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Claims Manager Resume Samples
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Candidate Info
years in workforce
year at this job
Claims Manager
Managed the Commercial and Medicaid/Medicare projects with issues due to the turn over to Managed Medicare and Medicaid.
- Built and maintained close relationship with all payer provider representatives to insure proper claims processing.
- Resolved Health First issue in regards to improper denials by 80%.
- Recognized and resolved issues pertaining to contracts and improper billing procedures.
- Assisted in implementing new intake as well as billing procedure to streamline the billing processes to improve the revenue cycle management by 45% overall 2013 fiscal.
Candidate Info
years in workforce
years at this job
Bachelor of Arts
CLAIMS MANAGER - PHYSICAL DAMAGE & RENTAL OPERATIONS
Successfully managed team of 30 geographically separated employees, with an oversight of Physical Damage and Rental Operations in the Mid-Atlantic and Northeast states.
- Led process consistency and consolidation of multi-regional workforce which resulted in a 35% increase in productivity and delivered a 1.6% reduction in operational expense.
- Developed rental analytics, engaged key stakeholders, and rolled out improved rental process which resulted in a savings in excess of $8.9M YTD.
- Improved employee engagement results by 28% and finished in the top quartile of all companies as identified through JD Powers.
Candidate Info
years in workforce
years at this job
History
Aic
Regional Claims Manager - Georgia, Alabama, South Carolina, Louisiana
Responsible for $100 million dollar property casualty claims operation
- Instituted claims best practices resulting in 8% reduction in severity payments.
- Created accountability standards resulting in 20% reduction in litigation costs.
- Enhanced employee communication through creation of monthly open forums.
- Improved employee retention by 15% through consistent personal feedback initiatives.
Candidate Info
years in workforce
years at this job
Business Management
Casualty Claims Manager
Led team of 3 supervisors, 20 adjusters, 1 nurse and 1 claims evaluator in the proper settlement of bodily injury claims. Managed processing of high-exposure and litigation claims with $100K in payment authority. Oversaw the budgeting, salary administration and expense control of the department.
- Improved and enforced claims handling efficiencies to speed up claims payments and adjust reserves more effectively.
- Reduced legal expenses by 20% within a year by utilizing in-house resources, cutting costs of outside counsel.
- Led and represented the Claims Department as a Steering Committee Member and Subject Matter Expert on the MetLife New Hire eOrientation project.
- Developed supervisory team to improve skills and assume additional responsibility.
- Introduced round tabling of special investigation claims to ensure compliance with state unfair practices statutes.
Candidate Info
years in workforce
years at this job
Accounting Coursework
Health Claims Manager
Manage all aspects of the claims and customer service area for clients supported in the Seattle Office.
- Directed staff of ~80 FTE's to ensure client performance guarantees and company goals were met.
- Developed and implemented a monthly production report template that was adopted by the entire Western Region in order to standardize performance goals.
- Prepared and managed expenses to meet departmental budget goals.
- Oversaw the successful transition over to a new claims system, Atlas for Sound Health.
- Assisted with the onboarding of two new clients - ILWU-PMA and County of Kern.
- Played integral role in the SSAE16 audit for certification of the Atlas Claims System.
Candidate Info
years in workforce
years at this job
Accounting
Claims Manager
Created and maintained accurate claim procedures and claims processing by federal regulations.
- Documented all customer interactions using appropriate computer systems with strict adherence to confidentiality agreements, policies and procedures.
- Established long term customer relationships through prompt and courteous service.
- Led warehouse improvement initiatives to advance operational efficiencies and reduce freight claims.
- Assisted in creating department's computer programing.
- Identified and implemented supply chain improvement opportunities.
Candidate Info
years in workforce
years at this job
Political Science
Master of Arts
Corporate Claims Manager
Reduced casualty claims corporate wide from $1.4 million to $17 thousand through contract compliance, negotiations, monitoring of TPA's, creating cost allocation mechanism for reimbursement of casualty claims which reduced the overall net claim cost's
- Coordinated safety and loss prevention programs for seventy-one properties through internal audits and on-site safety inspections.
- Responsible for compliance with Federal, State and local regulatory agencies.
- Administered all corporate insurance litigation files in twenty-nine jurisdictions in the U.S., Canada and Cayman Islands.
- Created and implemented corporate compliance reporting data bases. Areas of training include alcohol awareness, driver awareness, and accident investigation, MSDS, and claims mediation.
Candidate Info
years in workforce
months at this job
History
Claims Manager
Managed all Personal and Commercial line claims
- Monitored claims with insurance carriers to ensure prompt resolution and provided client feedback
- Evaluated all questionable and denied claims and successfully negotiated coverage with clients' insurance carriers
- Updated and maintained the Agency Management System (AMS) and related excel spreadsheets with all reported claims, claims notes, claims status, updated reserves, closures, and financial transactions
- Generated carrier loss runs and communicated with clients' insurance carrier representatives to provide comprehensive reports (daily, weekly and monthly) to clients and Account Managers
- Initiated claim reviews with Account Teams and Managers regarding claims in excess of $25,000 and presented status to Roehrs Chief Operating Officer
- Developed and implemented a claims reporting and filing system that provided an active record used to expedite claim closure which exceeded clients' expectations
Candidate Info
years in workforce
years at this job
Political Science
Claims Manager
Responsible for resolution of benefit claims from VISA-USA and VISA-Latin America cardholders.
- Supervised a thirty person claims department consisting of claims examiners, team leaders and analysts.
- Ensured compliance with Service Level Agreements between Mondial and Underwriters ACE & Chartis.
- Created and implemented a management leadership initiative for supervisors, "Lead By Example".
- Collaborated with Client Services to maintain timely, open communication with ACE and Broker, CBSI.
- Directed the professional development and individual growth of staff through mentoring and focus sessions.
- Delivered exceptional customer service in strict adherence to corporate mandates.
- Successfully complied with and met all Service Level Agreements.
Candidate Info
years in workforce
years at this job
Accounting
Claims Manager
Established long term customer relationships through prompt and courteous service.
- Led warehouse improvement initiatives to advance operational efficiencies and reduce freight claims.
- Created and maintained accurate claim procedures and claims processing by federal regulations.
- Assisted in creating department's computer programing.
- Identified and implemented supply chain improvement opportunities.
- Documented all customer interactions using appropriate computer systems with strict adherence to confidentiality agreements, policies and procedures.
Candidate Info
years in workforce
years at this job
Computer Information Systems
Project Management
Master of Arts
Claims Manager
Served as Administrative Manager for a group of 250 non-exempt employees
- Also Supervised 20 claims processors as my direct reports.
- Managed Rental department that monitored 40% of all rentals for the company
- Have successfully managed, coached and developed team members to build a high-performance team
- Working cross-functionally with other business units to develop strategies and tactics that will achieve key business results
- Fostering an environment that encourages continuous growth, education and personal development.
- Worked various projects to support the claims office.
Candidate Info
years in workforce
years at this job
Management
Regional Claims Manager
Oversaw 30 employees in 2 offices, 3,000 files, and $1B in reserves. Led strategic direction of claim settlements, continuous improvement processes, hiring, performance evaluations, budget management, and relations with multiple business partners. Conducted claim services issue resolution, surplus line program management, workers' compensation loss portfolio transfers, and guaranteed-cost reinsurance programs.
- Increased structured settlement results by 350% with new incentive programs.
- Achieved 40% growth in combined offices by implementing new strategies.
- Developed proactive communications protocol for office relations and underwriting on top 40 accounts.
- Coordinated performance improvements by revising core objectives.
- Supported new account marketing plans to procure multiple big name clients such as Auto Zone and Dr. Pepper/Snapple.
- Consistently accomplished all best practices and leakage goals.
Candidate Info
years in workforce
years at this job
Public Administration And Human Resource Management
Casualty Claims Manager
Leveraged 17+ years in high value sales, HR, client services, training, team management and lifecycle management of property, liability, injury and high-risk claims. Requested by upper management to undergo advanced training in administration of property insurance claims < 30 days of hire. Oversaw 8 Claims Associates (6 Inside Reps, 2 Property Field Claim Reps). Utilized academic and "real world" HR experience to recruit, interview, hire, mentor and continuously work with staff to improve knowledge and skill-set.
Developed off-boarding procedures within compliance to corporate, state and federal requirements. Worked with a diverse range of clients in garnering relevant data, verifying investigating and settling claims within established guidelines. Prepared supporting files to all incidents including photos, police reports, damage estimates, subsequent financial and legal findings. Led successful negotiations for adjustment of losses.
Key Accomplishments
- Earned region and nationwide highest Customer Service Scores through leading a team-centered effort in boosting morale, productivity and retention.
- Appointed by the Associate Vice President to serve as United Way Chairperson.
- Selected for the Leadership Development Program out of 150+ applicants, earning a certificate for completion and working with C-Level Executives in gaining additional skills.
- Exceeded corporate goals of 1:1 monthly closure rate by 106% on average.
- Served as a Property Catastrophe Team Member for Hurricane Ike, supervising Property Representative and inspecting damages up to $250K.
- Ensured estimates were in line with damage and personnel stayed within designated budget.
Candidate Info
years in workforce
years at this job
Financial Management
Branch Claims Manager
Advanced through positions of increased responsibility to manage liability for commercial and personal lines, Workers' Compensation cases, and litigation issues for 2 states with ~800,000 PIF, as well as bad faith litigation for all coverage lines. Handled mediation and arbitration for litigated claims; provided trial authority and served as expert witness. Administered $6M annual litigation budget. Communicated regularly with state Departments of Insurance to coordinate regulatory issues. Led branch audits to ensure compliance and recommend improvements; served as liability and litigation SME for Branch Claims Managers. Designated company representative for audit of Oklahoma Insurance Guaranty Fund. As Branch Claims Manager, oversaw Auto and Commercial Liability, as well as Workers' Compensation for Oklahoma and litigated claims. Managed 36-member team and $3M budget.
Selected accomplishments:
- Successfully handled inventory of 50-60 bad faith allegations to settlement or trial.
- Led company response to 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, OK.
- Participated in training program to further expertise in advanced Commercial Liability; led liability training for all new hires at 9 locations.
- Contributed to development of new legal offices in Oklahoma, as well as assisting with hiring top-performing candidates.
- Established department objectives and programs consistently aligned with overall corporate goals; ensured staff performed at optimal levels and met benchmarks.
- Excelled in earlier roles as Branch Claims Supervisor and Field Claims Representative.
Candidate Info
years in workforce
years at this job
Vocational Degree
Claims Manager
Accepted and reviewed property and auto damage claims from our clients, hh Gregg, General Electric, Home Depot, Room and Board, and Brandsmart
- Analyze claims to determine extent of company's liability, make approval or denial decisions and negotiate settlements with claimants
- Collaborate with insurance agents, attorneys and interviewed claimants
- Exceeded in keeping a yearly budget and saving the company over $200,000 a year
- Prepared and provided clients with spreadsheets of weekly updates
Candidate Info
years in workforce
years at this job
Bachelor of Arts
Risk Management
Global Claims Manager, Casualty Risk Manager
.
The first claims manager for merged corporation, expected to have over 1,000 WC claims totaling $12 million in loss costs. Accountable for workers compensation, “toxic tort” liability, product liability claims including medical products, general liability and class action suits. Served as the litigation manager for national and international claims. Analyze data identifying trends in claims and costs and delivered monthly reports to senior management.
Relevant Accomplishments
- Reduced annual casualty losses by 52% or approximately $15.5 million
- Dropped lost time frequency rates by 26%
- Return to work program reduced lost time days/year 86%
- Designed and provided WC awareness training to 15 major sites in 12 months
- Consolidated claims administration and data from 8 insurance carriers
- Developed national claims management training program and webinars.
Candidate Info
years in workforce
years at this job
Criminal Justice
Business - Human Resource
Payroll Bookkeeping
Corporate Claims Manager
Corporate Claims Manager for this multi million dollar light industrial staffing company with 1000 - 3000 employees assigned from 25 branch locations nationally.
Processed workers compensation documents and ensured employee received proper medical attention in accordance with California and twelve additional states workers compensation regulations. Worked with supervisors and injured workers to coordinate their return to work as directed by physician. Maintained the injured workers return to work policy and safety prize program. Maintained individual clients OSHA logs. Coordinated quarterly loss run meetings with the third party administrator (TPA) to review open claims. High deductible plan
Worked with clients; providing updates on injured workers, Certificate of Insurance, personal protective equipment, and much more. Worked with the sales team; researching potential clients to identify appropriate National Council on Compensation Insurance (NCCI) code.
Selected Accomplishments:
- Outstanding Achievement Award for workers’ compensation savings in excess of $1,000,000
- Handled workers comp claims in a variety of industries to include: warehouse, airline janitorial, recycling, manufacturing, logistics, refractory, clerical, Municipalities, nursing, pick & pack, assembly, bindery, etc...
- Implemented 24/7 Injury Management Program Nationally – reduced recordable claims in excess of 50%
- Trained and assisted office staff nationally with the handling of injured workers
Candidate Info
years in workforce
years at this job
Industrial Claims Association
Insurance Education Association
Commercial Claims Manager - Workers' Compensation
Direct the Workers' Compensation Commercial Claims Office for Northern California
- Account Executive duties interfacing with High Volume Agencies & Multi-line Client's
- Direct the activities of 60 Claims Personnel in two Office locations
- Introduced Best Practice Quality Assurance Program that Significantly Increased Departmental Performance and helped Reduce the Combined Loss Ratio by 30+ points
- Stabilized Department Financials (reserves) and implemented an Employee Retention Program that reduced turnover to fewer than 10%. Responsible for Compliance with published Corporate Policies and Procedures.
Candidate Info
months in workforce
month at this job
Liberal Arts
Political Science
International Relations
Claims Manager
Drafted claims strategy according to Zurich global practices
- Executed on plans and achieved targets within time and budget
- Modernized claims handling practices (CHP) to meet customer expectation
- Pioneered live auction on total loss cars
- Supported claim staff in Kuwait, Lebanon, and Oman
- Introduced market leading practice on litigated claims and reduced open cases over 400%
- Collaborated with regional team to develop Quality Assurance (QA) policy
Candidate Info
years in workforce
years at this job
Business Administration
Claims Manager
Managed a cross-function department responsible for Medicare reimbursements, hospital and physician accounts receivable issues, large claims with billed charges greater than $35,000, and dental pre-authorizations. Created teamwork within the department, audited claims to resolve claim disputes, open line of communication, provided tools and resources, wrote and implemented policies and procedures, developed individual performance improvement plans, managed within a budget, utilized management reports to achieve target objectives, hired and terminated employees.
- Implemented plan to reduce Medicare reimbursements to a 20 day inventory.
- Designed criteria for hospital claims to be eligible for clinical oversight and review resulting in a 10% net savings.
- Created process and database to track and report open accounts receivable issues
- Utilized customer service skills to establish a working partnership with providers to resolve
- Audited claims to resolve payment issues and exceed team financial accuracy of 99.5%.
Candidate Info
years in workforce
years at this job
Economic
Work Comp Claims Manager
Managed small staff of adjusters for company's work comp self-insurance and wrap around coverage in multiple states.
- Personally handled complicated claims, including litigation and catastrophic claims.
- Provided testimony in various depositions and hearings.
- Negotiated insurance renewals.
- Attended and mediated numerous claims in multiple jurisdictions.
- Responsible for return to work program, fitness for duty, and electrodiagnostic functional assessment programs.
- Wrote training manual for various jurisdictions to be used by staff.
Candidate Info
years in workforce
years at this job
Public Relations
Sales Skill School
Claims Manager
Primary responsibilities include the management of staff for the timely and accurate processing of claims in accordance with contracted prisons/jails and provider network, as well as monitoring the provider relations telephone lines and correspondence, and weekly Company check run for providers.
Major Accomplishments:
- Consistently meeting department performance goals for processing claims with a minimum of 98.5% accuracy and 95% timeliness.
- Successfully reduced a two-month claims backlog within one month with the implementation of a performance management project.
- Implemented Provider relations Specialists call log and correspondence protocol.
- Created positive relations with supporting areas if the Company to improve claims processing.
Candidate Info
years in workforce
years at this job
Legal Assistant/paralegal
Political Science
Claims Manager
Processed an average of 30-50 property and injury claims weekly
- Completed recorded statements from claimants and insureds as necessary
- Analyzed claims to determine extent of company's liability on $500k insurance policy
- Made approval or denial decisions and negotiated settlements with claimants in accordance with policy
- Collaborated with insurance agents and interviewed claimants to correct errors, rectify omissions and investigate questionable issues
- Managed litigation files, attended depositions, hearings, and trials.
- Communicated with excess insurer on any claims exceeding deductible or self-insured retention.
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