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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 processes and procedures, with a strong emphasis on leadership, training, and performance development. Capable of analyzing claims data, ensuring compliance, and fostering professional client relationships.
Highest-signal resume keywords
Claims Management ProcessesClaims Supervisor ExperienceLeadership/Management 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 AnalysisClaims CodingProcess ImprovementLicensing ComplianceReport CompilationClient Relationship ManagementNegotiation Skills
Soft Skills
Excellent CommunicationInterpersonal SkillsOrganizational SkillsMotivational SkillsTeam Collaboration
Certifications & Qualifications
Professional Certifications
Industry Keywords
Claims ExperienceTechnical OperationsContinuous Process ImprovementPerformance CompetenciesAudit Compliance
About the role
Key responsibilities & impact- Supervise multiple teams of examiners, product line examiners, and/or at least seven technical operations colleagues
- Monitor colleagues' workloads and individual claim activities
- Provide training and technical/jurisdictional direction on claims adjudication reports
- Identify and advise management on trends, problems, issues, and recommended actions
- Inform management of new procedures and continuous process improvement ideas
- Coordinate office projects with management
- Compile, review, and analyze management reports and take appropriate action
- Perform quality reviews on claims for audit, service contract, and quality standards compliance
- Act as second level of appeal for client and claimant issues and implement final 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, make claim-status recommendations, and provide written claim resumes
- 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
- Support organizational quality programs
- Perform other assigned duties
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 supervisor experience required
- Thorough knowledge of claims management processes and procedures for multiple product lines
- 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
- Inclusive, barrier-free recruitment and selection processes
- Accommodation support during recruitment if required