What does a claims manager do?
A claims manager is an individual who works in an insurance-based firm and is responsible for managing the insurance claims department that is composed of examiners and adjusters. Claims managers are required to maintain claim files and reviewing these files as well as communicate with customers to follow up regarding issues they face with insurance claims. They must determine who is liable for the damage if there were other parties involved. Claims managers must also include an expert to assess the amount of damage and avoid insurance fraud.
Claims manager responsibilities
Here are examples of responsibilities from real claims manager resumes:
- Manage multiple outsource PPO networks that enable company to increase top line revenue.
- Achieve improved structure and efficiency with initiation of pip specific unit.
- Manage day-to-day operations of claims department and provide general oversight and direction of all claims activity.
- Oversee implementation and management of litigation and expense protocols including AFA agreements and BLO oversight.
- Respond to all DOI questions and concerns.
- Work with TPA, service providers and personnel on the design, implementation, and management of wellness programs.
- Provide authority, as warranted, on all aspects of nationally handle TPA files, including reserve adequacy and settlement values.
- Develop metrics performance indicators, establish best practices, and take action to reduce allocate loss adjustment expenses (ALAE).
- Full investigation and settlement on all commercial lines, construction defect, third party liability and first party pip claims nationwide.
- Represent Sub-Zero/Wolf in court and/or mediation.
- Submit new participant enrollments and all require documents to Medicaid.
- Estimate damages to policy holder property using Xactimate estimating system.
- Create departmental policy and procedures base on Medicare and Medicaid regulations.
- Administer return-to-work program, participate in accident investigations and arbitration hearings.
- Develop reservations of rights and tender of coverage letters per insurance contract and/or indemnity agreement.
Claims manager skills and personality traits
We calculated that 15% of Claims Managers are proficient in Customer Service, Oversight, and Litigation. They’re also known for soft skills such as Analytical skills, Communication skills, and Detail oriented.
We break down the percentage of Claims Managers that have these skills listed on their resume here:
- Customer Service, 15%
Received recognition plaques and service center awards for consistently exceeding service center goals in productivity, quality and customer service.
- Oversight, 11%
Managed day-to-day operations of claims department and provided general oversight and direction of all claims activity.
- Litigation, 8%
Conduct claims reviews with Litigation business unit to provide feedback for specialty policy interpretation and technical physical damage support.
- Direct Reports, 4%
Created accountability factors and expectations for managers and direct reports resulting in higher service levels and better statutory compliance.
- Claims Handling, 4%
Prepared and updated claims handling software data reports, providing clients and insurance professionals with financial data supporting positive trust performance.
- Insurance Claims, 3%
Provided support to over 3,000 union members by processing insurance claims and special benefits, verified member eligibility for reimbursements.
"customer service," "oversight," and "litigation" are among the most common skills that claims managers use at work. You can find even more claims manager responsibilities below, including:
Analytical skills. To carry out their duties, the most important skill for a claims manager to have is analytical skills. Their role and responsibilities require that "adjusters and examiners must each evaluate whether the insurance company is obligated to pay a claim and determine the amount to pay." Claims managers often use analytical skills in their day-to-day job, as shown by this real resume: "researched, analyzed, and developed detailed support documents to challenge misleading competitor ads and to support resulting litigation. "
Communication skills. Another essential skill to perform claims manager duties is communication skills. Claims managers responsibilities require that "claims adjusters and investigators must get information from a range of people, including claimants, witnesses, and medical experts." Claims managers also use communication skills in their role according to a real resume snippet: "established, organized and administered catastrophic property and casualty claims and litigation, including directing claim field operations and executive communications. "
Detail oriented. This is an important skill for claims managers to perform their duties. For an example of how claims manager responsibilities depend on this skill, consider that "adjusters, appraisers, examiners, and investigators must carefully review documents and damaged property, because small details can have large financial consequences." This excerpt from a resume also shows how vital it is to everyday roles and responsibilities of a claims manager: "reviewed disability claims, ensuring accuracy of claim details and claim determination. ".
Interpersonal skills. A big part of what claims managers do relies on "interpersonal skills." You can see how essential it is to claims manager responsibilities because "adjusters, examiners, and investigators often meet with claimants and others who may be upset by the situation that requires a claim or by the settlement the company is offering." Here's an example of how this skill is used from a resume that represents typical claims manager tasks: "demonstrate qualities such as decision-making, customer service, excellent communication, and interpersonal skills. "
The three companies that hire the most claims managers are:
- Lincoln Financial Group104 claims managers jobs
- Markel18 claims managers jobs
- Zurich16 claims managers jobs
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Compare different claims managers
Claims manager vs. Account manager and customer service manager
An assistant customer service manager is in charge of performing support tasks for managers, helping customer service operations run smoothly and efficiently. Among their responsibilities include assisting managers in supervising customer service teams, managing schedules and objectives, coordinating staff, and addressing issues and concerns, resolving them promptly and efficiently. There are also instances when they must communicate with customers to identify and meet their needs. Moreover, as an assistant manager, it is essential to monitor the workflow and progress of the workforce, all while enforcing the company's policies and regulations.
While similarities exist, there are also some differences between claims managers and account manager and customer service manager. For instance, claims manager responsibilities require skills such as "customer service," "oversight," "litigation," and "direct reports." Whereas a account manager and customer service manager is skilled in "account management," "purchase orders," "customer accounts," and "vendor invoices." This is part of what separates the two careers.
Account manager and customer service managers tend to reach similar levels of education than claims managers. In fact, account manager and customer service managers are 2.9% less likely to graduate with a Master's Degree and 2.7% less likely to have a Doctoral Degree.Claims manager vs. Assistant customer service manager
An Assistant Front Office Manager welcomes guests and develops high-quality relationships with them throughout their stay. They supervise guest arrivals and departures with the front office executive and managers.
While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that claims manager responsibilities requires skills like "oversight," "litigation," "direct reports," and "claims handling." But an assistant customer service manager might use other skills in their typical duties, such as, "excellent interpersonal," "store operations," "customer support," and "bill pay."
Assistant customer service managers earn similar levels of education than claims managers in general. They're 4.0% less likely to graduate with a Master's Degree and 2.7% less likely to earn a Doctoral Degree.Claims manager vs. Assistant front office manager
A customer experience manager (CEM) links the gap between the brand they work for and the customer. It is their job to ensure that customer experience is engaging, efficient, and effective. They make sure that customer satisfaction and loyalty rates increase, gaining more recommendations from those customers. Typically, they focus on designing & improving the customer experience. They also build solid relationships with clients that are fostered by collecting customer feedback in real-time and incorporate the feedback into the sales process to improve the overall customer experience.
There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a claims manager is likely to be skilled in "oversight," "litigation," "direct reports," and "claims handling," while a typical assistant front office manager is skilled in "reservations," "guest complaints," "night audit," and "payroll."
Assistant front office managers earn the highest salary when working in the hospitality industry, where they receive an average salary of $50,661. Comparatively, claims managers have the highest earning potential in the insurance industry, with an average salary of $81,729.assistant front office managers typically earn similar educational levels compared to claims managers. Specifically, they're 3.2% less likely to graduate with a Master's Degree, and 2.7% less likely to earn a Doctoral Degree.Claims manager vs. Customer experience manager
Types of claims manager
Updated January 8, 2025
