CLAIMS MANAGER SKILLS, EXPERIENCE, AND JOB REQUIREMENTS

The Claims Manager ensures efficient handling of claims in accordance with legal requirements and CMS standards, specializing in complex regulations for Skilled Nursing Facilities. This role demands a resilient individual who can maintain a positive attitude in a fast-paced environment, managing priorities with precision under pressure. With a strong focus on development, the manager commits to coaching team members, enhancing their capabilities in automated and manual claims processing systems.

Essential Hard and Soft Skills for a Standout Claims Manager Resume
  • Claims Processing
  • Legal Compliance
  • Data Analysis
  • Financial Management
  • Technical Proficiency
  • Reporting
  • Risk Management
  • Regulatory Knowledge
  • Product Knowledge
  • Project Management
  • Effective Communication
  • Problem Solving
  • Leadership
  • Detail Orientation
  • Decision Making
  • Resilience
  • Adaptability
  • Customer Service
  • Time Management
  • Coaching Skills

Summary of Claims Manager Knowledge and Qualifications on Resume

1. BS in Risk Management and Insurance with 5 years of Experience

  • Examples of programs are Opportunity Rex, Business CIPs, Pipeline, Continuous Improvement Lead, Mass Change Lead.
  • Relies on peers for day-to-day tasks and direction on investigations.
  • A basic understanding of SW’s business units, products, Operations, and processes.
  • Working knowledge of the basic functions and benefits of the SW systems (PV, QAD, Batch tracking, Horizon, etc)
  • Completed formal training and can acquire raw data and make recommendations. 
  • Working knowledge of stats, ARC, and Lean.
  • Working knowledge of change leadership skills.
  • Trained, aware of the different social styles, needs little guidance on how to adjust to other styles.
  • Knowledge of Six Sigma Green Belt
  • Program knowledge of Business Objects.

2. BS in Business Administration with 10 years of Experience

  • Have property & casualty claims experience (General Liability, Professional Liability, Pollution Liability, Builder's Risk and Property/Contractors Equipment), particularly with construction defect claims handling.
  • General knowledge and understanding of Construction.
  • Strong knowledge base/experience working with Microsoft Office applications, including Excel, and various claim/risk management applications.
  • Multi-state claims handling experience.
  • Familiar with various state laws/regulations/case laws/statutes affecting Claims.
  • Strong communication skills (written & verbal).
  • Ability to travel to mediations, on-site investigations, etc
  • Demonstrated problem-solving, project, and program management skills.
  • Primarily facilitating program leadership

3. BS in Finance with 5 years of Experience

  • Have claims-related management experience
  • Obtains and maintain appropriate licensing or educational requirements
  • Proficient in Microsoft Office (Word, Excel, Outlook, PowerPoint)
  • Ability to interpret research and opinions to establish claims action plans
  • The high degree of initiative, mature judgment and discretion
  • Must possess effective verbal and written communication skills
  • Solid understanding of Insurance Laws and how they relate to claims
  • Solid understanding of the Insurance Industry
  • Effective leadership skills and customer-focused
  • Ability to work independently, remotely and as a self-starter
  • Capable of consistently handling aggregate file exposures of a least $40,000
  • Understanding of global company knowledge, totality of impact decisions, and leadership abilities
  • Successful completion of one or more professional designations: CPCU, SCLA, PLSC, CCLS, LPCS, AIC, AIM

4. BS in Health Administration with 4 years of Experience

  • Advanced Educational degree
  • Proficient in Insurance Software Programs (i.e. Xactimate, Homeowner Line Insurance programs, other estimating software, etc.)
  • Experience in multi-line adjusting
  • Leadership experience is multiple claims-related specialties
  • A customer-centric mindset, and a passion for helping people and making a difference
  • Previous customer service experience and a high level of computer literacy
  • High levels of self-motivation and enjoy contributing to a team environment
  • Follow all appropriate Federal and State regulatory requirements and guidelines applicable to Health Plan operations

5. BS in Economics with 5 years of Experience

  • Experience handling Cyber, Tech, and/or Media claims as well as other MPL experience
  • Recent experience handling cybersecurity claims
  • Demonstrated ability to work as part of a team, interact with others, meet deadlines, and successfully perform in a fast-paced, changing work environment
  • Excellent communication and interpersonal skills
  • Team-oriented with the ability to excel in a collegial environment but work independently
  • Knowledge of Juris Doctor 
  • Superior negotiation and litigation management skills
  • Strong communication (verbal and written) and interpersonal skills
  • Advanced negotiation skills

6. BS in Accounting with 7 years of Experience

  • Experience typically gained through skills/knowledge/abilities management experience in a managed care or health care environment, managing a minimum of 15 direct reports.
  • Knowledge or experience related to TQM, Process Improvement or Reengineering Methods.
  • Government programs operational experience.
  • Experience in the insurance /legal profession dealing specifically with Financial and/or Professional Lines claims.
  • In-depth understanding of policy language/coverage.
  • Experience managing, evaluating, mediating and negotiating EPLI. 
  • In-depth knowledge of the legal system, civil litigation, and ADR proceedings.
  • Comprehensive understanding and knowledge of federal and state laws applicable to various claims presented under Financial and Professional Lines policies.
  • Strong interpersonal and communication skills, both verbal and written.
  • Experience handling Cyber, Tech, and/or Media claims as well as other MPL experience
  • Ability to wear many hats and work in a fast-paced environment

7. BA in Public Administration with 6 years of Experience

  • Experience leading or managing teams of 8 or more people
  • Experience in listening to customer calls and providing feedback
  • Ability to identify trends and opportunities to enhance the customer or colleague experience and provide recommendations
  • Ability to coach/mentor and build teams effectively and demonstrate interpersonal skills
  • Ability to multi-task and adjust quickly to changing priorities
  • Manage time effectively and ability to work independently (self-starter)
  • Committed to providing superior customer service.
  • Enjoys working with and guiding others in their professional growth and development
  • Knowledge of Human Resource practices and employment policies
  • Champions Change and proficiency using MS Excel, Word, PowerPoint & Visio

8. BA in Legal Studies with 9 years of Experience

  • Experience in support services, projects, or programs
  • Have leadership or supervisory experience
  • Experience working with the technology industry
  • Experience working with company products and operating systems
  • Understanding of claims processing systems
  • Customer Service experience
  • Experience with Microsoft Office
  • Knowledge of the insurance industry, claims and the insurance legal and regulatory environment
  • Negotiation, leadership, coaching, or mentoring experience
  • Experience collaborating across work groups and in line of business 
  • People Management experience

9. BA in Psychology with 2 years of Experience

  • Have management experience in a Managed Care Claims environment.
  • Extensive knowledge of Managed Care claims practices, industry standards and State/ Federal regulations.
  • Extensive knowledge of professional and hospital claims along with billing/coding guidelines.
  • Current CPC License or equivalent, High School Diploma or GED.
  • Completed or are working toward a Chartered Insurance Professional (CIP) designation
  • Excellent communication and interpersonal skills with all levels of staff, and internal and external customers.
  • Experience in coaching and developing staff
  • Ability to collaborate across work groups
  • Excellent communication and analytical skills
  • Team lead of management experience
  • Proficiency in a variety of PC software

10. BS in Risk Management and Insurance with 3 years of Experience

  • Have supervisory experience.
  • Associates in Risk Management (ARM) and Chartered Property Casualty Underwriter (CPCU) or other industry certifications
  • Knowledge of Risk Management Information systems, database analytics, claims trends, methods for allocating risk management costs and setting of reserves for self-insured claims.
  • Proficiency in Windows office 365 (excel, Powerpoint), LPMS, Via one, or Riskonnect
  • Excellent communicator, strategic thinker, trainer, strong organizational skills and cross-functional collaborative team player, government laws and regulations.
  • Experience typically gained through skills/knowledge/abilities managed care experience and/or training or equivalent combination of education and experience.
  • Experience typically gained through skills/knowledge/abilities management experience in a managed care or health care environment.
  • Knowledge or experience related to TQM, Process Improvement, or Reengineering Methods.
  • Government program's operational experience 
  • Management experience in the Manage Care Claims environment.
  • Extensive knowledge of professional and hospital claims.
  • Extensive knowledge of coding, and billing.

11. BS in Business Administration with 4 years of Experience

  • Cognate experience in a reputable organization, especially HMO
  • Progressive management examiner experience within the Workers’ Compensation insurance industry.
  • SIP certificate and working knowledge of budgeting and profit/loss management.
  • Experience with computerized claims management and office systems.
  • Thorough knowledge of related government laws and regulations.
  • Experience in involves management and supervision of claims adjusters
  • Proven leadership and customer service skills
  • Demonstrated ability to lead by example through Intact’s Leadership Success Factors
  • Positive attitude while adapting to changing priorities and taking ownership of work
  • Self-starter with a sense of urgency and the ability to work independently under minimal supervision
  • Demonstrated knowledge of Auto Physical Damage line of business

12. BS in Finance with 4 years of Experience

  • A clinical health care degree and/or graduate degree in law or hospital administration 
  • Experience as a liability claims professional adjuster, defense malpractice attorney or hospital risk manager is necessary. 
  • Supervisory experience  and working knowledge of medical terminology
  • Advanced knowledge and working relationships in risk management, quality management and improvement are helpful.
  • Strong analytical skills are necessary as well as the ability to organize and communicate information both orally and in writing with all levels of the organization.
  • Initiative and the ability to handle responsibility independently are necessary.
  • Ability to meet deadlines and respond to shifting priorities is necessary. 
  • Must be comfortable operating in a collaborative, shared leadership environment.
  • A sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals and values of Trinity Health is essential.
  • Ability to wear many hats and work in a fast-paced environment

13. BS in Health Administration with 8 years of Experience

  • AIC designation and CPCU designation or work towards CPCU ongoing.
  • Have claim adjusting experience and/or management experience.
  • Experience in claim handling procedures, legal issues, policy interpretation and knowledge of judicial system processes.
  • Involvement in claim-related continuing education.
  • Managerial experience with responsibilities in the management of claims professionals and managed care programs
  • Ability to develop and manage quality assurance programs focused on producing superior outcomes in the management of loss costs
  • Ability to strategically develop programs and evaluate the effectiveness of existing programs and make recommendations for improvement
  • Knowledge of business systems, including Microsoft Word, Excel, and PowerPoint with the ability to monitor, measure, track and report on results to senior management
  • Ability to wear many hats and work in a fast-paced environment

14. BS in Economics with 2 years of Experience

  • Major experience in claims management/contracts administration/contract management/quantity surveying discipline in an international project contracting environment
  • Good track record of cost, an extension of time, and insurance claim preparation and settlement
  • Demonstrated knowledge and experience relating to delay analysis techniques and methodologies, calculating and analyzing productivity losses
  • Ability to interpret construction contracts, drawings, and specifications.
  • Good track record of conducting negotiations at a higher management level
  • Solid understanding of project contracts and contract law principles
  • Solid understanding of relevant technical, financial, and cost principles
  • Fluency in written and spoken English and preferable working knowledge of at least one other language.
  • Experience delivering claims management services on major infrastructure projects, preferably rail
  • Experience leading a claims management function is advantageous
  • Strong knowledge of contract law

15. BS in Accounting with 3 years of Experience

  • Fundamental understanding of company claims procedures
  • Strong interpersonal skills (including negotiating and consulting), solid communication skills, both oral & written
  • Professional attitude and customer-service oriented
  • Organized and possess the ability to make quick and sound recommendations.
  • A high-level business understanding of FM Global and a working knowledge of company-based technology are essential. 
  • Must be bilingual
  • Have FM Global experience in loss control and insurance operations or equivalent experience.
  • Experience within another FM Global business segment or equivalent.
  • Experience working as a quantity surveyor on large projects
  • Experience in arbitration and dispute resolution services

16. BA in Public Administration with 2 years of Experience

  • Proficient English (verbal and written)
  • Insurance claims and Healthcare administration background strongly
  • Know medical terminology, CPT, HCPCS, ICD-10
  • Strong computer skills, detail-oriented and interpersonal 
  • Analytical abilities and data entry skills
  • Prior Related Experience and experience in health care claims shop working with CMS1500 and UB04
  • Medicaid and Medicare experience
  • Excellent verbal communication skills, time management, and organizational skills.
  • Requires a high level of attention to detail.
  • Sense of urgency for execution

17. BA in Legal Studies with 5 years of Experience

  • Evaluate policy language and apply it to a claim
  • Utilize face-to-face technology methods in direct response center
  • Interpret and apply customized Insurance policies to real-life situations.
  • Willingness to accept challenges and take on new responsibilities
  • Solid planning & organizational skills including time management and prioritization
  • Analytical skills to identify, gather, and organize information
  • Customer-focused attitude and skills to resolve inquiries quickly and effectively
  • Strong verbal & written communication skills
  • Decisive writing skills are necessary to complete claim reports
  • Authority Target: 75/50 - depending on LOB

18. BA in Psychology with 3 years of Experience

  • Experience in work-related skills and knowledge
  • All Examiners must receive certification that meets the minimum standards of training, experience, and skills
  • Have experience in WCCA and WCCP, CPT and ICD -9 and ICD-10 coding
  • A State Worker's Compensation License is required in some branches.
  • Basic understanding of laws and jurisdictional restraints to manage injuries.
  • Knowledge of PCP, Capitation, Specialty, Ancillary, ER, and Facility claims to process
  • Excellent communication skills both written and verbal
  • Previous background in claims processing
  • Ability to wear many hats and work in a fast-paced environment

19. BS in Risk Management and Insurance with 6 years of Experience

  • Background in the global health insurance market, and be good at administrative services
  • A track record of achieving and exceeding productivity and quality targets
  • Excellent interpersonal, communication, and influencing skills with an emphasis on achieving results and successful outcomes
  • Experience in account managing the whole customer lifecycle
  • Responsible for the entire customer journey and acting as a single point of contact or ‘account manager
  • Learn new skills and adapt to changing work practices, extended hours, demonstrate a willingness to change, etc
  • Effective problem-solving and decision-making skills, using own initiative
  • Must be conversant in both Mandarin and English with a well-written ability
  • Flexible hours, unscheduled overtime, or occasional weekend work
  • Experience with Xactimate Property Software or other property software

20. BS in Business Administration with 5 years of Experience

  • Experience in mortgage default operations
  • Property preservation, REO, and claims experience for FHA, VA, Fannie Mae, and Freddie Mac loans, and asset loans
  • Strong analytical, accounting, and computer skills
  • Strong knowledge of current practices, procedures, and regulations/laws related 
  • Default administration for GSE/HUD/VA, RD, and Conventional mortgage loans
  • Working knowledge of MS Outlook, Word, Excel, PowerPoint, and ability to learn industry-related systems
  • Working knowledge of the Black Knight MSP servicing system
  • Ability to accurately work in a fast-paced environment within tight deadlines
  • Excellent Coaching and Counseling Skills
  • Excellent Verbal and Written Skills
  • Excellent Organizational Skills and Ability to Multi-Task

21. BS in Finance with 3 years of Experience

  • Prior claims management experience with legal expenses
  • A proactive and efficient approach
  • Commitment to developing and coaching others
  • Effective communication skills
  • Ability to work in a fast-paced and challenging claims environment whilst exhibiting a high degree of resilience and a positive can-do attitude
  • Ability to work effectively, to prioritize, and work with efficiency
  • Great attention to detail and ability to work under pressure 
  • Ability to work independently and meet strict deadlines
  • Strong working knowledge of claims processing standards, CMS claims processing requirements and various Medicare fee schedules
  • Knowledge of automated claims processing systems and other complex claim processing rules and regulations, especially for Skilled Nursing Facilities
  • Proficient in processing/auditing claims for Medicare and Medicaid plans

22. BS in Health Administration with 8 years of Experience

  • Supervisory claims management experience in worker's compensation and general liability.
  • Healthcare professional liability experience
  • Strong skills in MS Office (Word, Excel, PowerPoint, and Teams) Working knowledge of RMIS and claims systems.
  • Strong communication skills within all levels of the Company and with partners and vendors.
  • Excellent analytical and problem-solving abilities.
  • Prioritize effectively while meeting deadlines.
  • Ability to work effectively in a team environment.
  • Experience with most insurance classes
  • Personable, proactive and customer-focused
  • A self-starter and the ability to work autonomously
  • Comfortable in a high-volume environment
  • Great computer skills including MS Word and Excel

23. BS in Economics with 2 years of Experience

  • Strong working knowledge of Microsoft Office products including Outlook, Word, Excel, PowerPoint, etc.
  • Strong presentation verbal and written communication skills.
  • Strong time management and organizational skills.
  • Must possess knowledge and experience
  • Independent thinking and decision-making
  • Possess a supportive, responsive, customer service focus with internal and external customers.
  • Progressive management and claims experience.
  • Associate in Claims (AIC) designation.
  • System knowledge of Watson, MES, Product Vision, Discovery, and MES.
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