Claims Supervisor Resume Sample

4.5
7 votes
Marcellus Osinski
22143 Conn Mountain,  Boston, MA
+1 (555) 965 4174

Work Experience


Claims Supervisor
02/2018 - PRESENT
Phoenix, AZ
  • Perform research on questions regarding discrepancies, contract changes, and other issues impacting claims adjudication. Assist Appeals department and Claims Customer Care Leadership in resolving claims Inquiries
  • Works closely with Finance, Information Systems and Provider Relations to ensure that effective work processes are maintained for accurate and timely payment of claims
  • Performs extensive communication, investigation, and visibility with company employees, claimants, attorneys, outside adjusters, industry professionals, witnesses, and any other person(s) relevant to the investigation and evaluation of a given claim
  • Reviews field adjusters’ reports and estimates of damage to evaluate property damage for property losses and subrogation
  • Investigate, evaluates for coverage, liability, reserves and appropriate settlement value for liability, workers’ compensation and subrogation claims
  • Present to large audiences
  • Use exceptional time management and multi-tasking capabilities with consistent follow through to meet deadlines and find mutually beneficial solutions to claim issues
Branch Claims Supervisor
01/2011 - 01/2018
San Francisco, CA
  • Works thru processes, communicate solutions and make recommendations
  • Develop an effective working relationship and collaborate with risk management team and company to accomplish goals
  • Assist with Subrogation Reporting and Data Management
  • Complete the audit of adjusters’ expense accounts in a timely manner
  • Effectively manage claims’ staff in your region, rewarding/reprimanding when necessary
  • Promote the ADMCRS service standards to your adjusting staff.
  • Perform follow-through communication on assigned tasks
  • Supervise, monitor, track and direct day to day operations of staff
Asst Claims Supervisor
05/2008 - 09/2010
Philadelphia, PA
  • Two years’ experience in a claims processing production environment
  • Maintain current resident and non-resident adjuster’s licenses
  • Supervises the claims processing and clerical staff including participating in hiring, development, appraisals, and disciplinary action when necessary
  • Maintain workflow of Claims Department. Assures that the processing of medical and dental claims meets department production and accuracy standards and remains compliant with AHCCCS filing requirements. Assists with training and development of all Claims Department staff along with Claims Manager and Auditor/Trainer/Level IV processors. Represents Claims Department at meetings as assigned
  • Manages the Pend Report and overall inventory. Assists processors in resolving aged pended claims. Review and release interface edits from ICES. With Claims Manager and other UAHP Department Managers, coordinates and prioritizes projects consistent with Health Plan needs
  • Coordinates with UAHN, UMC and all network providers the payment of clams in a timely, efficient manner sharing responsibility for the education of these providers directly and through Network Development
  • Review daily processor audits, with auditor/trainer, evaluating individual production and accuracy of each claims processor
  • Provides back up for claims processors to maintain productivity standards and provider backup for processing of specialty claims such as transplants, hemophilia, and home infusion

Education


John Paul the Great Catholic University
2003 - 2008
Bachelor's Degree in Business

Professional Skills


  • Computer and mouse navigation skills including the use of Windows based applications with strong typing and 10 key skills
  • Five years of claims processing experience, strong communication and organizational skills
  • Demonstrates excellent interpersonal skills to interface with claimants, attorneys, court officers, utility management, employees and co-workers
  • Experience as a Team Lead, Supervisor or Manager with prior coaching, mentoring and goal setting experience
  • Strong writing, technical, editing, drafting and communication skills
  • Work independently; strong analytical, problem solving, research, inquisitive, interpretive and decision making skills
  • Strong case management background, organizational and planning skills

How to write Claims Supervisor Resume

Claims Supervisor role is responsible for interpersonal, leadership, analytical, software, negotiation, claims, organizational, microsoft, insurance, compensation.
To write great resume for claims supervisor job, your resume must include:

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

Contact Information For Claims Supervisor Resume

The section contact information is important in your claims supervisor 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 Claims Supervisor Resume

The section work experience is an essential part of your claims supervisor 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 claims supervisor responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular claims supervisor position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Claims Supervisor resume experience can include:

  • Develop employee’s skills, evaluate performance and provide feedback. Oversees resolution of employee relations issues. Conducts hiring, training, and evaluation of staff
  • Strong leadership and management skills with a demonstrated ability to effectively supervise a team
  • Demonstrate ability to work effectively independently and within a collaborative team oriented environment using sound judgment in decision making
  • Strong verbal and written communication skills; courteous and professional attitude
  • Experience in medical/institutional claims examining within a medical group/IPA setting claims processing experience
  • Experience in medical/institutional claims examining within a medical group/IPA setting claim processing experience

Education on a Claims Supervisor Resume

Make sure to make education a priority on your claims supervisor resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claims supervisor 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 Claims Supervisor Resume

When listing skills on your claims supervisor 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 claims supervisor skills:

  • Demonstrate strong analytical and problem-solving skills with ability to navigate complex situations
  • Demonstrated, Strong Customer Service Skills
  • Be able to work effectively under pressure by prioritizing work activities and re-negotiating deadlines
  • Position requires strong decision-making, leadership and motivational skills
  • Effective leadership, team-building and people development skills
  • Claims management work experience with the management skills necessary to achieve required performance objectives

List of Typical Experience For a Claims Supervisor Resume

1

Experience For General Liability Claims Supervisor Snow Related Claims Resume

  • Demonstrated leadership skills with the ability to motivate others toward success
  • Medicare experience required along with working experience with CMS and government or state programs
  • Mentor and support of team and provide SME support to staff, enhancing leadership skills & staff competency
  • Monitor Supervisor Phone software, and SalesForce, to effectively maintain agreed SLA for phones, and turnaround times for ECL claims
  • Industry experience in Claims processing
  • Claims processing experience required
  • Develop and maintain effective, efficient and respectful working relationships with local Risk Managers, CEO’s and Division leaders
  • Experience in workers compensation insurance industry
  • Hands on Experience in dealership or repair facility
2

Experience For Branch Claims Supervisor Resume

  • Manage prioritized and escalated claim issues
  • Experience in an service operations based role, i.e. Claim, Service, Financial Operations required
  • Proven history of increased responsibility due to high performance
  • Recording and executing scripts/macros on AS-400
  • Assisting with potential fraud case and sanction checking
  • Using data management, identify pend reason trends and perform impact analysis on automation
3

Experience For RCM Claims Supervisor Resume

  • Licensing to adjust claims in multiple states
  • Using data management, monitor individual staff activity for idle time and inconsistencies
  • Working understanding of managed care principles, indemnity insurers, and government insured
  • Manages employees including goal setting, performance planning, feedback, appraisals and development planning
  • Proficiency with Microsoft Excel (sorting, filtering) and Microsoft Word (creating and editing documents)
  • Provide assistance and/or guidance in resolving issues with non-paying insurers for outstanding settlements
  • Provide expertise and / or general claims support to teams in reviewing, researching and processing claims
  • Reduces risk and exposure to the company by overseeing proper claims handling and timeliness of claims processing
  • Assist in building, reviewing and adhering to the annual business plan
4

Experience For Triage Claims Supervisor Resume

  • Responsible for understanding, communicating, and meeting client performance guarantees
  • Supervise, provide direction, and mentor assigned staff, providing feedback on performance and developing/implementing action plans for improvement
  • Creates Training material used by the Team Lead to train all clerks in proper screening and sorting
  • · Enhance staff performance through goal setting, training and coaching
  • Comply with internal and external management reporting requirements, ensuring appropriate & timely production of output
  • Judge escalated issues pertaining to claims processing, provide resolution or defer to others as appropriate
  • Support Annual Enrollment Period activities, including review and updating of any materials
  • Developprocedures, workflows, training and sharing of best practices
5

Experience For Total Loss Claims Supervisor Resume

  • Track volume of Queue and Pending folders to determine productivity levels of the team and staffing requirements
  • Overall management of the Claims Management module in FLEXCARE including: New, Queues and Pending folders.Works in conjunction with other Claims Supervisors
  • Accomplish annual business plans including operating budgets
  • Meet with teams on a regular basis and share responsibility for surfacing and resolving opportunities / issues
  • Develop employees and teams in areas such as project management, meeting facilitation, interviewing, etc
  • Lead the team by assigning workload and providing direction on work related items
6

Experience For Field Claims Supervisor Resume

  • Present to Manager with findings and recommendations for ongoing, long-term resolution of issues; i.e. provider billing issues
  • Work with the team to improve production and quality through training and ongoing education
  • Assists in planning and coordinating daily/monthly cash activities
  • Participate in interviewing and evaluating department applicants
  • Provides adjusting training on Home Depot Quality Standards
7

Experience For Asst Claims Supervisor Resume

  • Negotiate settlement of claim by establishing appropriate negotiation strategy and utilizing available tools and resources within authority limits
  • Ensures claim suspense accounts for accurate claim processing, appropriate financial reporting, and controls
  • Assists in developing and implementing improvement processes
  • Gathers and analyzes trends and provides detailed reporting of claims reporting and monthly financial report
  • Familiarity with medical/hospital coding (CPT, ICD-9, AHA) and standard billing formats (HCFA 1500, UB-92)
  • Ensure claim suspense accounts for accurate claim processing, appropriate financial reporting, and controls
  • Daily monitoring and progression of reserves and payment exceeding adjuster authority levels
8

Experience For Medicaid Claims Supervisor Resume

  • Become subject matter expert in the claims processing system’s functionality
  • Challenge existing practices and develop Innovative solutions
  • Design, evaluate and implement business strategy whilst managing the impact and delivery of change
  • Provide expertise or guidance acting as a referral point for technical and/or procedural queries
  • Manage a portfolio of very complex or significant value claims, or client transactions, with quantum typically exceeding US$10M
  • Ensure productivity, quality handling, budget goals, and related KPI’s are achieved by the unit
  • Develop, educate, and train the staff on policies and procedures. Identify and create written processing guidelines and SOP’s
  • Communicatewith other departments and staff in order to increase understanding, distributeinformation and resolve Claims issues
9

Experience For WC Claims Supervisor Resume

  • Participate in a variety of projects interacting with multiple internal departments and external contacts
  • Develop best practices to optimize claim processing quality
  • Facilitate required claim processing changes with regional operations teams
  • Balance workloads to ensure optimal assignment of projects/reprocessing requests
  • Ensures availability as a resource to the team to assist with problem solving
  • Ensures annual P&P review and updating is completed
10

Experience For Casualty Claims Supervisor Resume

  • Maintain a thorough knowledge of the processing requirements for each Plan’s adjudication rules and industry standards
  • Establish training plan for new hires
  • Manage employee timecards and PTO requests using department guidelines
  • Supervises, coaches, and develops a unit of casualty adjusters involved in handling casualty and property claims
  • Stays abreast of litigation and laws impacting claims
  • Advanced understanding of insurance contracts, claims law, policy provisions, coverages, and exceptions
  • Broad knowledge of the legal and regulatory environments involving claims
  • Direct the training of team members on workflow and contractual modifications expeditiously
  • Ensure team is aligned to and meeting the goals of the business plan

List of Typical Skills For a Claims Supervisor Resume

1

Skills For General Liability Claims Supervisor Snow Related Claims Resume

  • Strong decision making skills are needed to facilitate timely and effective case management decisions and perform administration responsibilities
  • Customer oriented and a team player with good interpersonal skills
  • Solid analytical and risk-assessment skills
  • Strong evaluation and negotiation skills
  • Demonstrated successful customer service skills required
  • Strong leadership, management and motivational skills
  • Effective quantitative, analytical and interpretive skills
2

Skills For Branch Claims Supervisor Resume

  • Strong leadership, management, and motivational skills
  • Experience analyzing data is required (experience analyzing data and spotting trends or gaps that can be used to increase a team's efficiency)
  • Consistently demonstrate sound decision making, judgement, prioritization, and problem solving
  • Medicaid experience required along with working experience with CMS and government or state programs
  • Prior experience managing National Account transaction team
  • Seek, gather and analyze relevant data to address claim processing issues effectively
  • Knowledge, Skills & Abilities: Ability to handle demanding caseload, make independent decisions and multi-task
3

Skills For RCM Claims Supervisor Resume

  • Position requires ability to communicate effectively in both writing and verbally, and conduct meetings and deliver formal presentations
  • Proficient analytical and computer skills
  • Advanced skills in Microsoft Suite, especially Outlook and Excel
  • Develops with litigation, major case strategies and effectively manages litigation costs
  • Able to interact effectively with client, health care providers and brokers
4

Skills For Triage Claims Supervisor Resume

  • Proven experience as a supervisor or similar role
  • Maintain high level of organizational, administrative and clerical skills
  • Multi-task efficiently and effectively, be flexible and have positive attitude
  • Relevant Work Experience: 5years’ of related work experience required
  • Effectively provide direction for the teams
  • Responsible for providing direction, developing, training, and mentoring less experienced claims staff, including completing audits and providing feedback
  • Provides direction, developing, training, and mentoring less experienced claims staff, including completing audits and providing feedback
  • Work experience working with MS Excel (filtering, sorting, editing data, using pivot tables or spreadsheets)
  • Experience with handling casualty claims including the handling of Bodily Injury claims and complex coverage issues
5

Skills For Total Loss Claims Supervisor Resume

  • Experience working with Microsoft Word (creating and editing documents)
  • 6+ months of experience working with Powerpoint - creating basic presentations
  • Experience Supervising or Managing a team in an Operations or Production environment
  • Experience working with Microsoft Excel (filters, create and editing spreadsheets)
  • Demonstrate thorough understanding of LOB placements, markets and internal/external procedures, including TPA's
  • Two to Five years’ experience supervising General and/or Automobile Claims functions and personnel, or
  • Subcontractor subrogation - Manage and monitor the effectiveness of transferring accountability for loss to responsible party
6

Skills For Field Claims Supervisor Resume

  • Experience handling casualty claims
  • Experience in a leadership role, managing staff and processes
  • Claims processing experience within a healthcare environment
  • Work experience using a computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
  • Experience with Health Savings Accounts, Flexible Spending Accounts and Health Reimbursement Arrangements
  • Medical claims processing experience
7

Skills For Asst Claims Supervisor Resume

  • Knowledge of accepted business practices in the mortgage industry and/or strong understanding of claims process for HUD, FHLMC, FNMA and VA
  • Exercise good judgment in business decisions affecting the company
  • Use good judgment in making decisions within scope of authority and handle sensitive issues with tact and diplomacy
  • Experience in dealing with client/customer requests
  • Experience in a medical/institutional claims customer services unit within a health plan medical group or IPA setting
  • Insurance rating experience
  • Experience processing claims in relevant lines of business
  • Experience with Intercompany Arbitration is necessary
  • Be familiar with TPA and BrightView Risk Management Information Systems to establish and maintain effective interface, data management and report generation
8

Skills For Medicaid Claims Supervisor Resume

  • Multi-line adjusting experience
  • Claims handling experience, with extensive knowledge of worker’s compensation regulations
  • Assesses and implements effective employee training and development plans
  • 6+ months of experience working in MS Word - creating & editing documents
  • Experience leading or supervising a team of 15 employees or more
  • Experience as Team Lead, Supervisor, or Manager of a team of 15-25 members processing insurance or healthcare claims
  • Experience with MS Excel working with formulas, pivot tables and graphs
  • Experience as Team Lead, Supervisor, or Manager of a team of 10-20 people in office or clerical environment
9

Skills For WC Claims Supervisor Resume

  • Work experience in an office environment
  • Claims experience in a health insurance environment
  • Leadership or project management experience require
  • Experience with claim forms
  • Good command of spoken and written English Language, Bahasa Malaysia and Mandarin. Ability to speak in local Chinese dialects is an added advantage
10

Skills For Casualty Claims Supervisor Resume

  • Sound knowledge of health insurance principles and practice, allied with a strong work ethic
  • Experience in workers compensation insurance industry
  • Valid adjuster’s license in appropriate jurisdictions or ability to obtain such, if required by subordinate position
  • Related claim experience required
  • Any experience in a leadership role such as coach, mentor, supervisor, trainer, quality analyst

List of Typical Responsibilities For a Claims Supervisor Resume

1

Responsibilities For General Liability Claims Supervisor Snow Related Claims Resume

  • Strong leadership ability with proven capability to train, mentor, and develop subordinates
  • Effectively participate in settlement negotiations, mediations, arbitrations and trials as required for optimal outcomes
  • Effectively communicate with appropriate internal and external teams on all issues to obtain a resolution
  • Good understanding of managed care insurance, patient accounting activities for professional billing, referral and claims processing network and benefits
  • Experience analyzing and solving customer problems in an office setting environment
2

Responsibilities For Branch Claims Supervisor Resume

  • Direct supervision of processing staff, including the daily management and coordination of individual efforts, assignments, and priorities to meet all metrics
  • Develop and maintain positive, effective working relationships with associates at all levels across all departments
  • Coaching, Supervisory, or Managerial experience
  • Upervisory / leadership / training experience
  • Experience handling simple to complex to catastrophic claims
  • In supervisory capacity, including Lead role; or six months supervisory experience within Pacific Medical Centers
3

Responsibilities For RCM Claims Supervisor Resume

  • A good knowledge of the legal and regulatory environments involving claims
  • Claims experience
  • Strong knowledge of claims environment including reserving, loss development, industry trends and P&C line of business expertise
  • Actively participate in committees or task forces as assigned which call for claims input and experience
  • Work on multiple assignments simultaneously, prioritize work and complete projects within established timeframes
  • Drives and monitors high performance standards and service guarantees. Maintains a skilled, competent and motivated work force
  • QNXT experience, required
  • Evaluate staff skill sets
4

Responsibilities For Triage Claims Supervisor Resume

  • · Conduct quality review of all claims prior to submission
  • Strong knowledge of all job-related functions of subordinates
  • Working with manager, conducts trend and competitive analysis focused on identifying process improvement opportunities
  • Ensuring that claims are managed efficiently and professionally in accordance with Company’s’ guidelines and standards
  • Responsible for conducting performance appraisals and recommending salary and personnel actions, including promotions and terminations
5

Responsibilities For Total Loss Claims Supervisor Resume

  • Institutes process improvements regarding the handling of homeowner claims, and ensures consistent application of handling processes and procedures
  • Acts as subject matter expert for homeowner claims, applying expertise in working collaboratively with other departments on projects
  • Examines claim files to determine if proper investigation, evaluation, reserving, negotiation and settlement techniques and procedures are being followed
  • Assists the Unit Manager in formulating performance goals for the claims team and evaluating performance
  • Develop procedures, workflows, training and sharing of best practices
  • Directsandmonitors the follow-up and resolution of provider concerns regarding claims processing
6

Responsibilities For Field Claims Supervisor Resume

  • Conveys policiesandprocedures to Claim Examiners and Senior Claim Examiners by having periodic meetings and/or by distributing memorandums
  • Claims Examiner hiring, training and development
  • Nevada Hearing License or the Ability to Obtain Nevada Hearing license within 90 days
  • Communicates administrative policies and operating procedures, and conveys policy and procedural changes
  • Monitors workloads and reviews claims to ensure high quality processing and service levels
  • Reviews and approves claim files exceeding settlement authority of staff
  • Daily partnering with offshore counterparts to manage inventory real time
7

Responsibilities For Asst Claims Supervisor Resume

  • Assigns claims to staff or independent adjusters based on staffing levels, claim volume, type of claim and adjuster expertise
  • Advises staff on questions of coverage, immunity, liability, reserving, strategy and claim value
  • Selects defense and coverage counsel and is a key component in managing the litigation process
  • Handles claim files based on staffing levels, claim volume and expertise
  • Communicate with other departments and staff in order to increase understanding, distribute information and resolve Claims issues
8

Responsibilities For Medicaid Claims Supervisor Resume

  • Provides supervision to the claims processing unit and assigned staff
  • Monthly meeting with each assigned employee to review status
  • Plansandcoordinates the workload, productivity and quality of the assigned claims staff and makes decisions on matters requiring immediate attention
  • Reviews pending report to ensure claims are resolved within a timely manner
  • Reviews provider contracts to determine appropriate processing method
  • Copies and distributes contracts to claims examiners with any necessary instructions to ensure consistent and appropriate processing
  • Assists Provider Operations Coordinator with provider phone calls and written correspondence regarding claims issues on a daily basis
9

Responsibilities For WC Claims Supervisor Resume

  • Manage the claims reporting process and practice for work comp, general liability, auto liability
  • Administer TPA to ensure expeditious adjuster assignment, adequate investigation, appropriate reserve setting and payment in accordance to best practice
  • Administer all TPA accounting related functions
  • Support Director of Risk Management in the handling of all other claims e.g. Pollution and Property
  • Review team's work results and pattern of handling claims queues and adjustments
10

Responsibilities For Casualty Claims Supervisor Resume

  • Partner with supervisors to ensure teams are meeting production and quality metrics
  • Play a leadership role by implementing action plans to increase quality and productivity
  • Provide frequent formal and informal coaching sessions with supervisors
  • Work with supervisors to create a performance improvement / development plan that focuses on increasing job competency
  • Systematic problem solving – evaluates processes and systems; identify trouble spots and develop solutions or alternative routes to solve problems
  • Negotiate directly with insured, claimants or counsel in settling losses
  • Assist set up unit in review of new claim reports and assigns to appropriate Claim Representative with handling instructions
  • Participate in implementation of new clients, represent department during both internal and external meetings
  • Oversight of claims testing activities

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