Claim Manager Resume Sample

4.5
18 votes

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Alfredo Daniel
8954 Rau Creek,  Chicago, IL
+1 (555) 959 2918

Work Experience


Claim Manager
02/2018 - PRESENT
Los Angeles, CA
  • Strong communication skills (e.g. written, verbal, presentation). Mastery in English, Portuguese and Spanish
  • Lead PMC staff in assessing variations, claims, and reports to Client’s representative the position of the proposed variation
  • Assist on RFP’s
  • Provide leadership, direction and supervision to a team of Unemployment Insurance Consultants (UIC’s), Unemployment Claim Specialists (USC’s), Unemployment Hearing Consultants (UHC’s), Unemployment State Consultants (USC’s), associated Team Leads and/or other supporting claims personnel
  • Relevant working experience with previous supervisory experience
  • Solid working knowledge of Claims classes and service requirements
  • Strong analytical, negotiation and interpersonal skills
  • Able to work independently and meet service standards
Msla-claim Manager
12/2011 - 10/2017
Philadelphia, PA
  • Manages the work activities and staff of the functional area and has full management responsibility for the performance and development of subordinate staff in accordance with organizational direction
  • Manages team metrics by analyzing claim reports and driving for superior results
  • Contributes to organizational profitability by ensuring that claims are effectively managed in accordance with company guidelines and standards
  • Effectively manages loss costs and claim expenses
  • Builds and maintains collaborative relationships with both internal and external business partners such as Claim Regulatory, Client services, Claim Reporting and IT
  • Remains current on state/territory WC regulations and issues, industry activity and trends
  • Ensures timely elevation and transfer of Claims that exceed the Medical Only handling perimeters
  • Ensures all processes are operating to quality and SLA standards and are continuously reviewed for improvement opportunities
  • Addresses elevated customer service issues with a sense of urgency
Life Claim Case Manager
05/2005 - 08/2011
Boston, MA
  • Ensures team has the applicable designations and licenses required
  • LAR Partner Program claims management including validation to ensure compliance and eligibility for proper payment within defined SLA (service level agreement)
  • Compiles work and presents final deliverables to share to our stakeholders the claims payment information
  • Approve deals related to compensation program within 10BD and ensure the partners payment
  • Inform the finance team about the accruals to be contemplate on the next period (TAT 5BD)
  • Experience in a business related function, preferably finance, accounting, or compensation
  • Focus on fresh, creative, and quick approaches on every claim
  • Determine on each claim the need for attorneys, surveillance, and nurse case managers, and then assign, direct, and monitor the vendor
  • Communicate effectively and develop strong relationships with their team members

Education


Cabrini University
2001 - 2005
Bachelor's Degree in Management

Professional Skills


  • Strong communication skills (e.g. written, verbal, presentation). Advanced level of English, Portuguese and Spanish
  • Excellent interpersonal, written and oral communication skills are necessary
  • Technical expertise claims resolution skills and knowledge of insurance and claims principles practices and procedures
  • Prior supervisory experience desired
  • High level interpersonal, oral and written communication skills
  • Developed knowledge and skills in Excel (Intermediate level)
  • Prior management experience and the ability to motivate and develop a cohesive team is required

How to write Claim Manager Resume

Claim Manager role is responsible for finance, software, training, litigation, compensation, design, travel, insurance, research, reporting.
To write great resume for claim manager job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Claim Manager Resume

The section contact information is important in your claim manager resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Claim Manager Resume

The section work experience is an essential part of your claim manager resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous claim manager responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular claim manager position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Claim Manager resume experience can include:

  • Gain buy-in from our insureds regarding the direction each claim is taking, develop a strategy of how to best mitigate the potential loss through interaction with the claimant, and making sure that light duty jobs are available for quick return to work
  • Manage the litigation process (if any) and negotiate the settlement of claims seeking the most timely and cost effective resolution
  • Strong understanding of cosmetic development process and skin & Hair knowledge
  • Highly organized, good attention to detail and ability to work within tight deadlines
  • Build and nurture effective relationships internally and externally
  • Experience on projects in the multi-million dollar range

Education on a Claim Manager Resume

Make sure to make education a priority on your claim manager resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claim manager experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Claim Manager Resume

When listing skills on your claim manager resume, remember always to be honest about your level of ability. Include the Skills section after experience. Present the most important skills in your resume, there's a list of typical claim manager skills:

  • Track and improve the performance of your agents using the daily performance report and regularly assess your agents’ skills using the QA scorecard
  • Effectively identify lead coach develop and retain talented claim professionals
  • Experience in reporting, publishing and presenting results (internal and external) and in supporting scientific marketing and regulatory affairs
  • Experience working cross-functionally and building collaborative working relationships
  • Experience in working in cross-functional project teams including marketing, formulation, analytics and regulatory affairs
  • Extensive experience in clinical trial planning and oversight, interacting with clinical investigators and Contract Research Organizations

List of Typical Skills For a Claim Manager Resume

1

Skills For Msla-claim Manager Resume

  • Advanced analytical and problem solving skills with the ability to prioritize and effectively manage multiple priorities
  • Effectively collaborate with CNA's internal and external business partners possessing excellent communications negotiations and presentations skills
  • Superb analytical skills, problem solving and decision making abilities
  • Previous work experience in insurance as claim, underwriter, broker, loss adjuster or captive manager
  • PhD in life science, Pharmacist or MS with at least 10 years of clinical research experience within a dermal/cosmetic field
2

Skills For Manager, Claim Services Resume

  • Entrepreneurial spirit with a “can do” attitude, is able to take initiative and demonstrate a commitment to teamwork
  • Experience /Knowledge of Peer Reviews
  • Understanding of PC functions, including Windows-based applications and ability to learn/understand internal UCM technology
  • Advises reporting staff on claim files and extends settlement authority as necessary after reviewing files
  • Oversees the negotiation of claims settlement including setting reserves, MSA review and approval, and litigation
  • Protect Zurich’s reputation by keeping claims information confidential
3

Skills For Life Claim Case Manager Resume

  • Confirms and evaluates coverage and liability of varying complexity medical, indemnity and liability claims
  • Provide leadership, direction and supervision to a team of Unemployment Insurance Consultants (UIC’s) and other supporting claims personnel
  • Knowledge of risk management principles and insurance markets
  • Able to manage multiple projects with autonomy
  • Reviews claims and provides direction for handling investigation, coverage issues, subrogation, contribution, settlement value, and other procedures. Composes written correspondence including reservation of rights and excess letters and directs use of non-waivers
  • Prepares and presents files to committee for direction and authority on settlement value, coverage issues, potential fraud, liability, no fault, reserves, and other issues
  • Participates on various company committees and handles special projects as requested
4

Skills For PIP Regional Claim Manager Resume

  • Conducts claim file reviews for compliance with corporate claim standards, state and local regulations, and good business practices. Analyzes audit results, develops plan of action, and reviews with unit employees
  • Establishes and maintains factor and specific reserves within authority. Evaluates claim value and grants settlement authority as appropriate
  • Evaluates factual information and the legal environment to determine coverage, liability, and settlement value. Establishes and maintains appropriate reserves within settlement authority, requesting additional authority as needed
  • Manages units responsible for rental file handling, including authorizations, reimbursements, and extensions with vendors, third party administrators, claim offices, agents and customers
  • Manages units responsible for glass and ERS file handling, including authorizations, reimbursements, coverage denial, warranty issues, arbitration lawsuits, subrogation and vehicle inspections
5

Skills For OPC Claim Manager Resume

  • Produces and distributes management reports. Shares results with management and field force. Analyzes reports for trends, compliance, etc. Works with Business Technology on programming changes and enhancements to the centralized support process
  • Manages process, seeking best method for handling rental, ERSand glass expenses and exposures that are good for the customer and company
  • Works with the various vendors, shops, employees and customers in order to stay current on changes in the industry. Handles special projects as directed
  • Develops working relationships with lien holders, financial institutions, Certified Repair Program shops, rental, ERSand glass vendors to find ways to expedite claim processing
  • Manages a group who serves as a liaison between vendors, third party administrators, claim offices, agents and customers to ensure efficient, seamless processes customer satisfaction
  • Experience coaching and leading teams with five or more members
6

Skills For Claim Case Manager, SMD Resume

  • High level of organization and multi-tasking abilities and ability to follow policies and procedures
  • Work in a high volume fast paced claim environment
  • Proficiency in Microsoft Outlook, Access, Word, PowerPoint, and Excel
  • Familiar with DOE applications such as ATS, CAP, SESIS, and FAMIS
  • No Agency e-mails, calls or solicitations accepted
  • Professional insurance qualifications
  • Secures and analyzes necessary information and documentation in the investigation of claims
7

Skills For Crop Claim Manager Resume

  • Works toward the resolution of claims files
  • Coordinates the day-to-day work activities and procedures within the unit. Responsible for performance, development and coaching of staff (i.e., hiring, firing, performance management, salary increases, etc.)
  • Provides training to new members of the team / unit
  • Manage outside legal counsel, vendors and experts as necessary
  • Systems and software proficiency necessary
8

Skills For Scientific Claim Manager Resume

  • Reviews and manages investigations of claims, indemnity and medical management, and file resolution
  • Claim Policy, Procedures, and Strategy
  • Oversees activities within the Claims department. Provides file guidance
  • Receive the loss notification and open the claims process; Evaluate claims and liabilities based on the description of the event and on the policy terms and conditions
  • Investigate and gather information to determine the company’s exposure, with the support of the appointed loss adjuster, if necessary
9

Skills For Eso-casualty Claim Manager Resume

  • Discuss the legal/contractual basis for claims with the Business Unit and Contractor
  • Manage subrogation, if any
  • Legal reviews and investigations as per company policies and procedures for claims
  • Monitor the adequacy of claims reserves throughout the life of the claim

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