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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive claims management expertise, including supervision of teams, training on adjudication processes, and maintaining compliance with quality standards. Proven ability to analyze claims data, identify trends, and implement process improvements while fostering professional client relationships.
Highest-signal resume keywords
Claims Management ProcessesLeadership And Management SkillsAnalytical And Interpretive SkillsExcellent Oral And Written CommunicationPerformance Development Plans
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 ExperienceClaims AdjudicationQuality ReviewsPerformance CompetenciesClaims CodingManagement Reports AnalysisLicensing RequirementsProcess Improvement InitiativesHigh-Exposure Claims ManagementTeam Supervision
Soft Skills
Interpersonal SkillsNegotiation SkillsOrganizational SkillsMotivational SkillsTeam Collaboration
Tools & Technologies
Microsoft Office
Certifications & Qualifications
Professional Certifications
Industry Keywords
Liability ClaimsClaims SupervisorClient RelationshipsPerformance DiscussionsAudit Standards
About the role
Key responsibilities & impact- Supervise multiple teams of examiners and technical staff handling liability claims
- Monitor colleagues' workloads and individual claim activities
- Provide training and technical/jurisdictional direction on claims adjudication
- Maintain diaries on team claims, including complex and high-exposure claims
- Identify trends, problems, and issues and advise management on recommended actions
- Coordinate office projects and continuous process improvement initiatives
- Compile, review, and analyze management reports and take appropriate action
- Perform quality reviews on claims according to audit, service contract, and quality standards
- Act as second-level appeal authority for client and claimant issues and implement final appeal dispositions
- Review reserves on high-cost claims and claims exceeding examiner authority
- Monitor third-party, litigated, serious vocational rehabilitation, questionable, and sensitive claims
- Maintain client contact, promote professional client relationships, and provide claim recommendations and written summaries
- Ensure direct reports are properly licensed in serviced jurisdictions
- Ensure claims files are correctly coded and adequately documented
- Administer personnel policies, interview and hire colleagues, establish performance development plans, and conduct performance discussions
- Provide leadership, guidance, support, and motivation to maximize performance
- Support the organization's quality programs
Requirements
What you’ll need- Six (6) years of claims experience or equivalent combination of education and experience, including two (2) years of claims supervisor experience
- Licenses as required
- Thorough knowledge of claims management processes and procedures for multiple product lines
- Excellent oral and written communication, including presentation skills
- PC literacy, including Microsoft Office products
- Leadership, management, and 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
- Bachelor's degree from an accredited college or university preferred
- Professional certifications as applicable to line of business preferred
Benefits
Comp & perks- Work-life balance
- Career growth opportunities
- Caring culture
- Diversity, equity, and inclusion workplace
- Equal opportunity employer
- Drug-free workplace