CLAIMS MANAGER SKILLS, EXPERIENCE, AND JOB REQUIREMENTS

Updated: Nov 20, 2024 - 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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