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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates strong leadership capabilities in managing teams and driving strategic initiatives while ensuring compliance with claims adjudication and risk management practices. Proven ability to enhance customer experience and operational efficiency through effective project management and change management principles.
Highest-signal resume keywords
Leadership SkillsChange ManagementClaims ExperienceProject ManagementCustomer Service Orientation
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 AdjudicationRisk ManagementProject ManagementAnalytical SkillsProblem-Solving Skills
Soft Skills
Communication SkillsRelationship BuildingInfluencing SkillsCoaching SkillsTime Management
Certifications & Qualifications
Related Professional Designations
Industry Keywords
Employee BenefitsVoluntary BenefitsOperational ExcellenceCustomer-Centric CulturePerformance Management
About the role
Key responsibilities & impact- Lead professional-level employees and/or direct reports responsible for managing claims in a multi-disciplined environment
- Implement strategic direction and guide direct reports in tactical management and initiative delivery
- Support complex strategic, transformational, and growth projects
- Lead cross-product, cross-brand, cross-functional, and digital transformation initiatives
- Deliver best-in-class customer experience for voluntary benefits
- Manage leaders and/or individual contributors across multiple lines of business, products, and/or brands
- Manage team selection, training, resource capacity, job design, career development, coaching, and performance management
- Build leadership capabilities throughout the organization
- Ensure accurate claims adjudication according to contract/plan provisions, procedures, state regulations, and risk management practices
- Perform file reviews and approve payments according to claim manual/practice protocols
- Partner with business leaders, project managers, and subject matter experts to identify opportunities and build solutions
- Monitor spending and identify operational efficiency opportunities
- Monitor results and trends, address profitability concerns, and recommend solutions
- Implement customer service, productivity, and quality enhancements
- Champion customer-centric culture, operational excellence, process management, and efficiency
- Track, measure, report, and evaluate external partner performance
- Collaborate with external partners on training, workflow changes, and implementation
- Ensure external partner compliance with company and department policies
- Support sales through RFPs, customer finalist presentations, broker education and training, and sales/marketing materials
- Serve as backup for Director/VP during absences
- Perform other duties as assigned
Requirements
What you’ll need- College degree preferred plus 5-7 years of increasingly responsible management experience
- Proven strong leadership skills, including guiding others in setting direction, monitoring performance, and communicating changes
- Ability to excel in a fast-paced, changing, dynamic environment using change management practices
- Excellent relationship and communication skills with ability to influence, motivate, and collaborate across all levels and geographic markets
- Significant customer service orientation focused on continuous improvement
- Excellent analytical, problem-solving, time-management, and decision-making skills
- Experience and knowledge of change management principles
- Ability to identify opportunities and implement solutions
- Ability to think conceptually, handle ambiguity, solve complex problems, and make thoughtful recommendations
- Proven track record of developing others
- Ability to travel approximately 20%
- Project management skills preferred
- Risk management experience preferred
- Related professional designations preferred
- Claims experience, both product and system, preferred
- Knowledge of employee and voluntary benefits industry preferred
- Existing remote workers are eligible to apply
