FIND PERSONALIZED JOBS
Sign up to Zippia and discover your career options with your personalized career search.
Sorry, we can't find that. Please try a different city or state.

Claims Manager

This job has expired and is no longer available.
APPLY NOW
Apply Now
×
FIND
PERSONALIZED JOBS

Sorry, we can't find that. Please try a different city or state.

CONTENT HAS
BEEN UNLOCKED
Close this window to view unlocked content
or
find interesting jobs in

Log In

Log In to Save

Sign Up to Save

Sign Up to Dismiss

Sign Up

SIGN UP TO UNLOCK CONTENT

or

The email and password you specified are invalid. Please, try again.

Email and password are mandatory

Forgot Password?

Don't have an account? Sign Up

reset password

Enter your email address and we will send you a link to reset your password.

Back to Log In

Log In

Log In to Save

Sign Up to Save

Sign Up to Dismiss

Sign up to save the job and get personalized job recommendations.

Sign up to dismiss the job and get personalized job recommendations.

or

The email and password you specified are invalid. Please, try again.

Email and password are mandatory

Already have an account? Log in

reset password

Enter your email address and we will send you a link to reset your password.

Back to Log In

Company Saved

Answer a few questions and view jobs at that match your preferences.

Where do you want to work?

Job Saved

See your Saved Jobs now

or

find more interesting jobs in

Job Dismissed

Find better matching jobs in

Your search has been saved!

Top 50 Claims Manager Skills

Below we've compiled a list of the most important skills for a Claims Manager. We ranked the top skills based on the percentage of Claims Manager resumes they appeared on. For example, 8.3% of Claims Manager resumes contained Customer Service as a skill. Let's find out what skills a Claims Manager actually needs in order to be successful in the workplace.

These are the most important skills for a Claims Manager:

1. Customer Service

demand arrow
high Demand
Here's how Customer Service is used in Claims Manager jobs:
  • Partner with customers by responding to all customers telephonic & e-mail inquiries within communicated customer service protocols.
  • Provided analysis and feedback to the leadership team regarding timely and professional delivery of superior customer service.
  • Provided leadership and management direction to achieve efficient claim handling and quality customer service.
  • Managed claims and customer service activities to optimize profitability and customer satisfaction.
  • Maintained high-level of customer service with group policyholders and individual insured.
  • Delivered exceptional customer service in strict adherence to corporate mandates.
  • Handled escalated customer service calls.
  • Maintained day to day customer service relations with clients, job sites, insurance companies, and other agents.
  • Demonstrated understanding of common law, tort law and applicable statutory law; excellent customer service and negotiation skills.
  • Collaborated and partnered with cross-functional departments to deliver increased customer service, manage risk, and drive revenue goals.
  • Work closely with underwriting to ensure a smooth transition of claims and continuity of customer service.
  • Maintained high level of customer service and worked as liaison between Insurance Company and Insured.
  • Improved customer service from 52% to 85% positive and implemented measurement tools.
  • Enhance fraud awareness and regulatory compliance among our insured's while providing customer service.
  • Provide customer service such as track loads, locate proof of delivery etc.
  • Mentored the claims and customer service team in performing at optimal levels.
  • Led a team of twelve claim payment and customer service professionals.
  • Provided customer service and worked with MS Office.
  • Manage 37 claims approvers, customer service representatives and resolution specialist including exempt and no-exempt employees.
  • Key Accomplishments/Duties Ensured all claim decisions were made accurately and with a sense of urgency while delivering consistent customer service.

Show More

4 Customer Service Jobs

No jobs at selected location

2. General Liability

demand arrow
high Demand
Here's how General Liability is used in Claims Manager jobs:
  • Major Accomplishments: Manage all general liability, casualty investigation, commercial and residential property claims and catastrophic losses.
  • Directed operation of General Liability and Workers' Compensation claims unit for six self-insured properties.
  • Maintained a caseload of Farm Liability, General Liability and Commercial General Liability claims.
  • Maintained RMIS database on all general liability, pollution liability and auto liability losses.
  • Purchased general liability, worker compensation and excess liability insurance for OCIP.
  • Managed professional and general liability claims asserted against all TriHealth entities.
  • Managed General Liability operation for the City of Minneapolis -Risk Management Department
  • Directed all Property & Casualty first/third-party General Liability matters.
  • Risk management consulting, claims investigations, and managing of medical malpractice and general liability claims arising from the dialysis centers.
  • Type of claims supervised, Garage Keepers Liability, Commercial General Liability, Business Auto, Personal Auto and Homeowners Claims.
  • Investigated, negotiated, and settled property claims, arson related claims, general liability, and worker's compensation claims.
  • Managed unit consisting of six claim analyst/claim attorneys who handled Medical Malpractice, Allied Health Care and General Liability Claims.
  • Manage workers' compensation and general liability insurance claims as well as consummate a relationship with the medical community.
  • General management of automobile and general liability claim team (5) and support staff (2).
  • Handled several severe general liability claims including multiple death claims and amputations prior to move to TPA.
  • Supervised and managed all the Professional/General Liability (PL/GL) litigation claims for 189 medical facilities.
  • Handle 400-500 Auto, BI, General Liability, and Garage-Keepers claims per year.
  • Directed handling of physical damage and general liability subrogation.
  • Handled all non-litigated general liability and subrogation matters.
  • Managed 30 associates handling General Liability, Auto, Property, Worker s Compensation, Fraud, and Subrogation claims.

Show More

10 General Liability Jobs

No jobs at selected location

3. Ensure Compliance

demand arrow
high Demand
Here's how Ensure Compliance is used in Claims Manager jobs:
  • Monitored all aspects of service and performance to ensure compliance with Company and governmental regulatory agencies' policies and safety procedures.
  • Conducted quality file audits to ensure compliance with best practices and regulatory requirements.
  • Audited PACE shops (direct repair facilities) to ensure compliance with corporate targets for first and third party appraisals.
  • Led branch audits to ensure compliance and recommend improvements; served as liability and litigation SME for Branch Claims Managers.
  • Researched state laws and licensing requirements for all 50 states to ensure compliance and improve claims handling efficiency.
  • Reviewed and examined claims documents to ensure compliance with applicable laws, instructions, and regulations.
  • Perform file review of claim adjusters to ensure compliance with company standards and or criteria.
  • Create team meetings and agendas to communicate policies and procedures and ensure compliance.
  • Completed audits on claim representative's files to ensure compliance with handling guidelines.
  • Monitor and Review employee practices and performance to ensure compliance with company standards.
  • Accompanied field associates to assess performance and ensure compliance with Best Claims Practices.
  • Perform reviews of contracts (treaties) to ensure compliance with all terms.
  • Performed regular audits to ensure compliance with all relevant policies and regulations.
  • Perform internal audits in order to ensure compliance with Federal government standards.
  • Performed claims audit to ensure compliance with audit guidelines.
  • Audited employees processing of claims to ensure compliance.
  • Investigated all claims for coverage, exposure, subrogation/recovery, and resolution to ensure compliance with regulatory guidelines.
  • Negotiated agreement with automobile valuation company to ensure compliance with state fair claims practices and improve consistency of total loss handling.
  • Analyzed quality assurance data to ensure compliance with company and state standards for WC handling.
  • Performed MGA and TPA audits to ensure compliance with best practices and loss reporting.

Show More

4. Liability Decisions

demand arrow
high Demand
Here's how Liability Decisions is used in Claims Manager jobs:
  • Ensured compliant claim handling, accurate liability decisions, appropriate settlement, adherence to key performance metrics and management of litigation.
  • Reviewed liability decisions with all claim adjusters to insure fair payments were being issued.

Show More

5. Insurance Companies

demand arrow
high Demand
Here's how Insurance Companies is used in Claims Manager jobs:
  • Negotiated escalated claims and authorized settlements with insurance companies, opposing counsel, state agencies and other organizational entities.
  • Managed claims operations of 12 insurance companies during rehabilitation by the California Department Of Insurance.
  • Established relationships with providers and insurance companies for claim processing.
  • Responded to correspondence from insurance companies.
  • Managed and led the provision of independent adjusters to various insurance companies to service their policyholders in the review of claims.
  • Awarded and responsible for several state board of insurance receivership programs for insurance companies closed by the state.
  • Communicate with lenders, primary insurance companies, dealers, and clients to resolve questionable contract issues.
  • Worked with numerous mortgage insurance companies to ensure efficient payment of Mortgage Insurance and Recourse claims.
  • Managed Errors and Omissions claims filed against insured broker/dealers, insurance companies, agents and brokers.
  • Negotiated with transportation providers, insurance companies, and vendors for resolution of claims.
  • Verified and created claim numbers by communicating with various insurance companies.
  • File claims with insurance companies and municipalities when applicable.
  • Reviewed and edited claims reports sent to insurance companies.
  • Managed accounts with vendors and insurance companies.
  • Bill insurance companies for fire department claims.
  • Posted and adjusted payments from insurance companies.
  • Collected subrogation interest for insurance companies and reviewed for disbursement.
  • Improved communication with defense counsel, adjustors, insurance companies and clients.
  • De-escalated manager calls from the insurance companies, contractors, adjustors, lawyers and mortgage companies to ensure an adequate resolution.
  • Manage activity with cargo claims withn all of the U.S. Apex operation, and coordinate interface with the appropriate insurance companies.

Show More

Job type you want
Full Time
Part Time
Internship
Temporary

6. Insurance Adjusters

demand arrow
high Demand
Here's how Insurance Adjusters is used in Claims Manager jobs:
  • Examined claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.
  • Communicated and negotiated with insurance adjusters and customers regarding written estimates to obtain agreed cost.
  • Established excellent rapport with insurance adjusters, attorneys and medical providers in the industry
  • Developed working relationships with medical providers and insurance adjusters.
  • Assist insurance adjusters with escalated insurance claims.
  • Communicate with insurance adjusters regarding claim information.
  • Update insurance adjusters and agents on job status and seek approvals on work that need to be performed.
  • Maintained close interaction with City personnel, attorneys for claimants and defendants, and insurance adjusters.
  • Served as 1 of 16 Catastrophic Claims Managers, overseeing independent insurance adjusters.
  • Conversed with Insurance Adjusters and Contractors for rapid resolutions and submitted claims.
  • Schedule appointments and meet with insurance adjusters to assess home damage.
  • Trained over 2500Insurance adjusters on RV adjusting and repair.

Show More

7. Long-Term Disability

demand arrow
high Demand
Here's how Long-Term Disability is used in Claims Manager jobs:
  • Analyzed pertinent medical facts and evidence needed to determine claimant eligibility for Long-Term Disability benefits based on complex contractual language.
  • Investigated and adjudicated non-contractual disability claims for multiple long-term disability and compensation benefit accounts.
  • Led efforts to investigate, evaluate, and negotiate Long-Term Disability claims at the initial, reconsideration, and ongoing phase.
  • Manage complex long-term disability claims for multinational and Fortune 500 companies.
  • Managed long-term disability claims for third parties within diverse industries.

Show More

8. Company Policies

demand arrow
high Demand
Here's how Company Policies is used in Claims Manager jobs:
  • Developed and implemented company policies to address Transitional Duty across diverse work environments of the Kellogg Company.
  • Aligned with client company policies to provide labor relation specific claim decisions and benefit determinations.
  • Worked with vendors to establish non-subscriber benefit parameters and established company policies and procedures.
  • Developed and trained staff adjusters in proper adjustment procedures and company policies.
  • Trained new Customer Service Representatives in company policies standards and procedures.
  • Evaluated claims in accordance to established company policies.
  • Worked closely with subordinate personnel to insure all work is completed timely in accordance with the company policies and applicable laws.
  • Coordinated process implementation throughout Claim Unit, resulting in clear and concise employee understanding of company policies and procedures.
  • Trained new and present employees on company policies, operational procedures, systems and Quality Assurance.
  • Audited claim files to ensure adherence to state laws, and company policies and procedures.
  • Train new Field technicians on company policies and procedures, field training and safety policies.
  • Trained and instruct employees in job duties and company policies and arrange for training.
  • Adhere to budgetary guidelines and company policies as well as enhance employee performance.
  • Maintain clientele files in accordance with company policies and legal requirements.
  • Assure office compliance with company policies, procedures and reporting requirements.
  • Lead, devised and implemented procedures based on company policies.
  • Interpreted and communicate work procedures and company policies to staff.
  • Monitored staff to ensure compliance with company policies.
  • Handled all customer relations issues in a gracious manner and in accordance with company policies.
  • Assisted Senior Management with setting up company policies and procedures.

Show More

9. Bodily Injury Claims

demand arrow
high Demand
Here's how Bodily Injury Claims is used in Claims Manager jobs:
  • Managed senior and master bodily injury claims associates handling non-standard liability exposures.
  • Conducted training seminars on how to properly evaluate bodily injury claims.
  • Managed Bodily Injury Claims Adjusters Resolved all customer service issues
  • Resolve escalated bodily injury claims within policy limits.
  • Manage 10 Third Party Administrators in the processing of property damage or bodily injury claims against Honeywell arising from products brought.
  • Managed 6 team managers, 60 bodily injury claims handlers and the Support team in a large New Jersey claims operation.
  • Supervised a staff of claims adjusters to ensure the efficient handling of collision, property damage, and bodily injury claims.
  • Master Claim Representative, Field Bodily Injury: Responsible for investigating, evaluating, negotiating and settling bodily injury claims.
  • Investigated and took appropriate resolution action for all cargo, property, and bodily injury claims for the company.
  • Major accomplishments included reducing average paid bodily injury claims in SC by 9.5% in 2003 vs. 2002.
  • Manage a team of 8 claims adjusters handling bodily injury claims in all states as well as Canada.
  • Managed outside Claims Adjusters handling commercial property and auto bodily injury claims valued up to one million dollars.
  • Worked as a field claims adjuster, handling auto and bodily injury claims from inception to conclusion.
  • Maintain cost controls for property damage claims and proper evaluation of bodily injury claims.
  • Managed casualty claims unit handling a cross between auto liability and bodily injury claims.
  • Handled bodily injury claims from litigation files up to $1,000,000 in reserve.
  • Average paid bodily injury claims remained flat over a 2 year period.
  • Participated in mediation sessions for the settlement of bodily injury claims.
  • Worked 60 hours/week negotiating and settling high limit bodily injury claims.
  • Supervised team of claims adjusters with primary responsibility for attorney representedbodily injury claims.

Show More

10. Claims Department

demand arrow
high Demand
Here's how Claims Department is used in Claims Manager jobs:
  • Reduced process inefficiencies and inconsistencies by aligning team roles and staffing expertise within foreclosure and claims departments.
  • Charged with accountability for managing and overseeing all operational matters within the travel insurance claims department.
  • Facilitated development of cross-functional work teams within the Claims Department.
  • Maintained statistical information on the Claims department.
  • Achieved 3rd highest customer satisfaction rate in claims department with 4.7 out of 5.
  • Oversee workers' compensation claims department, handling multiple state jurisdictions.
  • Worked as a liaison between underwriting and claims departments.
  • Audited other stores' Claims departments once a month.
  • Managed claims department for pest control companies.
  • Introduced process improvements to enhance efficiency and profitability in the claims department.
  • Coordinated ICD-10 implementation from a claims department perspective.
  • Acted as liaison between IT and users in the claims department for development of technology and BETA testing of software.
  • Analyze all report and quality audits to ensure the efficient operations of the claims department.
  • Developed and evaluated claims department KPls including claims processing and call center metrics.
  • Provided claims-related services to providers and support services to the claims department.
  • Manage the adjudication and operations of the claims department.
  • Established a claims department using industry Internet programs.
  • Created all forms (in PDF & Word) for the commercial claims department.
  • Managed litigation pending for multi-line, multi-state claims department.
  • Documented claims Created implemented procedures, Prepared supporting documentation for internal and external audits Managed operations exclusively for the claims department.

Show More

7 Claims Department Jobs

No jobs at selected location

11. Process Claims

demand arrow
high Demand
Here's how Process Claims is used in Claims Manager jobs:
  • Contract review prior to implementation to assess ability to process claims without manual intervention.
  • Maintained state specific turnaround times and instructed my team to process claims according to specific guidelines.
  • Take phone calls, process claims, able to navigate a computer
  • Entrusted with high draft authority to approve and process claims efficiently.
  • Supervised all claim examiners to process claims for one product lines.
  • Process claims to the correct benefit level and coverage policy.
  • Process claims for homeowners and assist with warranty coverage inquiries.
  • Process claims for overages, shortages or damaged shipments.
  • Process claims, as needed, per Medicare guidelines.
  • Pay and process claims within designated authority level.
  • Create and process claims for home owners.
  • Create & process claims for damaged merchandise.
  • Process claims and provide policy services.
  • Process claims for short term disability.
  • Process claims up to $1.5 million.

Show More

1 Process Claims Jobs

No jobs at selected location

12. Counsel

demand arrow
high Demand
Here's how Counsel is used in Claims Manager jobs:
  • Partnered with vocational rehabilitation counselors, nurse case managers, medical directors, and special investigations for action planning.
  • Counseled and assisted adjusters with the negotiation and resolution of injury settlements.
  • Develop litigation strategies with Defense Counsel on litigated claims.
  • Implemented defense counsel assignment and reporting requirements.
  • Developed litigation plan with defense counsel.
  • Supervised outside counsel overseeing litigation.
  • Selected defense and coverage counsel for each state, and had full budgetary responsibility for $10 mil.
  • Led regional casualty litigation team providing guidance & direction on high exposure claims to defense counsel.
  • Directed activities of corporate and plant injury counselors in the management of workers' compensation matters.
  • Participate in discovery, investigations, hearings, and appeals to limit outside counsel cost.
  • Retain and work with coverage counsel on all extra-contractual claims against the company.
  • Started a specific litigation unit and revised the current approved counsel listings.
  • Managed outside counsel carrying an average load of eighty cases annually.
  • Assign counsel where needed and monitor and manage trial developments.
  • Confer with legal counsel on claims requiring litigation.
  • Deal directly with all claimant/plaintiff and defense counsels.
  • Hire, train, coach, counsel and terminate claims staff.
  • Conferred with legal counsel on claims requiring litigation and participated in mediations.
  • Provide advice, counsel, and training to Claims Representatives of all levels.
  • Conducted I-9's and HRIS audits; coach and counsel on policies and procedures as contained in the employees handbook.

Show More

7 Counsel Jobs

No jobs at selected location

13. Oversight

demand arrow
high Demand
Here's how Oversight is used in Claims Manager jobs:
  • Reserve establishment and/or oversight of reserves for designated claims within established reserve authority levels.
  • Provided consultation and oversight to claims staff regarding coverage and litigation strategies.
  • Manage oversight of Texas Non-subscriber injury benefit plan and renewal process.
  • Performed oversight and supervision of Third-Party Administrators and Independent Adjusters.
  • Provided functional oversight over Chicago and Atlanta offices.
  • Designed criteria for hospital claims to be eligible for clinical oversight and review resulting in a 10% net savings.
  • Participated as member of committee reviewing DIAMOND 950 Claims Configuration and provided oversight to Diamond 950 system conversion activities.
  • Participated in new claim processing system (Facets) implementation, provided demonstration, testing, training and oversight.
  • Provided oversight and management of 2 outsource vendors that had a staff of over 100+ employees and contractors.
  • Provided regional oversight for 5 commercial lines claims offices in NY and NJ comprised of 200 claims professionals.
  • Developed and promulgated claims policy and oversight of New York City adjusters and upstate field offices.
  • Provided oversight of Auto Physical Damage, Workers Compensation, Property and Customer Service units.
  • Managed the oversight of all defense counsel for the upstate New York territory.
  • Provided oversight of daily operations for the Clams Department.
  • Provide account management oversight and service for larger accounts.
  • Provided oversight to project team during an office relocation.
  • Provide oversight of medical, legal and damage estimates.
  • Reason for Leaving: Company downsized Responsible for complete oversight of claims and customer service division.
  • Provide direct oversight to day to day claims operation with 150 employees in the operation.
  • Developed, revised and implemented workflow processes to ensure efficiencies and provide oversight of individual caseloads.

Show More

14. Medical Records

demand arrow
high Demand
Here's how Medical Records is used in Claims Manager jobs:
  • Reviewed insurance documents, employer records, and client medical records to determine client short term disability benefit eligibility.
  • Obtained medical records from providers for evaluation of claims appeals, while complying with federal confidentiality regulations.
  • Reviewed and discussed customer medical records and physical functionality with clinical staff to determine specific plan eligibility.
  • Requested medical records and once obtained presented medical documentation to medical resources to determine restrictions and limitations.
  • Analyzed legal contractual provisions, expedited assessment of medical records, validated and monitored monthly payments.
  • Reviewed and deciphered medical records to determine supportive diagnoses for LTD benefits.
  • Reviewed, managed, and processed electronic medical records and correspondences.
  • Obtained medical records from treating sources to determine disability.
  • Ensured confidentiality of all medical records.
  • Reviewed and processed incident reports, legal demands for medical records, legal pleadings including summonses, complaints and discovery requests.
  • Verified insurance eligibility, benefits payable and length of disability by analyzing insurance plans, policies, and medical records.
  • Worked closely with Employee Health, Human Resources, Medical Records and Payroll in reference to Workman Compensation.
  • Assess potential liability of claims, including significant events, through investigation and review of medical records.
  • Handled outbound requests for medical records, and reviewed medical documentation to fairly assess claim files.
  • Reviewed and assessed all medical records as part of strategic settlement plan.
  • Liaised with doctors and medical staff for medical records.
  • Recorded and filed patient data and medical records.
  • Reviewed and organized clients' medical records.
  • Reviewed medical records with clinical staff.
  • Calculate payments and research conditions and injuries Track, order and review medical records.

Show More

1 Medical Records Jobs

No jobs at selected location

15. Workers Compensation

demand arrow
average Demand
Here's how Workers Compensation is used in Claims Manager jobs:
  • Work closely with medical staff at manufacturing facility to enable coordination of medical welfare and cost containment for workers compensation programs.
  • Revamped claim forms, and reorganized workers compensation handling of three-state operation into centralized unit.
  • Adjusted benefits for workers compensation and social security.
  • Supervised Workers Compensation Administrator and Product Claims Representatives.
  • Transitioned workers compensation program to a medical provider network in the State of California, rolling out to over 400 employees.
  • Prepared a RFP for our workers compensation program in a monopolistic state and transitioned our claims management to a new TPA.
  • Investigated claims and negotiated settlements for Workers Compensation benefits, lawsuits, USL&H, and Jones Act.
  • Ensured 100% accurate payments by adjusting payments for workers compensation, social security, and retirement payments.
  • Issue corrected orders based on decisions from Workers Compensation Office of Judges and Appeal Board.
  • Secured eleven defense verdicts in Superior Court and the Workers Compensation Board.
  • Managed staff of 35 employees and 4,000 Workers Compensation claims.
  • Retired from Workers Compensation Fund after thirty years of service.
  • Represented Berkley accounts at Texas Workers Compensation Commission Benefit Review Conferences.
  • Managed property & casualty claims programs, including multi-state workers compensation.
  • Managed a portfolio of policies for multiple carrier pools providing excess coverage to a wide number of primary workers compensation carriers.
  • Resolved all liability claims, administered the self-funded unemployment claims program, and supervised the workers compensation claim staff.
  • Completed a request for proposal (RFP) for a new workers compensation claim management software package.
  • Supervised three multilane claims representatives handling personal, commercial, and workers compensation lines of business.
  • Set up workers compensation and life and accidental death claims.
  • Attended mediations on bodily injury claims, workers compensation hearings and trained property claims representatives.

Show More

7 Workers Compensation Jobs

No jobs at selected location

16. Performance Reviews

demand arrow
average Demand
Here's how Performance Reviews is used in Claims Manager jobs:
  • Handled all personnel actions including hiring, performance reviews, salary recommendations, and coordinated training and development.
  • Position included budget, hiring, performance reviews and salary administration, disciplinary action including termination.
  • Administered performance reviews and assisted team in developing supervisory accountability goals.
  • Conducted performance reviews and property and liability adjuster training.
  • Evaluated production, delivered monthly and annual performance reviews.
  • Administered salary increases; conducted performance reviews.
  • Conducted performance reviews and disciplinary actions.
  • Conducted quarterly and annual performance reviews.
  • Prepared performance reviews and conducts interviews.
  • Participated in employee performance reviews.
  • Performed all human resource duties for direct report staff including payroll, employee counseling and employee performance reviews.
  • Performed annual performance reviews, responsible for hiring and separation of employees under my supervision.
  • Conduct performance reviews, and lead jurisdictional training; devised/implemented a new claims task log.
  • Perform monthly performance reviews, internal audits and prepare reports for Chief Operating Officer.
  • Implemented goal and growth development plans, plus performance reviews for new employees.
  • Provide coaching and performance reviews on a regular basis.
  • Perform formal and informal performance reviews of department staff.
  • Completed monthly unit file audits and yearly performance reviews.
  • Covenant Management Managed Claims administration to include daily work assignments, training, supervising and annual performance reviews.
  • Issued the adjustor's audit limits based on routine performance reviews and accuracy ratings.

Show More

17. Manage Claims

demand arrow
average Demand
Here's how Manage Claims is used in Claims Manager jobs:
  • Partnered with customers and physicians to medically manage claims and evaluate ongoing medical information.
  • Partnered directly with customers and/or their representatives and their doctors to medically manage claims.
  • Manage claims processing department for industry leading third party administrator.
  • Manage claims processing for clients of every income level, from nationally recognized organizations down to small two person operations.
  • Manage claims adjusters in 5 states, accept new assignments for property & vehicle claims from insurance companies.
  • Manage claims department, including daily operations, claims handling and resolution, service standards and monthly reporting.
  • Manage claims duration based on contractual terms, medical conditions and work capacity while pursuing applicable offsets.
  • Manage claims with a diverse population of customers, including claimants with physical and mental impairments.
  • Review and manage claims involving an excess of $160 million in reserves.
  • Manage claims, responsible for the approval or denial decisions on the claims.
  • Initiate and manage claims for individuals while out on short term disability.
  • Manage claims and TPA handling for clients insured under Captive programs.
  • Monitor and manage claims activities to assure compliance with regulatory agencies.
  • Manage Claims Team to achieve 100% closing ratio.
  • Manage claims quality and ensures all guidelines are met.
  • Manage claims inventories to meet departmental goals.
  • Manage claims for fleet of 750+ vehicles.
  • Manage claims department with 9 direct reports.
  • Manage Claims auditing, Claims Training.
  • Manage claims valued up to [ ] throughout litigation.

Show More

6 Manage Claims Jobs

No jobs at selected location

18. TPA

demand arrow
average Demand
Here's how TPA is used in Claims Manager jobs:
  • Directed all TPA activities for the organization; with settlement authority for all claims reserved at $50,000 or greater.
  • Implemented the strategic cost savings measure to utilize the TPA's adjusters to serve as appraisers for appraisal claims.
  • Manage and build relationships with Counties, Brokers, Reinsurance Carriers and TPA s and other external business partners.
  • Conducted corporate claims audits for third party administrators and acted as a business consultant to (TPA).
  • Managed 6-8 individuals including: TPA management, hiring, training, budgeting and performance evaluation.
  • Lead semi-annual TPA audits, ensuring accuracy and identifying fraudulent, abusive and duplicate claim submissions.
  • Developed, trained and monitored claim reporting policies and procedures, claims protocols and TPA guidelines.
  • Managed WC TPA unit with five adjusters handling 21 self-insured accounts, including two large pools.
  • Coordinated mass move of programs from AIX's internal TPA to several disparate outside firms.
  • Oversee TPA claim files to ensure proper handling, coverage analysis and accurate claim settlements.
  • Provide claims expertise to TPA's and assume corporate authority for reserves and settlements.
  • Managed activities of all TPA's and outside counsel assigned to litigated claims.
  • Involved in TPA integration planning, systems compatibility and data transfer issues.
  • Audited TPA's on Medical Professional and Governmental Entities.
  • Evaluated the performance and effectiveness of TPA claims staff.
  • Recognized as industry leaders in the TPA management.
  • Retained TPA to handle claims for captive.
  • Drafted and implemented client-specific account instructions as to TPA and insurance carrier workflow and responsibilities.
  • Managed fifteen TPA employees including management and reported to the CEO, VP of Underwriting and board of directors.
  • Supervised multi-line claim activities for large restaurant program of over 3000 units, including TPA audits and claim reviews.

Show More

2 TPA Jobs

No jobs at selected location

19. Medical Treatment

demand arrow
average Demand
Here's how Medical Treatment is used in Claims Manager jobs:
  • Assisted employees with arrangements for ongoing medical treatment along with building and maintaining relationships with treating physician and medical facilities.
  • Evaluated the plans for individual rehabilitation/return to work for ongoing medical treatment for a successful return to life accommodations.
  • Monitored medical condition of claimant; as well as integrated individual rehab/return to work plans into ongoing medical treatment.
  • Monitored injured associates' medical treatment by obtaining all necessary medical documents to prevent treatment from exceeding recommended guidelines.
  • Managed and reviewed progress of medical treatment and requested special examinations.
  • Reduced medical treatment by effectively utilizing medical care.
  • Coordinated medical treatment when needed.
  • Authorized medical treatment as needed.
  • Review police reports, medical treatment records, medical bills, or physical property damage to determine the extent of liability.
  • Review all first reports of injury to determine if lost time or medical treatment.
  • Applied medical aid rules and authorized medical treatment.
  • Coordinate medical treatment for injured employees.
  • Evaluated and made decisions regarding requests for medical treatment, surgery, diagnostic studies and reimbursements.

Show More

20. Direct Reports

demand arrow
average Demand
Here's how Direct Reports is used in Claims Manager jobs:
  • Completed personal development and oversaw development of direct reports.
  • Managed operations through 7 direct reports for a staff of 90 located in and out of office for the entire state.
  • Directed and managed 5 supervisors with 55 indirect reports responsible for the overall processing of medical and facility claims.
  • Directed and managed a staff of 30 direct reports responsible for the processing of medical and facility claims.
  • Reduced cycle time and increased productivity through my commitment to excellence in work product of my direct reports.
  • Key Contributions: - Managed and developed direct reports who include Team Leaders and front-line associates.
  • Lead a department of 40 professionals (4 direct reports, 36 indirect reports).
  • Led a team of 3 direct reports, including two claims specialists and team assistant.
  • Manage 15 direct reports, to include hiring, training, career development and evaluation.
  • Led a team of 75 Claims Adjusters, with 6 supervisory direct reports.
  • Develop claims goals for direct reports to drive improvement in focus areas.
  • Managed staff of 80 employees through 8 Unit Manager direct reports.
  • Manage 3 direct reports, overseeing national claims team of 28.
  • Review and authorize claims over the limits of direct reports.
  • Managed total staff of 17 through 5 direct reports.
  • Managed a claims unit consisting of 8-10 direct reports.
  • Manage a unit comprised of 34 direct reports.
  • Developed and lead direct reports.
  • Acted as a Team Lead with six (6) direct reports.
  • Direct the benefit installation and plan build for new clients Identify reinsurance claims Manage 8 direct reports.

Show More

2 Direct Reports Jobs

No jobs at selected location

21. New Claims

demand arrow
average Demand
Here's how New Claims is used in Claims Manager jobs:
  • Lead office trainer for the implementation of Allstate's new claims management program; training over 150 employees.
  • Interviewed, hired, dismissed, and trained new claims adjusters for damage and injury claims throughout Maryland.
  • Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
  • Assisted Short Term Disability claim managers from other accounts with new claims and ongoing communications with clients.
  • Worked with other health plan departments to develop, document and implement new claims policies.
  • Reviewed new claims for direction to staff and monitored claims for appropriate activity and closure.
  • Implemented new claims litigation strategies and use of technology to reduce litigation.
  • Managed and oversaw projects for new claims system and imaging systems.
  • Make proper decisions on new claims while in the investigation period.
  • Mentored and trained new claims adjusters on best practices.
  • Monitored new claims inventory, appeals and correspondence.
  • Hired and trained new claims processors.
  • Assist clients with filing new claims.
  • Prepared and reported monthly aggregate and specific bordereaux, which included setting reserves for existing and potential new claims activity.
  • Project Management - Mapped a new Claims Standard Work process to re-define production standards and improve quality by 10 percent.
  • Managed and supervised staff of claims professionals Implementation of new claims organization for the State of Connecticut unit.
  • Supported development, rollout and implementation of new claims processing platform (Duck Creek).
  • Evaluate new claims and make appropriate claim decisions in a timely manner.
  • Created a new claims department for a mini-medical and reinsurance insurance company.
  • Manage both new claims daily as well as open claims equally.

Show More

1 New Claims Jobs

No jobs at selected location

22. Data Entry

demand arrow
average Demand
Here's how Data Entry is used in Claims Manager jobs:
  • Provided required training to all data entry personnel according to management policies and procedures.
  • Supervised claims examiners and data entry personnel.
  • Answered a thirteen phone line system, data entry, Manage 4 employees, in charge of time keeping and payroll.
  • Managed and provided support to a staff of 27 employees including claims technicians, claims processors and claims data entry staff.
  • Limited oversight to the Regional Mail Office in (RMO) in Utah and the Data Entry Vendor in Jamaica.
  • Managed the employees and activities of the Medicare claims processing department whose activities included data entry and claims examination.
  • Manage daily office duties; such as: filing, organizing, data entry, spreadsheets and faxing.
  • General office duties, including filing, answering phones, handle incoming / outgoing mail and data entry.
  • Managed a team of Claims Examiners, Data Entry Operators, Mail Clerk and Team Leaders.
  • Created training protocols and manuals for EDI, ICR, Data Entry, and Suspense processes.
  • Performed data entry of dental claims and answered customer calls to provide benefit or claim information.
  • Interviewed, hired, trained, and managed the five-member claims and data entry staff.
  • Conduct data entry and rework, analyzes and identifies trends and provides reports as necessary.
  • Take on-line classes for medical billing codes and did some Data Entry.
  • Observed data processing and data entry with attention to detail.
  • Carried out data entry, bookkeeping, daily billings.
  • Back up data entry and/or clerical, as needed.
  • Performed data entry in MS Excel daily.
  • Performed routine onsite audits of the process for both the RMO and the Data Entry Vendor.
  • Managed mailroom staff, data entry clerks, administration staff and senior payment specialists.

Show More

23. Performance Management

demand arrow
average Demand
Here's how Performance Management is used in Claims Manager jobs:
  • Managed office operations including scheduling, supply ordering, and performance management of adjusters.
  • Develop individual development plans to assist with rep performance management and individual development.
  • Provided performance management evaluations and mentoring of exempt employees and skilled non-exempt employees.
  • Developed Performance Management Programs to encourage higher production and quality results.
  • Evaluate all associates via performance management bi-annually.
  • Identify and manage performance management issues.
  • Hired and conducted performance management of staff, with direct reports composed of six unit managers and one administrative support specialist.
  • Oversee consistent application of performance management policies to achieve 98 percent financial accuracy and 99 percent quality goals.
  • Reviewed reports through Performance Management and Information System (PMIS) for all claims teams for accuracy.
  • Achieved successful results by means hiring, training, and performance management of employees in the department.
  • Conduct performance Management of employees and supervisors as needed- including daily and yearly performance metrics and reviews.
  • Managed all daily HR issues such as hiring, terminating, corrective action, performance management.
  • Participated in conducting new hire interviews, training, coaching, and performance management.
  • Evaluate staffing needs including hiring, termination, employee development and performance management.
  • Conducted performance management sessions with senior staff and customer care leadership teams.
  • Keep DOC updated on all relevant performance management/personnel issues that arise.
  • Demonstrated strong performance management, coaching and staff development skills.
  • Provided performance management and career developmental needs of the staff.
  • People management skills, interviewing skills, performance management.
  • Advised managers and employees on performance management matters.

Show More

1 Performance Management Jobs

No jobs at selected location

24. Property Damage

demand arrow
average Demand
Here's how Property Damage is used in Claims Manager jobs:
  • Managed property damage and business interruption claims suffered during Hurricanes Katrina, Rita and Wilma.
  • Hired and managed activities of eight agents originating economic and property damage claims.
  • Performed field inspections and scene investigations to ascertain property damages and liability.
  • Worked closely with Public Safety officers with property damage and incident reporting.
  • Investigated, evaluated and negotiated all settlement of property damage claims.
  • Created and provided training for injury management and property damage.
  • Conducted auto property damage repair facility field re-inspections.
  • Negotiate disputed property damage recovery claims.
  • Reviewed claim forms, police / hospital records, and inspected property damage in order to determine extent of liability
  • Investigated and adjusted property and liability claims involving water, fire, soot or other property damage.
  • Manage up to 10 claim representatives handling bodily injury, property damage and medical payments claims.
  • Handled all property damage claims and losses and implemented procedures for claims reporting.
  • Handle commercial auto bodily injury, property damage and no-fault claims and suits.
  • Worked directly with clients, negotiating all of their property damage claims.
  • Resolved property damage claims on behalf of moving companies.
  • Assessed property damage and typed property loss estimates.
  • investigated/settled personal injury, property damage and motor vehicle accidents.
  • Maintained case load of over 200 active construction defect, property damage and bodily injury cases.
  • Conducted review of property damage subrogation proofs / P.D.
  • Review policy for coverage Developed Subrogation and Property Damage Departments.

Show More

1 Property Damage Jobs

No jobs at selected location

25. Casualty Claims

demand arrow
average Demand
Here's how Casualty Claims is used in Claims Manager jobs:
  • Established, organized and administered catastrophic property and casualty claims and litigation, including directing claim field operations and executive communications.
  • Supervised all activities of casualty claims third party administrator, disability case management vendors and litigation panel.
  • Managed the Casualty Claims Department, including technical and administrative matters.
  • Resolve and settle casualty claims without attorney representation.
  • Managed a unit of inside telephone adjusters in the disposition of property and casualty claims in accordance with company policies and procedures
  • Managed up to 30 employees, including supervisors, adjusters and support staff, handling specialty commercial property and casualty claims.
  • Selected to lead casualty claims triage unit which focused on settling claims the same day the customer reported the loss.
  • Managed and processed all Personal, Property, and Commercial Multi-Line Casualty claims for this established insurance agency.
  • Manage all workers' compensation claims and property casualty claims for the pallet manufacturing and transportation industry nationwide.
  • Managed a staff of 6 adjusters as well as direct handling of the complex property and casualty claims.
  • Managed the claim handling process and the casualty claims results in New Jersey, Maryland and Delaware.
  • Created Specialization for the adjusting staff for Auto, PIP, and Casualty claims handling.
  • Train internal quality control staff in all areas of Property and Casualty claims handling.
  • Managed the handling of property and casualty claims in the state of Tennessee.
  • Administered the resolution of over 16,000 property and casualty claims annually.
  • Supervised 8-10 direct reports who handled property and casualty claims.
  • Document, investigate, and estimate property and casualty claims.
  • Promoted twice over 20 months to Casualty Claims Manager.
  • Led Milwaukee office handling commercial casualty claims.
  • Home Office supervisory position overseeing multi-state branch office direct insurance claims handling of high exposure, complex casualty claims.

Show More

26. Personal Lines

demand arrow
average Demand
Here's how Personal Lines is used in Claims Manager jobs:
  • Managed independent adjusting claim office and adjusted commercial and personal lines bodily injury and property damage claims.
  • Managed manufactured housing insurance carrier's personal lines claim department.
  • Consolidated western commercial and western personal lines claim operations.
  • Managed team of eight adjusters responsible for evaluating and processing casualty and property claims for personal lines and commercial lines losses.
  • Handled commercial and personal lines bodily injury, property damage, property, workers compensation and environmental claims in Michigan.
  • Managed 6 field adjusters with caseloads consisting of personal lines, attorney represented, bodily injury claims.
  • Manage eight Property Claims managers, responsible for Personal Lines Property claims in the Sacramento metro area.
  • Worked up from Claim Representative to District Claim Manager handling personal lines and commercial lines casualty claims.
  • Managed mid and senior level claims examiners handling complex commercial and personal lines physical damage claims.
  • Managed personal lines, commercial auto and trucking claims on behalf of various insurance company clients.
  • Assist Commercial and Personal Lines Departments with Marketing, New Business and Account Current problems.
  • Managed the office, trust account, supplies, and sold personal lines.
  • Directed personal lines claims operations including 18 claims representatives and 18 support staff.
  • Managed over 100 diverse commercial and personal lines technical and administrative employees.
  • Completed QA through claim audit process on NY Personal Lines claim team.
  • Analyzed coverage on commercial claims, personal lines claims and entertainment claims.
  • Managed all claims for the Personal Lines & Commercial Lines clients.
  • Managed initial organization of claims department and handled claims for large personal lines agency specializing in high-net-worth clients.
  • Managed commercial and personal lines office of 16 multi-line adjusters and support staff of 10 clerical personnel.
  • Promoted to Personal Lines Agent after earning required licensure.

Show More

27. Claims Staff

demand arrow
average Demand
Here's how Claims Staff is used in Claims Manager jobs:
  • Initiated and successfully streamlined and consolidated claims processes and claims staff to reduce deficiency rates and improve productivity levels.
  • Identified Claims staffing requirements for additional positions as state expansion occurred.
  • Ensured that the claims staff is following company procedure and that benefits are paid to those who are eligible.
  • Managed a claims staff with a pending of over 400 claims that included up to 200 files in litigation.
  • Hired and developed 12 managers and increased the Utah claims staff from three to sixty employees in nine years.
  • Reviewed and audited claims staff to ensure quality handling and provided feedback to assist staff with increasing claims excellence
  • Stayed abreast of all training needs for the entire claims staff and address them as needed.
  • Managed the daily operation of a branch office that included office support and claims staff.
  • Supervised administrative support personnel and claims staff, provided staff evaluations, managed claim flow.
  • Directed claims staff hiring, oversight, coaching, training, and performance reviews.
  • Managed a claims staff for ensuring liability is clear and that contribution potential is addressed
  • Managed office budget, hiring, training and management of claims staff.
  • Managed technical claims staff in the evaluation of coverage and liability.
  • Supervised claims staff adjusting license bond claims in California and Nevada.
  • Establish and evaluate accuracy standards for claims staff.
  • Diversified the Claims Staff operation by 30%.
  • Trained and supervised claims staff.
  • Managed service office claims staff.
  • Manage NC Branch claims staff.
  • Managed claims staff of 22, from mailroom to supervisor.

Show More

3 Claims Staff Jobs

No jobs at selected location

28. Medicaid

demand arrow
average Demand
Here's how Medicaid is used in Claims Manager jobs:
  • Developed Medicaid Provider reference manuals encompassing all claim types and provider types.
  • Led multiple Medicaid Management Information Systems implementations for multiple states.
  • Coordinated with Medicare and Medicaid cost sharing responsibilities.
  • Provided one on one education sessions for Providers educating them on the Nevada Medicaid benefits and resolution of claims.
  • Manage inventory and strict guidelines and performance metrics established by various state plans with regard to Medicaid coverage.
  • Ensured centers for Medicare and Medicaid service (CMS) guidelines were executed by creating new processing procedures.
  • Manage claims for 380,000 lives across multiple lines of business including Medicaid, Medicare and Commercial Exchange.
  • Hired, trained, and directed staff to process Georgia HMO Medicaid claims and other commercial business.
  • Apply working knowledge of Maryland Medicaid policies and procedures to current coding, claims and billing practices.
  • Managed claim processing and customer service functions for Medicaid and commercial (self-funded) health insurance plans.
  • Coordinate payments from all insurance carriers, including AHCCCS/Medicaid, Medicare, and various PPO insurances.
  • Communicated directly with Medicaid Health Plan COO's to ensure prompt resolution of client issues.
  • Completed extensive backlog cases of Medicaid provider appeals and complaints within the Claims Department.
  • File all insurance claims for patients with multiple carriers, Medicare and Medicaid.
  • Worked on the implementation of the Nevada Medicaid claims processing system.
  • Maintained DC Medicaid's, MMIS claims processing database.
  • Managed Claims department (Commercial and Medicaid).
  • Led the claims department for a start-up Medicaid Health Plan ensuring accurate processing of claims, auditing, and payment.
  • Executed claims agreements with specialist physicians yielding full compliance with OK State Medicaid coverage requirement.
  • Planned, organized, and delegated claims workflow for this Medicaid MCO.

Show More

29. File Reviews

demand arrow
average Demand
Here's how File Reviews is used in Claims Manager jobs:
  • Conducted semi-annual file reviews and provided guidance and additional training as necessary.
  • Performed quarterly complete quality assurance file reviews with exceeds range calibration results.
  • Developed audit criteria for quarterly open file reviews and annual assessments.
  • Conduct quality file reviews and implements quality team recommendations.
  • Participated in file reviews and resolved DOI inquiries/disputes.
  • Conduct medical and administrative file reviews.
  • Conducted one-on-one file reviews with Claims Representatives re: negligence issues, settlement values, and strategies to resolve disputed cases.
  • Fostered high performing environment based upon Claim Best Practices through goal setting, claim file reviews, authority requests and training.
  • Conducted monthly file reviews for each claim analyst to ensure compliance, quality, and financial standards were achieved.
  • Utilized file reviews to recognize trends and provide follow-up coaching to improve and develop the team s skills.
  • Completed file reviews and ride- along with claims associates and provided immediate coaching and feedback.
  • Completed file reviews to determine compliance with claim handling guidelines, policies and procedures.
  • Schedule and lead file reviews and approve reserves.
  • Conducted quarterly file reviews with the insurance carrier
  • Complete and document file reviews.
  • Conduct periodic claim audits/file reviews.
  • Participated with policyholders, agents, brokers, and other stakeholders in multi-jurisdictional claim file reviews as warranted.
  • Conducted open and closed claim file reviews to ensure files met Best Practice and Market Conduct requirements.
  • Audited files and performed file reviews to ensure quality standards compliance with company standards.
  • Completed file reviews, ride alongs and re- inspections with field employees.

Show More

30. Claims Office

demand arrow
low Demand
Here's how Claims Office is used in Claims Manager jobs:
  • Coordinated claims office operation-managed activities and objectives of team leaders and adjusters.
  • Selected by Claims Director to assist with assuming claims pending of departing adjusters and various claims office projects.
  • Collaborated with Senior Management and Human Resources during the closing of the Charlotte Underwriting and Claims office.
  • Led team of clerical employees and was responsible for operational and compliance related aspects of claims office.
  • Managed the largest auto/casualty branch claims office in Phoenix, AZ, 35 employees, 17000+ claims/year.
  • Opened and staffed 11 new claims offices, expanded specialty staffing and streamlined weekend claim process.
  • Supervised and directed activities of regional branch claims offices, prepared annual budgets, etc.
  • Opened the Houston Claims office for AFIA, handling all lines of claims and litigation.
  • Directed claims office staff up to 37 liability and property damage claims examiners.
  • Conducted auto liability training in New York and Massachusetts law to claims offices.
  • Opened and directed the operation of the first company branch claims office.
  • Supervised the daily operations of an auto liability claims office.
  • Managed a new start-up claims office.
  • Opened and staffed claims offices.
  • Directed eight person claims office handling multi-line claims in Alaska, Hawaii, Washington, Oregon and Texas.
  • Managed a multi-line insurance claims office, as well as providing claims services.
  • Established and managed a PHO satellite claims office in Piscataway, New Jersey.
  • Managed a staff of 11 team members who supported the local claims office.
  • Managed multi-line claims office that was part of Farmers Easter operation.
  • Relocated claims office and legal department from White Plains to Elmsford.

Show More

31. Action Plans

demand arrow
low Demand
Here's how Action Plans is used in Claims Manager jobs:
  • Developed and implemented corrective action plans necessary to comply with state, federal and contractual requirements for existing contracts.
  • Evaluate claim documentation and financial exposure to present senior management with recommendations for reserves and appropriate action plans.
  • Managed loss cost objectives by conducting quality assurance reviews and implementing action plans to drive technical excellence.
  • Created quarterly action plans to improve the performance of each team member to meet corporate and customer expectations.
  • Organized and completed numerous diagnostic events each year to measure quality and create action plans for development.
  • Participated in strategic planning and recommendation of action plans, to improve the effectiveness of the process.
  • Provided technical direction on complex cases and developed action plans to resolve escalated complaints and issues.
  • Develop action plans and identify the Likely Claim Progression including identifying the return to work potential.
  • Coached and mentored a team including when necessary corrective action plans in order to drive results.
  • Supported employee's career planning through the completion of performance action plans and counseling sessions.
  • Worked closely with department heads for trending, risk assessments and corrective action plans.
  • Develop action plans for claim managers to ensure goals are being met.
  • Monitor customer satisfaction in an effort to drive action plans for improvement.
  • Develop corrective action plans when associate's performance is below standard.
  • Implemented action plans to address deficiencies and resolved billing disputes.
  • Develop action plans to claim resolution.
  • Review And Analyze Claim Trends To Identify Risks, Fraud, And Develop Action Plans To Prevent Future Reoccurrence.
  • Create action plans based on workflow, inventory, goals, and trends.
  • Managed client driven 'Corrective Action Plans.
  • action plans, tracking tools) - Coordinate project activity and facilitate project meetings with staff and matrix partners.

Show More

2 Action Plans Jobs

No jobs at selected location

32. Party Administrators

demand arrow
low Demand
Here's how Party Administrators is used in Claims Manager jobs:
  • Maintain communication between hospitals, third party administrators and department heads by attending meetings and coordinating interdepartmental functioning.
  • Investigated, evaluated and settled claims for insurance carriers, Third Party Administrators, Municipalities and Political Subdivisions.
  • Conducted on-site operational reviews and claim adjudication audits of other third party administrators.
  • Forged and maintained productive relationships with third-party administrators and external claim vendors.
  • Maintained daily oversight of Third Party Administrators claim operations.
  • Facilitated claim setup and reporting to third-party administrators.
  • Conduct regular audits of third party administrators.
  • Approved all reserve changes, settlements, litigation referrals, investigation referrals and AOE/COE decisions by Third Party Administrators.
  • Administer property, casualty, and automobile liability claims; monitor Third Party Administrators and attorneys.
  • Communicate with customers, health care providers, employers, third party administrators and attorneys.
  • Participate in market selection of Third Party Administrators and Carriers as required by the producers.
  • Coordinated 45 new group implementations with 80 financial service partners and 20 third party administrators.
  • Conducted quarterly audits, monthly reviews and processed payments for Third Party Administrators.
  • Ensured claim turn-around and issued weekly reimbursement checks to third party administrators.
  • Audited the third party administrators handling of claims & overall performance.
  • Evaluate and Contract with Third Party Administrators when applicable.
  • Assigned claims to in-house and third-party administrators.
  • Managed 15 professionals in two multi-state self-administrated claims offices and two third-party administrators.
  • Liaised with third party administrators on coverage issues, managed care assistance and/or subrogation options.
  • Monitor and supervise Third Party administrators, insurance companies, and outside venders.

Show More

6 Party Administrators Jobs

No jobs at selected location

33. Claims Representatives

demand arrow
low Demand
Here's how Claims Representatives is used in Claims Manager jobs:
  • Conducted one-on-one training sessions with less experienced claims representatives and maintained on-point for questions and concerns.
  • Developed, implemented and monitored programs to maximize customer satisfaction and manage on-site claims representatives.
  • Direct supervision of ten property claims representatives of varying experience levels.
  • Implemented internal auto property damage training seminars for Claims Representatives.
  • Followed up on potentially fraudulent claims initiated by claims representatives.
  • Supervised a staff of four claims representatives that handled all aspects of commercial lines casualty and property claims to resolution.
  • General office duties, interviewing new employee prospects, and giving monthly and annual reviews of claims representatives.
  • Supervised the day-to-day activities of STOLI DDA Claims Representatives with the assistance of a coach.
  • Managed a team of 25 claims representatives, responsible for tracking departmental data and metrics.
  • Recruited by Nationwide to this position where I supervised eight field claims representatives in Charleston.
  • Promoted to management position to recruit, train and supervise 6 claims representatives.
  • Led inside group of claims estimating adjusters as well as field claims representatives.
  • Hired, supervised, trained, developed and evaluated Claims Representatives.
  • Conduct daily and monthly coaching of customer claims representatives.
  • Lead 15 claims representatives in a call center environment.
  • Provide advice and direction to claims representatives.
  • Manage a team of 2-3 Claims Representatives.
  • Supervised staff of 6 claims representatives.
  • Automobile liability claims representatives for a third party administrator with several auto insurance carrier client accounts.
  • Managed Tampa and Miramar Florida offices with 7 claims supervisors, operations manager, 46 claims representatives and 8 administrative staff.

Show More

2 Claims Representatives Jobs

No jobs at selected location

34. Litigation Management

demand arrow
low Demand
Here's how Litigation Management is used in Claims Manager jobs:
  • Rolled out guidelines for material damage, bodily injury, uninsured motorist, medical payments and litigation management.
  • Performed additional paralegal functions as necessary and provided litigation management support to legal department staff counsel as requested.
  • Developed litigation management program to ensure appropriate legal intervention, litigation plans and adherence with legal budgets.
  • Developed risk management plans through the implementation of new claims programs involving run-off scenarios and litigation management.
  • Provided and delivered telephone etiquette and litigation management training programs to multiple AIG offices.
  • Formulated action plans in collaboration with internal litigation management team and outside counsel.
  • Conducted detailed bill reviews to implement sound litigation management and expense control.
  • Directed litigation management in property and casualty operation
  • Created Department Staff responsibilities, a litigation management program, claims handling manual, budget, reserve and dairy procedures.
  • Developed staff in areas of coverage, investigation, evaluation, litigation management, negotiation, and settlement.
  • Handled all types of property and casualty claims on behalf of multiple clients including litigation management.
  • Implemented medical and litigation management cost containment programs to help reduce claim cost.
  • Coordinate with legal department on litigation management for all claims.
  • Managed auto claims for Colorado taxicab companies Investigate and resolve BI claims Litigation Management Supervised PIP and PD adjusters

Show More

35. Osha

demand arrow
low Demand
Here's how Osha is used in Claims Manager jobs:
  • Work closely with Safety, Loss Control, and Risk Management on facility safety investigations and OSHA compliance.
  • Participate in annual audit of OSHA logs for select locations and documentation of claims process for SOX.
  • Administer EAIP and Return-to-Work programs, as well as maintaining OSHA 300 and 300a logs.
  • Served as the company Safety Contact, and handled all OSHA employee injury reporting.
  • Maintain OSHA logs for multiple locations, do quarterly OSHA audits of all locations.
  • Identify OSHA standards and regulations as needed on third party claims.
  • Maintained and prepared district s annual OSHA 300 log.
  • Maintained the OSHA logs for multiple sites.
  • Manage the corporation's OSHA program.
  • Maintained OSHA logs for all locations
  • Interfaced with Human Resources to coordinate FMLA and OSHA Streamlined loss reporting system, resulting in prompt reporting.
  • Serve as a resource for haz mat, OSHA, and other safety issues.
  • Helped customers with product knowledge and jobsite requirements including OSHA and building codes.
  • Tracked OSHA recordable incidents and oversaw distribution of OSHA logs.
  • Attended OSHA and workers compensation hearings as needed.
  • Created spreadsheets and trending reports for risk management, logged Workman Compensation activity to OSHA and State of Il, .
  • self-insured and self-funded Responsible for OSHA Logs.

Show More

36. Customer Complaints

demand arrow
low Demand
Here's how Customer Complaints is used in Claims Manager jobs:
  • Developed and implemented department quality improvement plan measuring deficiencies identified by customer complaints, appeals, and most common claims errors.
  • Coordinated with account representative contacts and medical staff to resolve any customer complaints.
  • Resolved customer complaints and answered customers' questions regarding policies and procedures.
  • Reviewed, investigated and resolved all customer complaints with empathy and compassion.
  • Facilitated the settlement of customer complaints within company guidelines.
  • Provided final resolution to all escalated customer complaints.
  • Investigate accidents, personal injury, property damage, vehicle accidents, explosions, customer complaints, construction accidents, etc.
  • Acted as a liaison with the Better Business Bureau to investigate and resolve all customer complaints.
  • Inspected and documented any damages or customer complaints that arose after work had been completed.
  • Resolve client and customer complaints timely through use of effective verbal and written communication.
  • Supervised 15 person staff that responded to customer complaints, inquires, and suggestions.
  • Use corrective action and problem solving skills to address customer complaints and concerns.
  • Resolved customer complaints and communicated the outcome with the Department of Insurance.
  • Handled customer complaints and assisted service and sales to resolve issues.
  • Handle customer complaints, and prepare routine Management Reports.
  • Handle customer complaints and adjusting where appropriate.
  • Resolved customer complaints according to Best Practices.
  • Reviewed damage claims and customer complaints.
  • Resolved all customer complaints in a professional manner while prioritizing customer satisfaction.
  • Handled customer complaints to ensure speedy resolution and customer satisfaction Maintained working relationships with internal/external customers Sunset FACTS platform

Show More

37. Settlement Authority

demand arrow
low Demand
Here's how Settlement Authority is used in Claims Manager jobs:
  • Directed case investigations, evaluated and provided settlement authority, recommended reserve figures.
  • Conferred with companies regarding policy settlement for losses over settlement authority.
  • Participate in Claims Conferences for reserve and settlement authority.
  • Established and monitored claims reserves and granted settlement authority.
  • Established reserves, settlement authority and approved coverage denials.
  • Reviewed claims for settlement authority on files exceeding Supervisors' authority limits; acted as a resource for new Supervisors.
  • Delivered outstanding financial performance while managing regular caseload of 250 claims with settlement authority up to $100K.
  • Presented cases to committee on high exposure files for further reserve and settlement authority up to policy limits.
  • Review and calculate claim exposures to provide reserve and settlement authority to the Third Party Administrator.
  • Check claim file quality, granted settlement authority, review reserves, and negotiation strategy.
  • Extended coverage, reserve and settlement authority to the twenty-six claims personnel under my supervision.
  • Approved all total losses, providing settlement authority on claims, within approved authority limits.
  • Extended settlement authority to the TPA's and Defense Attorney's handling the claims.
  • Evaluated claims and provided settlement authority up to 250,000.00 to third party administrator.
  • Govern high limit settlement authority and personal handling of all claims in litigation.
  • Evaluated the adequacy of claim reserves and granted settlement authority.
  • Authorize settlement authority up to $1 million.
  • Entrusted with $750K reserving/settlement authority.
  • Grant reserve and settlement authority.
  • Managed bodily injury claim payments in excess of [ ] annually with a personal settlement authority of 100,000 per injury claim.

Show More

38. Physical Damage

demand arrow
low Demand
Here's how Physical Damage is used in Claims Manager jobs:
  • Conduct claims reviews with Litigation business unit to provide feedback for specialty policy interpretation and technical physical damage support.
  • Participate in technical physical damage and policy interpretation reviews for my business unit as well as others.
  • Assisted in setting company expectations around an Auto Physical Damage structure.
  • Promoted to Physical Damage Specialist & then Physical Damage Supervisor.
  • Managed bodily injury, physical damage and property units.
  • Implemented efficiency measures within the auto physical damage group which allowed us to redistribute 20% of the staff.
  • Lead a staff of 30+ employees in the ownership and resolution of auto physical damage and injury claims.
  • Manage a regional claims office responsible for trucking liability and physical damage claims in the southeastern United States.
  • Handled and managed physical damage, medical payments, bodily injury, litigation and bad faith exposures.
  • Partner with the West Region offices Physical Damage Management teams within the organization to establish consistency.
  • Oversee auto liability, auto damage appraising and physical damage claims for nine states.
  • Managed the largest Physical Damage claims operation in the country for this carrier.
  • Managed property damage claims department and physical damage fast track department.
  • Managed 3 claim operations: physical damage, Sub & QC.
  • Inspect and estimate property for physical damage.
  • Handle liability and/or physical damage claims.
  • Supervised claims teams including subrogation, physical damage, and bodily injury.
  • Managed the physical damage, subrogation and quality control for claim department.

Show More

39. Complex Claims

demand arrow
low Demand
Here's how Complex Claims is used in Claims Manager jobs:
  • Handled extensive policy interpretation regarding complex claims involving foreign and domestic exposure.
  • Required exceptional coverage and complex claims analysis across all coverage lines.
  • Detailed complex claims analysis, increased revenue for group due to knowledge of Insurance benefits & fee schedules for services.
  • Participated in the decision making of the methodology of payment of complex claims of $100,000 and above.
  • Determined action to be taken on complex claims, policy language interpretations, and coverage questions.
  • Provide necessary support for more complex claims issues and assist with periodic investigations of claims.
  • Led team of in-house and remote employees in executing highly complex claims management processes.
  • Authored the Global Claims Policy and Large and Complex Claims Team s Best Practices.
  • Provided training and resources to adjust complex claims to a varied customer base.
  • Used independent judgment and discretion to review and resolve complex claims issues.
  • Reviewed complex claims, especially surgical, for correct billing and coding.
  • Provided technical assistance to claim examiners for more complex claims.
  • Coordinated US and UK audits of large and complex claims.
  • Managed all Claims litigation, large and/or complex claims.
  • Consulted on complex claims, coverage and litigation issues.
  • Claim auditing and processing of complex claims.
  • Research, investigate, and process complex claims in a timely manner.
  • Resolved complex claims to facilitate case closures in a timely manner.
  • Attend mediations on complex claims and negotiate settlement agreements.

Show More

40. PIP

demand arrow
low Demand
Here's how PIP is used in Claims Manager jobs:
  • Manage a department of PIP Claim Representatives that are handling Oregon, Washington, Florida, Utah, Kentucky & Texas.
  • Supervised and monitored performance of 50 claim adjusters handling non-litigated and litigated Auto, PIP and physical Damage claims.
  • Managed a pipeline of up to 300 claims, adhering to the deadline requirements of each specific client.
  • Analyzed, approved or denied standard; complex accident PIP medical claims for group policy holders.
  • Handled PIP, No Fault coverage/ Assigned to Auto fraud unit for Rhode Island-Salvage claims.
  • Selected and trained the Claims staff for PIP Claims, including catastrophic injuries.
  • Risk Management point person at pipeline ruptures or explosions.
  • Conducted training on PIP statutes/laws within several states.
  • Developed PIP Claims Standards and documentation standards.
  • Worked on regional committees that implemented the electronic claim environment and managed care for Personal Injury Protection (PIP) claims.
  • Created and implemented computer based programs to calculate interest due and Loss Wages for New York and New Jersey PIP claims.
  • Managed the Claims, Underwriting, PIP, Special Investigations, Subrogation and Fraud Units for a five-state area.
  • Managed and supervised automobile insurance claims including Personal Injury Protection (PIP), Property Damage and Bodily Injury.
  • Lead a multi-functional team that includes Casualty, PIP Litigation, Medicare and Admins.
  • Subject matter expert for PIP claims that involve multiple states (Ex.
  • Gas Offshore Pipeline, Nigeria * Work executed during pre-contract/tender package stage.
  • Created and implemented workflows for PIP Claims.
  • Subject Matter Expert for PIP Subrogation.
  • Team of up to 8-10 including PIP, Casualty, PD, and Support.
  • Created the PIP subrogation unit and workflows.

Show More

41. SIU

demand arrow
low Demand
Here's how SIU is used in Claims Manager jobs:
  • Introduced special investigation (SIU) tools and techniques to organization with tangible, favorable, results.
  • Investigated, negotiated and settled bodily injury claims with emphasis on SIU and litigation issues.
  • Managed Litigation, Commercial Auto, non-standard Auto Casualty, Material Damage, and SIU.
  • Worked closely with internal SIU and state agencies to ensure facts of loss on claims.
  • Job Description: Intake of claims and SIU assignments for regional technical claims service.
  • Audited bills for detection of possible fraud; refers findings to SIU as directed.
  • Identify claims for SIU referral with follow up reporting to Insurance Fraud Bureau.
  • Appointed as only non-SIU employee with access to conduct complete background checks.
  • Report any potential fraud to Special Investigation (SIU) when appropriate.
  • Examined claims for potential fraud (SIU) while adjusting all claims.
  • Recognize and refer files to the Special Investigations Unit (SIU).
  • Examined and investigated all claims for potential fraud (SIU).
  • Work closely with SIU and Counsel.
  • Acted as the fraud (SIU) liaison for the company.
  • Investigate fraud claims (SIU).
  • Promoted and facilitated training for claims department including litigation and property examiners, underwriting, SIU and subrogation.
  • Worked directly with audit re- inspectors, SIU and multi-state field staff to inspect and properly appraise damages.
  • Maintained on-going diary on claims requiring management involvement (SIU, large losses, litigation).
  • Acted as an expert for SIU and attorney represented claims involving suspected fraud and pending litigation.
  • Attended anti-fraud trainings, conferences, client SIU trainings and industry seminars.

Show More

42. Staff Members

demand arrow
low Demand
Here's how Staff Members is used in Claims Manager jobs:
  • Establish and implement departmental policies, goals, objectives, and procedures, organization officials, and staff members as necessary.
  • Managed risk assessment and insurance claims for this non-profit religious organization with over 26, 000 staff members world-wide.
  • Hired and developed staff members in order to help them achieve their goals while obtaining the corporate goals.
  • Organized and provided training for the Irvine claims section chiefs and training for their subordinate staff members.
  • Developed new staff members to achieve a seamless uninterrupted service model for these customers.
  • Trained other claims staff members on proper handling and evaluation of property claims.
  • Managed Claims Department (15 staff members) of Provider Sponsored Health Plan.
  • Developed staff members through career counseling sessions, file audits and constructive feedback.
  • Trained new staff members in the detection of external and internal fraud.
  • Directed 40 staff members in processing more than 250,000 claims annually.
  • Assisted and mentored staff members to meet their daily quotas.
  • Trained & instructed staff members and performed Team Initiative Meetings.
  • Developed training materials and methods for new staff members.
  • Completed annual performance reviews for 7 claim staff members.
  • Position supervised approximately twenty (20) staff members.
  • Provided Career Coaching to all junior staff members.
  • Recruit staff members and oversee training programs.
  • Trained and mentored new staff members.
  • Conduct or arrange for ongoing technical training and personal development classes for staff members.
  • Benefit Payment Control Unit Managed 16 staff members.

Show More

43. HR

demand arrow
low Demand
Here's how HR is used in Claims Manager jobs:
  • Promoted through multiple positions supporting finance and insurance product administration on behalf of various automotive manufacturers and independent programs nationwide.
  • Managed department through difficult period of branch office downsizing and demonstrated ability to provide a positive environment.
  • Reviewed adjuster estimates for quality and accuracy through re-inspection and file review.
  • Received and managed collections claim for all retail locations for each of the eight Salvation Army thrift stores throughout the Dallas/Ft.
  • Provide direction and supervision to staff through delegation of work assignments, projects, and task to staff.
  • Developed a high-energy staff through staff development and when necessary, through recruitment from outside of the organization.
  • Resolve customer complaints, monitor customer satisfaction, and drive excellent customer service through training and development.
  • Recovered over $900k from responsible parties through expert processing of property loss claims in 2016.
  • Sorted and shipped large merchandise back to distribution center and vendors daily through FedEx and UPS.
  • Developed employees through regular coaching and feedback that lead to improved customer focused results.
  • Manage all claims according to policy/ plans through the employer and compliance standards.
  • Manage and prioritize claims workload through ongoing assessment, assistance and staff management.
  • Make adjustments to the inventory as needed, following through investigation research.
  • Manage open workers' compensation cases throughout the entire state of California.
  • Manage New England branch claims office with a staff of three.
  • Process provider's settlements through the Special Extract process.
  • Worked with outside Counsel throughout the litigation process.
  • Supervised three claims administrators and two administrative/clericals.
  • Managed claims unit of six to eight examiners and a third party administrator through Sanwa Bank.
  • Managed insurance claim distribution to independent contractor adjustors throughout 5 states Managed natural disaster claims

Show More

4 HR Jobs

No jobs at selected location

44. Providers

demand arrow
low Demand
Here's how Providers is used in Claims Manager jobs:
  • Developed and maintained cooperative and supportive relationships with claimants, their health care providers and corporate plan administrators.
  • Gathered information for investigation into application of coverage in order to reduce leakage for providers.
  • Established and maintained network of medical and pharmaceutical providers for injured workforce.
  • Directed and coordinated treatment between medical providers and injured employees.
  • Communicate pertinent information to department and providers.
  • Utilize rehabilitation network of licensed providers.
  • Worked closely with finance, clients, members, providers and attorneys, ensuring a smooth flow of all processes.
  • Communicate directly with medical providers, employers and claimants concerning inquires on claim status, providing decisions and directions.
  • Worked with Brokers, Clients, Providers, PPO networks, and employees to resolve claim issues.
  • Assisted customers, health care providers and internal departments; entered data via SAP ERP system.
  • Work with claimants and providers to obtain clinical findings to support each Short Term Disability claim.
  • Assisted in the contractual negotiation with network providers and the negotiation of claim settlements.
  • Take calls from patients, providers & office staff, as needed.
  • Worked with insurance vendors and medical providers in resolving claims issues.
  • Establish relationships with providers and resolve provider issues when appropriate.
  • Assisted providers with reconciliation of AR reports.
  • Worked directly with providers and other departments in regards to claims and claims resolution.
  • Managed HMOs claims disbursement department, reimbursing 25,000 contracted medical providers.
  • Worked closely with claimants, authorized representatives, medical providers and other sources to establish liability and compensability.
  • Assist providers with claim denials Reconcile payables and receivables to the general ledger Develop policies, procedures and management reports.

Show More

2 Providers Jobs

No jobs at selected location

45. Special Projects

demand arrow
low Demand
Here's how Special Projects is used in Claims Manager jobs:
  • Handled all special projects to resolution keeping the provider/vendors constantly updated on progress.
  • Coordinated department activities and special projects to ensure quality and meet timetables.
  • Participated in special projects and performs additional duties as required.
  • Executed special projects for senior management and executives as necessary.
  • Assisted home office with special projects and operational analysis
  • Focus area South Florida * Assisted with special projects with CFO in active and incurred reserving.
  • Participated in special projects involving run in of new plans and implementation of claims Co-Op Plans.
  • Assisted management with special projects to correct and eliminate claims back log.
  • Perform special assignments or assist in special projects as instructed by management.
  • Participate as needed in due-diligence claim reviews and other special projects.
  • Assisted Vice-President of Claims with all special projects as needed.
  • Perform special projects recreated by NJPLIGA management staff.
  • Completed special projects and research requests as assigned.
  • Assist manager with special projects as they arise.
  • Handle special projects assigned by senior management.
  • Assist other departments with various data related tasks Special projects as needed or assigned.
  • Provided guidance, leadership, and analytical support for special projects.
  • Deligated special projects to my adjusters or customer service people.

Show More

46. Quality Standards

demand arrow
low Demand
Here's how Quality Standards is used in Claims Manager jobs:
  • Develop and ensure all individuals understand and meet production/quality standards, and communicate performance regularly up and down.
  • Managed a team of customer service professionals that focused on meeting Customer Service efficiency and quality standards.
  • Maintained open communications with claims processors and providers to successfully meet established production and quality standards.
  • Developed audit program for all positions that ensured quality standards were achieved.
  • Managed work of all subcontractors according to required quality standards.
  • Delivered educational workshops and coordinated quality standards meetings.
  • Established productivity and quality standards.
  • Developed policies & procedures that ensured consistency and developed production and quality standards that were a stretch, however attainable.
  • Maintained quality standards of over 95% financial accuracy, 95% quality accuracy, and 97% compliance accuracy.
  • Supervised employees to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors or problems.
  • Conducted periodic quality reviews on medical and dental claims to oversee compliance with audit requirements and quality standards.
  • Assessed training and development of the staff to ensure that department quality standards were exceeded for each position.
  • Collaborate with the TL to ensure team achieves overall quality standards of 97% for financial accuracy.
  • Process claim review, analyze claim requests and ensure data output is up to quality standards.
  • Monitored production and quality standards on a daily, weekly and monthly basis.
  • Developed and instituted production and quality standards to enhance service to clients.
  • Ensured all claims were managed according to compliance and quality standards.
  • Implement and maintain high pace productivity and quality standards for staff.
  • Led educational workshops and a series of Quality Standards meetings.
  • Led Department in high quality standards and boosted productivity.

Show More

47. Monthly Reports

demand arrow
low Demand
Here's how Monthly Reports is used in Claims Manager jobs:
  • Reviewed and analyze monthly reports and provided training on selected areas of opportunity.
  • Reviewed monthly reports for statistical and financial accuracy of processed claims.
  • Provided weekly/monthly reports to management staff and customers.
  • Included the completion of weekly and monthly reports, coordination of time off, and conferencing of claims for coverage concerns.
  • Provided daily/weekly/monthly reports on results, abandon rates, contact and conversion rates for all projects to Director.
  • Prepared daily and monthly reports of call stats for individual administrators as well as entire department.
  • Furnished weekly or monthly reports to each entity during the process of resolving the claim.
  • Prepared monthly reports relating to statistical results, staff issues and any areas of concern.
  • Monitored, verified and provided monthly reports and dashboards as requested by upper management.
  • Constructed monthly reports on claim developments including expense, and reserve adequacy.
  • Well versed in filing the NY Public Health Pool monthly reports.
  • Complete monthly reports showing closing ratio and average paid claims results.
  • Completed monthly reports for health plan timeliness and audits.
  • Compiled weekly and monthly reports for executive team.
  • Produced monthly reports using advanced Excel spreadsheet functions.
  • Completed daily, weekly, and Monthly reports.
  • Prepared monthly reports for company owners.
  • Prepare monthly reports for management.
  • Prepared quarterly and monthly reports to analyze team & individual results.
  • Produced monthly reports for presentation to finance vice president, and quarterly reports to head quarters.

Show More

48. External Customers

demand arrow
low Demand
Here's how External Customers is used in Claims Manager jobs:
  • Communicated with internal and external customers to obtain proper information for claim processing.
  • Manage all customer service recovery interactions for internal and external customers.
  • Point of contact for internal/external customers.
  • Maintain positive interactions with internal and external customers, including but not limited to Third Party Administers and Risk Management accounts.
  • Respond to questions and concerns respective to both internal and external customers with demonstrated ability to manage irate and difficult calls.
  • Communicate with internal and external customers, medical providers, attorneys, etc both in oral and written communication.
  • Negotiate with our external customers on payment arrangements, adjustments or settlements - recommend solutions.
  • Interact with internal and external customers to ensure claims are brought to an appropriate outcome.
  • Served as primary contact for CIGNA Account Managers and external customers for National Policyholders.
  • Assisted all staff members to resolve all issues for internal and external customers.
  • Communicate on a day to day basis with internal and external customers.
  • Give direction and respond to claim inquiries from internal and external customers.
  • Foster and maintain strong business relationships with Internal & External Customers.
  • Maintain a favorable rapport with internal and external customers.
  • Provided outstanding services to internal and external customers and strived to resolve member and provider needs on the first call.

Show More

49. Contractual Language

demand arrow
low Demand
Here's how Contractual Language is used in Claims Manager jobs:
  • Determine customer eligibility by reviewing contractual language and medical documentation, interprets information and makes decision based on facts presented.
  • Completed LTD claims by communicating with claimants and physicians and properly interpreting contractual language and responsibilities.
  • Understand and interpret contractual language and responsibilities.
  • Interpreted and understood contractual language.
  • Interpreted contractual language and responsibilities as well as manage all claims according to published Quality and Compliance standards.
  • Understand and interpret complex contractual language and responsibilities in order to make approvals or denials of coverage.
  • Understand and interpret contractual language and responsibilities, and articulate this information to employers and claimants.
  • Interpreted various client's contractual language and managed claims according to published Quality and Compliance standards
  • Assisted customers in understanding the claims process and contractual language.
  • Evaluated contractual language to make legal and binding decisions.
  • Manage new and existing claims Understand and interpret contractual language.

Show More

50. Process Improvement

demand arrow
low Demand
Here's how Process Improvement is used in Claims Manager jobs:
  • PROCESS IMPROVEMENT Analyzed revised and documented processing guidelines for highly complex procedures to improve customer satisfaction and meet Government regulations.
  • Ensured continuous achievement of division performance standards through execution of strategic initiatives for process improvement.
  • Facilitated process mapping of three major accounts along with suggested process improvements.
  • Identify training opportunities and implement claims and safety process improvements in stores.
  • Reviewed work product and made recommendations for process improvement and performance.
  • Identified and implemented process improvements leading to divisional process changes.
  • Developed and executed process improvement to increase productivity and efficiency.
  • Identified and documented Provider Claims process improvements.
  • Established plans for business process improvements.
  • Established process improvements based on results.
  • Reduced claims re-work by 20% by developing a process improvement program that corrected front-end process and procedural issues.
  • Addressed team performance challenges with process improvements and coaching thereby reducing turnaround backlog from 30 to 10 days.
  • Improved productivity by 50% through system enhancements, process improvements as well as re-alignment of team structure.
  • Served as facilitator, sponsor, leader and member of several quality Process Improvement Teams.
  • Develop and review claim production reports, for trends and implement process improvement initiatives.
  • Recommended process improvements and intermediate workarounds to reduce overpayment of claims.
  • Assisted with process improvements Conducted bi-annual audit of cases to ensure that CMS standards and expectations were met.
  • Participated in a Six Sigma Process Improvement team designed to improve the incoming healthcare claims mail process.
  • Create reports to identify possible trends and suggest process improvements.
  • Implement process improvements to increase department workflow; created standardized reporting criterion for reinsurers and brokers to ensure consistency.

Show More

1 Process Improvement Jobs

No jobs at selected location

Claims Manager Jobs

NO RESULTS

Aw snap, no jobs found.

20 Most Common Skills For A Claims Manager

Customer Service

10.7%

General Liability

8.9%

Ensure Compliance

8.3%

Liability Decisions

8.2%

Insurance Companies

8.0%

Insurance Adjusters

7.8%

Long-Term Disability

7.5%

Company Policies

5.3%

Bodily Injury Claims

4.9%

Claims Department

4.4%

Process Claims

4.3%

Counsel

3.4%

Oversight

2.9%

Medical Records

2.8%

Workers Compensation

2.6%

Performance Reviews

2.3%

Manage Claims

2.0%

TPA

1.9%

Medical Treatment

1.9%

Direct Reports

1.7%
Show More

Typical Skill-Sets Required For A Claims Manager

Rank Skill
1 Customer Service 8.3%
2 General Liability 6.9%
3 Ensure Compliance 6.4%
4 Liability Decisions 6.4%
5 Insurance Companies 6.2%
6 Insurance Adjusters 6.1%
7 Long-Term Disability 5.8%
8 Company Policies 4.1%
9 Bodily Injury Claims 3.8%
10 Claims Department 3.4%
11 Process Claims 3.4%
12 Counsel 2.7%
13 Oversight 2.2%
14 Medical Records 2.2%
15 Workers Compensation 2.0%
16 Performance Reviews 1.8%
17 Manage Claims 1.6%
18 TPA 1.5%
19 Medical Treatment 1.5%
20 Direct Reports 1.3%
21 New Claims 1.3%
22 Data Entry 1.1%
23 Performance Management 1.0%
24 Property Damage 1.0%
25 Casualty Claims 1.0%
26 Personal Lines 1.0%
27 Claims Staff 0.9%
28 Medicaid 0.9%
29 File Reviews 0.9%
30 Claims Office 0.9%
31 Action Plans 0.8%
32 Party Administrators 0.8%
33 Claims Representatives 0.8%
34 Litigation Management 0.7%
35 Osha 0.7%
36 Customer Complaints 0.7%
37 Settlement Authority 0.7%
38 Physical Damage 0.6%
39 Complex Claims 0.6%
40 PIP 0.6%
41 SIU 0.6%
42 Staff Members 0.6%
43 HR 0.6%
44 Providers 0.6%
45 Special Projects 0.6%
46 Quality Standards 0.5%
47 Monthly Reports 0.5%
48 External Customers 0.5%
49 Contractual Language 0.5%
50 Process Improvement 0.5%
{[{skill.rank}]} {[{skill.name}]} {[{skill.percentageDisplay}]}%
Show More

7,142 Claims Manager Jobs

Where do you want to work?

To get started, tell us where you'd like to work.
Sorry, we can't find that. Please try a different city or state.