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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive knowledge of claims management procedures and processes, particularly in disability claims, while providing leadership and training to teams. Capable of analyzing claims data, ensuring compliance with quality standards, and fostering professional client relationships.
Highest-signal resume keywords
Claims Management ProceduresClaims Supervisory ExperienceLeadership SkillsAnalytical SkillsMicrosoft Office Proficiency
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AdjudicationQuality ReviewsPerformance Development PlansClaims CodingData AnalysisProcess ImprovementLicensing ComplianceClaims ReportingClient Relationship ManagementNegotiation
Soft Skills
Excellent CommunicationInterpersonal SkillsOrganizational SkillsMotivational SkillsTeam Collaboration
Certifications & Qualifications
Professional Certifications
Industry Keywords
Disability ClaimsClaims ExperienceAudit ComplianceService Contract StandardsPerformance Competencies
About the role
Key responsibilities & impact- Supervise multiple teams of examiners and/or technical operations colleagues
- Monitor colleagues' workloads and individual claim activities
- Provide training and technical/jurisdictional direction on claims adjudication
- Identify and advise management on trends, problems, issues, and recommended actions
- Inform management of new procedures and continuous process improvement ideas
- Coordinate projects with management
- Compile, review, and analyze management reports and take appropriate action
- Perform quality reviews on claims in compliance with audit, service contract, and quality standards
- Act as second level of appeal for client and claimant issues and implement final dispositions
- Review reserve amounts on high-cost and over-authority claims
- Monitor third-party, litigated, serious vocational rehabilitation, questionable, and sensitive claims
- Maintain client contact, promote professional client relationships, make claim-status recommendations, and provide written claim summaries
- Ensure direct reports are properly licensed in serviced jurisdictions
- Ensure claims files are correctly coded and adequately documented
- Administer personnel policies and staffing standards
- Interview, hire, establish performance development plans, and conduct performance discussions
- Provide support, guidance, leadership, and motivation
- Perform other duties as assigned
- Support organizational quality programs
Requirements
What you’ll need- Bachelor's degree from an accredited college or university preferred
- Licenses as required
- Professional certifications as applicable to line of business preferred
- Six (6) years of claims experience or equivalent combination of education and experience required
- Two (2) years of claims supervisory experience preferred
- Thorough knowledge of claims management procedures and processes for disability
- Excellent oral and written communication, including presentation skills
- PC literate, including Microsoft Office products
- Leadership/management/motivational skills
- Analytical and interpretive skills
- Strong organizational skills
- Excellent interpersonal skills
- Excellent negotiation skills
- Ability to work in a team environment
- Ability to meet or exceed Performance Competencies
Benefits
Comp & perks- Work-life balance
- Career growth opportunities
- Caring culture
- Reasonable accommodations when applicable and appropriate
- Equal opportunity workplace
- Drug-free workplace