Claims Manager Resume Examples

Managed the Commercial and Medicaid/Medicare projects with issues due to the turn over to Managed Medicare and Medicaid.

Successfully managed team of 30 geographically separated employees, with an oversight of Physical Damage and Rental Operations in the Mid-Atlantic and Northeast states.

Responsible for $100 million dollar property casualty claims operation

Led team of 3 supervisors, 20 adjusters, 1 nurse and 1 claims evaluator in the proper settlement of bodily injury claims. Managed processing of high-exposure and litigation claims with $100K in payment authority. Oversaw the budgeting, salary administration and expense control of the department.

Manage all aspects of the claims and customer service area for clients supported in the Seattle Office.

Created and maintained accurate claim procedures and claims processing by federal regulations.

Reduced casualty claims corporate wide from $1.4 million to $17 thousand through contract compliance, negotiations, monitoring of TPA’s, creating cost allocation mechanism for reimbursement of casualty claims which reduced the overall net claim cost’s

Managed all Personal and Commercial line claims

Responsible for resolution of benefit claims from VISA-USA and VISA-Latin America cardholders.

Established long term customer relationships through prompt and courteous service.

Served as Administrative Manager for a group of 250 non-exempt employees

Oversaw 30 employees in 2 offices, 3,000 files, and $1B in reserves. Led strategic direction of claim settlements, continuous improvement processes, hiring, performance evaluations, budget management, and relations with multiple business partners. Conducted claim services issue resolution, surplus line program management, workers’ compensation loss portfolio transfers, and guaranteed-cost reinsurance programs.

Leveraged 17+ years in high value sales, HR, client services, training, team management and lifecycle management of property, liability, injury and high-risk claims. Requested by upper management to undergo advanced training in administration of property insurance claims < 30 days of hire. Oversaw 8 Claims Associates (6 Inside Reps, 2 Property Field Claim Reps). Utilized academic and “real world” HR experience to recruit, interview, hire, mentor and continuously work with staff to improve knowledge and skill-set.

Developed off-boarding procedures within compliance to corporate, state and federal requirements. Worked with a diverse range of clients in garnering relevant data, verifying investigating and settling claims within established guidelines. Prepared supporting files to all incidents including photos, police reports, damage estimates, subsequent financial and legal findings. Led successful negotiations for adjustment of losses.

Key Accomplishments

Advanced through positions of increased responsibility to manage liability for commercial and personal lines, Workers’ Compensation cases, and litigation issues for 2 states with ~800,000 PIF, as well as bad faith litigation for all coverage lines. Handled mediation and arbitration for litigated claims; provided trial authority and served as expert witness. Administered $6M annual litigation budget. Communicated regularly with state Departments of Insurance to coordinate regulatory issues. Led branch audits to ensure compliance and recommend improvements; served as liability and litigation SME for Branch Claims Managers. Designated company representative for audit of Oklahoma Insurance Guaranty Fund. As Branch Claims Manager, oversaw Auto and Commercial Liability, as well as Workers’ Compensation for Oklahoma and litigated claims. Managed 36-member team and $3M budget.
Selected accomplishments:

Accepted and reviewed property and auto damage claims from our clients, hh Gregg, General Electric, Home Depot, Room and Board, and Brandsmart

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The first claims manager for merged corporation, expected to have over 1,000 WC claims totaling $12 million in loss costs. Accountable for workers compensation, “toxic tort” liability, product liability claims including medical products, general liability and class action suits. Served as the litigation manager for national and international claims. Analyze data identifying trends in claims and costs and delivered monthly reports to senior management.

Relevant Accomplishments

Corporate Claims Manager for this multi million dollar light industrial staffing company with 1000 – 3000 employees assigned from 25 branch locations nationally.

Processed workers compensation documents and ensured employee received proper medical attention in accordance with California and twelve additional states workers compensation regulations. Worked with supervisors and injured workers to coordinate their return to work as directed by physician. Maintained the injured workers return to work policy and safety prize program. Maintained individual clients OSHA logs. Coordinated quarterly loss run meetings with the third party administrator (TPA) to review open claims. High deductible plan

Worked with clients; providing updates on injured workers, Certificate of Insurance, personal protective equipment, and much more. Worked with the sales team; researching potential clients to identify appropriate National Council on Compensation Insurance (NCCI) code.

Selected Accomplishments:

Direct the Workers’ Compensation Commercial Claims Office for Northern California

Drafted claims strategy according to Zurich global practices

Managed a cross-function department responsible for Medicare reimbursements, hospital and physician accounts receivable issues, large claims with billed charges greater than $35,000, and dental pre-authorizations. Created teamwork within the department, audited claims to resolve claim disputes, open line of communication, provided tools and resources, wrote and implemented policies and procedures, developed individual performance improvement plans, managed within a budget, utilized management reports to achieve target objectives, hired and terminated employees.

Managed small staff of adjusters for company’s work comp self-insurance and wrap around coverage in multiple states.

Primary responsibilities include the management of staff for the timely and accurate processing of claims in accordance with contracted prisons/jails and provider network, as well as monitoring the provider relations telephone lines and correspondence, and weekly Company check run for providers.

Major Accomplishments:

Processed an average of 30-50 property and injury claims weekly