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Claims director skills for your resume and career

Updated January 8, 2025
4 min read
Below we've compiled a list of the most critical claims director skills. We ranked the top skills for claims directors based on the percentage of resumes they appeared on. For example, 16.5% of claims director resumes contained customer service as a skill. Continue reading to find out what skills a claims director needs to be successful in the workplace.

15 claims director skills for your resume and career

1. Customer Service

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how claims directors use customer service:
  • Managed operational performance and developed successful actions that improved customer service and relationships.
  • Implemented and oversaw efficiency targets, quality control and customer service.

2. Litigation

Here's how claims directors use litigation:
  • Maintained relationships with attorneys and managed litigation strategy; ensured strong relationships with insureds, brokers and third party administrators.
  • Redesigned processes and procedures for managing litigation through the implementation of an aggressive process for managing discovery and case typing.

3. Oversight

Having oversight of someone means to monitor a process or a situation. If someone has oversight of something, they are responsible for the completion of the project. Oversight is usually given to experts as they monitor their juniors or newbies as they go through a project.

Here's how claims directors use oversight:
  • Provided oversight for quarterly system testing ensuring system integrity was not compromised by directing consistent testing practices across multiple groups.
  • Recognized for excellence in coverage analysis; granted authority to issue coverage position letters including disclaimers with little oversight.

4. Coverage Issues

Here's how claims directors use coverage issues:
  • Evaluated general liability coverage issues and arranged monthly meetings with underwriters regarding indemnity exposures and reserves.
  • Developed state by state surveys to aid the line of business claim professionals on recurring coverage issues.

5. Claims Handling

Here's how claims directors use claims handling:
  • Restructured the entire claims handling process, implementing strategies that increased claim recovery percentages and decreased resolution turn-around times.
  • Complete claims handling and medical malpractice risk management for high exposure self-insured hospital accounts.

6. Claims Operations

Here's how claims directors use claims operations:
  • Developed capacity plan for claims operations.
  • Led claims operations for Michigan Medicaid health plan with over 100 employees generating over $165 million in sales.

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7. CMS

A Content Management System or CMS is computer software that works as a framework where content can be assembled and managed by using a database. CMS is an important asset in web development. This platform enables users to create, edit, collaborate on, publish and store digital content. It helps users to manage their content and modify it from a single system.

Here's how claims directors use cms:
  • Maintained daily claims adjudication requirements directly related to NYS DOH and CMS specifications.
  • Established a temporary call center to handle newly CMS mandated drug benefit calls on behalf of Pearson Government Services.

8. General Liability

Here's how claims directors use general liability:
  • Conducted claims investigation working with adjusters and carriers for General Liability, Medical Malpractice, Directors and Officers and Worker Compensation.
  • Supervised and directly handles auto liability, commercial truck liability homeowner property / liability, and general liability claims.

9. Defense Counsel

A defence attorney is a counsel representing the defendant in a criminal prosecution or lawsuit. A defence attorney aims to solve court cases as swiftly and satisfactorily as possible. Client representations at arraignments, hearings, and court trials along with preparing and drafting legal documents, including legal briefs and appeals is all part of their job description. They are responsible for presenting convincing evidence to a jury and/or judge if the case goes to trial.

Here's how claims directors use defense counsel:
  • Monitor defense counsel and coverage counsel concerning coverage, liability, damages and resolution strategy.
  • Developed case strategy in collaboration with defense counsel.

10. Claims Management

Here's how claims directors use claims management:
  • Develop, plan and schedule for the effective use of personnel and technology to optimize claims management for warranty services.
  • Hired, trained and closely mentored both adjusters and claims management staff at all levels of the organization.

11. Claims Processing

Claims Processing is the entire workflow involved within the insurance company to evaluate a claim before it gets approved. It has many administrative layers such as assessing insurance eligibility, investigating the medical treatments taken, and reviewing medical codes before it settles or denies a claim with the insured healthcare provider.

Here's how claims directors use claims processing:
  • Provided leadership and direction in the identification and resolution of operational barriers as it relates to efficient and compliant claims processing.
  • Interfaced with the Business customer to identify business requirements for system enhancements that resulted in accelerated claims processing.

12. Litigation Management

Here's how claims directors use litigation management:
  • Developed staff in areas of coverage, investigation, evaluation, litigation management, negotiation, and settlement.

13. Quality Standards

Quality standards are a specific level of standards of products that are set by the companies for the customers that have to be met and maintained throughout the process until the time of delivery. Quality standards are information that includes the customer's requirements, guidelines, and characteristics for the needed final product or service.

Here's how claims directors use quality standards:
  • Maintained productivity, service and quality standards for 3 million claims annually.
  • Release assigned claims in accordance with designated production and quality standards.

14. TPA

Here's how claims directors use tpa:
  • Directed all interaction between field operations and TPA staff to ensure compliance with multiple state laws and London syndicate instructions.
  • Prepared the request for proposal (RFP) for TPA services, and reviewed and evaluated the responses.

15. Process Improvement

Here's how claims directors use process improvement:
  • Project Management, and Process Improvement including directly managing staff.
  • Awarded Outstanding Leader in 2000 for continuous problem solving and process improvements that had direct ties to bottom-line revenue generation.
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List of claims director skills to add to your resume

The most important skills for a claims director resume and required skills for a claims director to have include:

  • Customer Service
  • Litigation
  • Oversight
  • Coverage Issues
  • Claims Handling
  • Claims Operations
  • CMS
  • General Liability
  • Defense Counsel
  • Claims Management
  • Claims Processing
  • Litigation Management
  • Quality Standards
  • TPA
  • Process Improvement
  • Medicaid
  • Direct Reports
  • Settlement Conferences
  • Insurance Carriers
  • Auto Liability
  • Auto Claims
  • Staff Development
  • CPT
  • Employee Development
  • Arbitration
  • Regulatory Compliance
  • Executive Management
  • WC
  • Settlement Authority
  • Professional Liability Claims
  • Coverage Analysis
  • Insurance Policies
  • Commercial Property
  • Health Plan
  • Loss Ratio
  • SIU
  • PPO
  • HMO
  • Claims Issues
  • Coverage Counsel
  • HR
  • Claims Audits
  • DOT
  • Compensation Claims
  • Omissions

Updated January 8, 2025

Zippia Research Team
Zippia Team

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

Updated January 8, 2025

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