedback based on trends as necessary
  • Respond to claims escalations
  • Lead culture and engagement activities and support employee development
  • Coordinates, supervises and is accountable for the daily activities of a team of claim processors
  • Ability to travel less than 25% of the time
  • Work shift is typically 7:30am-5pm Monday-Friday
  • 3+ years of experience in Operational Leadership
18

Supervisor Claims Resume Examples & Samples

  • HS Diploma/GED
  • 3+ years of experience analyzing and solving customer problems in an office setting environment
  • Experience with MS Word (creating documents/templates /lists), Excel (data entry, sorting/filtering), Outlook (send/receive email, create tasks, update calendar, set out of office), and PowerPoint (creation and presentation)
  • 1+ years leadership/supervisory experience
  • Undergraduate degree (or higher)
  • Medical claims experience in a production environment
19

Supervisor, Claims Audit Resume Examples & Samples

  • Acts as a Subject Matter Expert (SME)
  • Reviews all second level rebuttals
  • Reviews Peer Review scores with Auditors and recommends process improvement
  • Works with Manager to maintain appropriate work balance in the department in order to maximize productivity
  • Assists in developing of long-range goals for claims audit specialist and Sr. claims audit specialists
  • Accept the responsibilities of the manager of Claims Audit in his/her absence and ensure that the department runs smoothly & without disruption to the daily routine
  • Researches and recommends solutions for escalated issues. Presents proposed solutions in a clear and concise manner
  • Responsible for performance management responsibilities for direct reports
  • Assists with developing and maintaining departmental policies and procedures including desk top procedures
  • Assists with developing training materials for the department and facilitate training as needed
  • Analyzes errors and performs root cause analysis in order to determine appropriate classification
  • Presnts audit findings and / or mediates issues external to the department
  • Assists with identification and communication of process improvement opportunities across operation areas based on quality reviews
  • Performs additional duties as assigned
  • LI-JL1
  • Required A High School or GED
  • Required 5+ years of experience in a healthcare organization
  • Required 5+ years of experience in understanding and interpreting contracts as related to claims processing and system configuration
  • Advanced Knowledge of healthcare delivery
  • Intermediate Demonstrated organizational skills
  • Intermediate Demonstrated time management and priority setting skills
  • Advanced Demonstrated analytical skills
  • Advanced Demonstrated problem solving skills
  • Advanced Demonstrated interpersonal/verbal communication skills
  • Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
  • Intermediate Ability to work as part of a team
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Ability to multi-task
  • Intermediate Other Decision making ability that requires the use of considerable judgment in the analysis of processes and problems/errors resulting from those processes
  • Intermediate Other Knowledge of HCPCS Coding
  • Advanced Other Ability to facilitate small group meetings
  • Advanced Other Ability to remain calm under pressure
  • Intermediate Other Ability to concentrate for extended periods on specific tasks
  • Preferred Other Certified Medical Coder
  • Required Intermediate Microsoft Excel
  • Required Intermediate Other Demonstrated technical expertise in performing quality reviews along with analysis of results
  • Preferred Intermediate Other Knowledge of Perot / Peradigm system
20

Supervisor Claims Resume Examples & Samples

  • Hours of operation between 6:00 am - 6:00 pm
  • 1+ year experience as a supervisor or team lead
  • Intermediate level of proficiency with Microsoft Word and Excel (Word – creating and editing Word documents; Excel – creating and editing spreadsheets, sorting/filtering)
  • CSP FACETS experience
21

Supervisor Claims Resume Examples & Samples

  • 3+ years of work experience in an Operations or Production environment as a Team Lead, Supervisor or Manager
  • 6+ months experience using an email tool for professional/business communication
  • Experience with Microsoft Excel (i.e. data entry, filter and edit spreadsheet)
22

Supervisor, Claims Resume Examples & Samples

  • Human Resource Mgmt - Plans, organizes, staffs, leads and controls activities pertaining to the Claims department to include: planning projects and capital and human resource budgets; interviewing, selecting and training subordinate staff; monitoring and appraising performance of subordinates to hold them accountable for end results including human resource management; coaching and motivating subordinates; administers disciplinary action as needed; administers compensation to subordinates; and ensures the department complies with affirmative action guidelines
  • Procedural Compliance and Process Improvement - Remains current on pertinent federal and state legislation affecting business processing and claims handling. Ensures all departmental activities support the division's effort to meet or exceed corporate policies, procedures, and/or directives while meeting or exceeding expense management objectives. Assesses and analyzes any areas of procedural non-compliance, modifies and/or enhances existing processes, and initiates corrective actions where appropriate. Leads and/or participates in cross-functional work groups that analyze, develop and implement processes, procedures and activities that enhance corporate profitability, efficiency and/or quality. Leads the development of short range business plans and budgets. Leads and/or participates in the planning and execution of organizational initiatives
  • Business Leadership - Effectively represents the Claims department as a subject matter expert within and outside of the division/operation. Interacts frequently with key external customer and internal stakeholders. Handles significant volume of escalated issues. Exercises appropriate discretion in formulating and implementing department business decisions. Works with the Law Division on any legal matters, and may participate in depositions or trials. Reviews, analyzes and takes appropriate action to resolve claims issues, attorney inquiries
  • Training and Development - Develops staff through training, communication and delegation of responsibility. Establishes, implements and monitors training requirements and effectiveness. Develops and demonstrates strong leadership skills in the areas of talent, visionary and business leadership
  • This position requires you to lift, move, or carry heavy objects
  • Minimum of 2 years of Individual Claims processing or customer service experience
  • Personal computer operation with skills in various software applications, including word processing, spreadsheet, electronic mail and presentation
  • Extensive product, distribution and industry knowledge
  • Strong judgment, communication, presentation, planning and organizational skills
  • Effective analytical, problem-solving, and decision-making skills
  • Understanding of Corporate policies, philosophies and objectives
  • Ability to work in a fast-paced, dynamic environment
23

Supervisor Claims Resume Examples & Samples

  • Ability to effectively and objectively manage a team of hourly staff
  • Knowledge of prescription and/or medial terminology
  • Intermediate skills utilizing MS Office Word and Excel
  • Knowledge of Med D compliance requirements and regulations is preferred
  • Experience with internal claims systems is preferred (RxClaim)
24

Supervisor, Claims Audit Resume Examples & Samples

  • Reviews benefit plans to ensure that claims are being adjudicated accurately and consistently according to Magellan contracts. Audits claims for statistical and financial accuracy
  • Responsible for documenting and reporting issues found
  • Assists with the establishment and updating of processes and audit manuals
  • Identifies areas where issues exist and works with appropriate individuals to ensure resolution
  • Completes special focused audits as assigned by management
  • Trains and mentors new auditors; works with trainers to audit and develop trainees
  • Act as a resource for the auditing team
25

Supervisor Claims Resume Examples & Samples

  • Manage inventory and performance to business metrics
  • Submit P&P update requests
  • Perform monthly mentoring or coaching and development for team members
  • Provide team members with monthly scorecards
  • Complete required individual development courses/trainings
  • Work/Lead special projects as assigned
  • Support and participate in social responsibility events throughout the year
  • Host/Attend meetings as required
  • Moderate proficiency with Windows PC applications - Word (Ability to create/edit document); PowerPoint (Ability to create and send presentations); Excel (Vlookup and formulas)
  • Effective communication skills (verbal and written)
26

Supervisor, Claims Resume Examples & Samples

  • Manage the post-foreclosure servicing functions as required by MI, investor, insurer, and internal guidelines including
  • Eviction management
  • Property inspection and maintenance
  • Conveyance of Title
  • Title Delivery
  • Maintenance of HOA, Taxes, and/or property insurance during the GSE REO process
  • Filing claims for reimbursement of expenses
  • Reconciliation of claim proceeds and filing supplemental claims as needed
  • Develop required process infrastructure, policies, procedures, and operational routines
  • Audit functions/quality assurance of key processes to ensure compliance
  • Data accuracy
  • Report key metrics associated with process
  • College Coursework or Equivalent
  • 3+ minimum years of experience
  • Should have previous management experience
  • Process management experience is a plus
  • Default-related experience is preferred
  • An aptitude for data, reporting, and working with numbers, is desired
  • MS office, and Visio
  • Familiar with GSE, and Insurer servicing guidelines
27

Supervisor, Claims Resume Examples & Samples

  • Develop and lead a team of liability claims specialists who have accountability for customers in multiple jurisdictions. 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
  • Work closely with other business partners to create and implement business plans for the region which highlight marketing, loss cost and expense management
  • 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
  • Must have good business acumen (i.e. understand how an insurance company works and makes money, including how this role impacts both Argo Insurance’s and our customers’ ability to be profitable)
  • 8 years claims experience, preferably with 3 years in a Claims Supervisory capacity
  • Strong leadership and management skills or potential to develop them
  • 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. The ability to read and write Spanish fluently is considered a plus
  • Strong analytical and presentation skills
  • Ability to work with Business Unit leaders at strategic level or learn to do so
  • Ability to travel, sometimes overnight, approximately 10% of the time
  • 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 your views, opinions and decisions
  • Strong focus on selection – determined to have the right people who do the best job. Able to identify, attract and hire talented people
  • Desire 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
  • Ability to develop and maintain 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
  • Have an aptitude for working with complex medical and legal issues, while staying focused on managing those issues to the appropriate financial outcome
  • Have a collaborative orientation and ability to work with multiple partners (insured, claimant, doctors, and attorneys)
  • Possess a real passion for improving results through proactive claim management
28

Asst Supervisor Claims Resume Examples & Samples

  • Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution
  • Manages the litigation process; ensures timely and cost effective claims resolution
  • Coordinates vendor referrals for additional investigation and/or litigation management
  • Communicates claim activity and processing with the claimant and the client; maintains professional client relationships
  • Ensures claim files are properly documented and claims coding is correct
  • Refers cases as appropriate to supervisor and management
  • Provides limited assistance/support to Team Lead with monthly review of adjuster workloads; notes trends and suggests adjustments when necessary
  • Subject matter expert of appropriate insurance principles and laws for line-of-business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedures as applicable to line-of-business
29

Supervisor Claims Resume Examples & Samples

  • Is able to bring together information from a number of different sources when forming a decision
  • Makes decisions on the best course of action based on available data
  • Clarifies key issues and weighs up the pros and cons of alternative solutions before reaching a decision
  • Takes personal responsibility for decisions
30

Supervisor, Claims Resume Examples & Samples

  • Hire, inspire, motivate, coach, counsel and supervise staff
  • Monitor performance of employees
  • Assess and allocate work volumes on a daily basis
  • Special project work as assigned
  • Ensure task completion and performance goals are met, such as Quality, Adherence, service levels
  • Accountable for daily/weekly/monthly activities of all team members
31

Supervisor Claims Resume Examples & Samples

  • Provide expertise and / or general claims support to teams in reviewing, researching, negotiating, processing and adjusting claims
  • 1+ years of experience in a leadership role
  • 2+ years of experience in CSP facets platform
  • 2+ years of experience with computer and Windows PC applications
  • Experience with Microsoft Excel (create / update spreadsheets, filters, sort, pivot tables), Word (create / update documents, formatting), and PowerPoint (creating / updating / formatting slides)
  • 2+ years of Claims Adjustment experience
  • Ability to learn new and complex computer system applications
32

Supervisor Claims Resume Examples & Samples

  • 1+ years of claims processing and/or claims review, claims research
  • 1+ years of Supervisor / Team Lead experience leading a team of 15+ in an office setting
  • Experience with Microsoft Word (basic document creation), Microsoft PowerPoint (putting together a basic presentation), and Microsoft Excel (basic formulas, sorting, and navigating the application)
  • Ability to work Monday through Friday between the hours of 6:00 am and 6:00 pm CST and provide after hours, weekend, and holiday coverage on occasion, as business dictates
  • Bachelor’s Degree or higher
  • 3+ years of Supervisor experience of 15+ employees in an office setting
  • FACETS knowledge and experience
33

Supervisor Claims Resume Examples & Samples

  • Able to effectively communicate to direct reports, Sr. Leadership and matrix partners on a consistent basis
  • Ability to work independently in remote environment
  • Proven ability to build and maintain customer relationships through communication, collaboration and efficiency
  • Excellent attention to detail and time management skills
  • Demonstrated ability to manage multiple priorities at the same time
  • Willingness to take calculated risk
  • Anticipates and drives change through the organization, equipping staff to adapt quickly
34

Supervisor, Claims Resume Examples & Samples

  • Manages cross-functional team members to meet or exceed service requirements. Independently examines and analyzes the team's performance; develops, recommends and implements plan(s) of action to improve the team's service level. Evaluates multiple reports to assess work distribution/delegation in order to meet client expectations and/or state regulations. Reports performance results to account management. Demonstrate flexibility in assigning resources based on business need and fluctuating inventory. Adheres to budget allocations
  • Provides ongoing feedback and coaching to ensure appropriate levels of performance. Recognizes and rewards effectively; provides appropriate levels of direction and support; Consistently follows corporate and departmental polices and guidelines; Utilizes corporate tools for performance appraisals; engages team members in development planning and progress. Identifies training needs within the team; works independently and/or through other sources to develop a training plan
  • Maintains a positive work environment that supports self-directed teams; provides a structure to optimize the experience, skill, knowledge and capability of the team; facilitates collaboration among team members
  • Interfaces with customers (internal and external) by telephone, correspondence and/or in person to answer inquiries and resolve concerns. Assesses, investigates and resolves difficult issues; Assist in preparing and/or conducting customer presentations; Partners with account management to achieve customer satisfaction
  • Facilitates regular team meetings, with an agenda and minutes; disseminate information consistently and timely; ensure all claims processing documentation is current and accurate; Interacts professionally, and presents ideas and information with confidence
  • Recruits, attracts, develops, motivates and manages a high caliber of employees; Trains employees on products, policies and procedural changes; Orients new employees
  • Expert knowledge of medical terminology and ECD-9/CPT-4 coding experience
  • Experience in processing various products including HMO/PPO and Indemnity under both fully insured and self-funded arrangements
  • Experience managing budgets- 1+ years direct supervisory experience- Strong influencing, negotiation and analytical skills
  • Team advocate
35

Supervisor, Claims Resume Examples & Samples

  • Ensure team performance meets or exceeds claim timeliness and quality standards for regulatory compliance and performance guarantees
  • Maintain a positive work environment through employee recognition and interaction
  • Participate in interviewing, hiring, and training of team members
  • Strategize, plan, organize, and execute efficient inventory management
  • Bachelors degree in business, health care or management related field or equivalent experience
  • Minimum 3 years leadership experience (leading, mentoring, coaching, or teaching)
  • Excellent planning, communication, documentation, organization, analytical and problem solving abilities
  • Medical Terminology or medical billing experience
  • High level of professionalism, enthusiasm, and initiative on a daily basis
  • Working knowledge of Commercial, Medicaid and Medicare plans
  • Ability to maintain quality and production designated standards established for handling work, problem solve effectively and organize workflow
36

Supervisor Claims Resume Examples & Samples

  • Consistently meet established productivity, schedule conformance, and quality standards
  • Facilitate daily meetings to communicate team performance goals / results
  • Assume accountability for ensuring individuals / team meet their performance metric goals, and support / adhere to improvement initiatives
  • Serve as first point of escalation for SME's on procedural and technical issues; coach staff regarding how to effectively resolve the issue (s)
  • Use a balanced scorecard to manage the team's performance
  • Able to review data, determine trends, gaps, issues, and identify ways to drive improvements
  • Provide formal and informal performance feedback to individuals and the team; conduct annual performance reviews
  • Incentive and reward individuals based on contribution and performance
  • Investigate trends, surface issues, identify root problem and collaboratively work with specific team / individuals, and other business areas to resolve issues
  • Partner with Training / QA team to identify skill development needs associated with performance and ensure employees receive appropriate coaching and training
  • Partner with Training / QA team to identify skill development needs associated with career development opportunities
  • Able to work across multiple time zones
  • Ability to use Microsoft Excel to sort, filter, pivot, formulate and display data
  • Ability to use Microsoft Word to generate professional correspondence
  • Ability to use Microsoft PowerPoint to create and edit presentations
  • Knowledge of Community and State line of business
37

Supervisor Claims Resume Examples & Samples

  • Respond to claims appeals which includes appropriate rerouting as needed
  • 3+ years of experience with medical claims processing
  • 1+ years of experience managing staff, team metrics and/or team inventory
  • Experience utilizing Microsoft Excel, including the ability to create a spreadsheet, pivot tables, V - lookups, and filter / sort
  • Experience working with FWA (Fraud, Waste, and Abuse) claims
  • Claims processing experience utilizing the COSMOS platform