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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates extensive experience in claims supervision and adjudication, with a strong focus on quality compliance, team leadership, and process improvement. Possesses jurisdiction knowledge across multiple states and the ability to manage complex claims effectively.
Highest-signal resume keywords
Claims Supervision ExperienceJurisdiction KnowledgeQuality ComplianceProcess Improvement InitiativesTeam Leadership
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 AdjudicationClaims AnalysisClaims CodingPerformance Development PlansQuality ReviewsManagement ReportingTrend IdentificationProblem SolvingTechnical DirectionLicensing Compliance
Soft Skills
Excellent JudgmentClear ThinkingStress ManagementMotivationCommunication
Certifications & Qualifications
Professional CertificationHome State LicenseNew York License
Industry Keywords
Liability ClaimsClaims ExperienceTechnical Staff ManagementClient RelationshipsPerformance DiscussionsAudit ComplianceHigh-Exposure ClaimsColleague SupervisionContinuous ImprovementWorkload Monitoring
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 management projects and continuous process improvement initiatives
- Compile, review, and analyze management reports
- Perform quality reviews of claims for audit, service contract, and quality compliance
- Act as second-level appeal authority for client and claimant issues
- Review reserve amounts on high-cost and examiner-authority claims
- Monitor third-party, litigated, serious vocational rehabilitation, questionable, and sensitive claims
- Maintain client relationships and provide claim recommendations and written claim summaries
- Ensure direct reports are properly licensed in applicable jurisdictions
- Ensure accurate claims-file coding and documentation
- Administer personnel policies and staffing standards
- Interview, hire, and establish performance development plans
- Conduct colleague performance discussions and provide leadership, guidance, and motivation
- Support the organization's quality programs
- Perform other duties as assigned
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
- Six (6) years of claims experience or equivalent combination of education and experience required
- Two (2) years of claims supervisor experience
- Home state or reciprocal license required
- New York licensing preferred
- Jurisdiction knowledge of all states
- Ability to supervise multiple teams and at least seven technical operations colleagues
- Ability to handle work-related stress and multiple priorities simultaneously
- Clear and conceptual thinking ability
- Excellent judgment, troubleshooting, problem solving, analysis, and discretion
- Ability to meet deadlines
- Computer keyboarding, hearing, vision, and talking abilities
Benefits
Comp & perks- Flexible work schedule
- Referral incentive program
- Opportunity to work in an agile environment
- Career development and promotional growth opportunities
- Medical, dental, and vision coverage
- 401K on day one
- 401K matching
- Paid time off (PTO)
- Disability insurance
- Life insurance
- Employee assistance
- Flexible spending or health savings account
- Other additional voluntary benefits
- Remote work flexibility and autonomy