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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims management, including analyzing medical-only claims, negotiating settlements, and ensuring compliance with industry best practices. Proficient in multitasking and meeting deadlines while maintaining clear communication with clients and claimants.
Highest-signal resume keywords
Claims Management ExperienceNegotiation SkillsProblem SolvingJurisdiction KnowledgeProfessional Certification
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 AnalysisClaims ProcessingAdjudicationInformation GatheringSettlement NegotiationComputer Keyboarding
Soft Skills
Clear ThinkingExcellent JudgmentDiscretionAbility to Handle StressAbility to Manage Priorities
Certifications & Qualifications
Professional Certification
Industry Keywords
Medical ClaimsSoutheast StatesNortheast StatesClient Service RequirementsExcess Carrier Reporting
About the role
Key responsibilities & impact- Analyze medical-only claims on behalf of valued clients to determine benefits due
- Ensure ongoing adjudication of claims within service expectations, industry best practices, and specific client service requirements
- Analyze and process claims through action plans to timely resolution
- Investigate and gather information to determine claim exposure
- Negotiate claim settlements within designated authority
- Communicate claim activity and processing with claimants and clients
- Report claims to the excess carrier
- Respond to requests for directions professionally and promptly
Requirements
What you’ll need- High School Diploma or GED required
- Bachelor's degree from an accredited college or university preferred
- Professional certification as applicable to line of business preferred
- 2 years of claims management experience or equivalent combination of education and experience required
- Jurisdiction knowledge: Southeast and Northeast states
- Clear and conceptual thinking ability
- Excellent judgment, troubleshooting, problem solving, analysis, and discretion
- Ability to handle work-related stress
- Ability to handle multiple priorities simultaneously
- Ability to meet deadlines
- Computer keyboarding
- Travel as required
- Hearing, vision and talking
Benefits
Comp & perks- Flexible work schedule
- Referral incentive program
- Career development and promotional growth opportunities
- Medical, dental, and vision coverage
- 401K on day one
- 401K matching
- PTO
- Disability and life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
- Reasonable accommodations when applicable and appropriate