CLAIMS OPERATIONS MANAGER SKILLS, EXPERIENCE, AND JOB REQUIREMENTS
Updated: Nov 20, 2024 - The Claims Operations Manager brings a robust background in managing Call/Contact Centers and collaborating with outsourced service providers, combined with expertise in call center metrics to enhance operational efficiencies. With a strong foundation in Managed Care, this role capitalizes on extensive knowledge of reimbursement methodologies, Claims Auditing Software, and regulatory compliance with CMS and TDI guidelines. Proficiency in communication, alongside a deep understanding of enrollment, eligibility, and utilization review processes, ensures effective management and oversight within healthcare operations.
Essential Hard and Soft Skills for a Standout Claims Operations Manager Resume
- Claims Processing
- Regulatory Compliance
- Data Analysis
- Risk Management
- Insurance Law Knowledge
- Financial Reporting
- Policy Review
- Process Improvement
- Software Proficiency
- Quality Control
- Leadership
- Communication
- Problem Solving
- Decision Making
- Attention to Detail
- Negotiation
- Adaptability
- Team Management
- Strategic Thinking
- Empathy
Summary of Claims Operations Manager Knowledge and Qualifications on Resume
1. BA in Business Administration with 4 years of Experience
- Knowledge of property claims contracts and interpretation of case law
- Knowledge of Xactimate, Xactanalysis and Xact Contents
- Experience handling moderate to complex dwelling and liability claims
- Experience managing Examiner Level claims professionals (complex property)
- Experience with P&C claims leadership and development skills
- Superb interpersonal skills including verbal and written communications
- Strong training, coaching, and mentoring skills
- The ability to work under pressure, meet deadlines and manage expectations in a fast-moving environment.
- Strong commercial awareness.
- Experience in working and implementing change in matrix organization.
- Proven leadership skills and the ability to coach and motivate others.
- The ability to plan and organize, making the best use of time and resources.
2. BA in Finance with 3 years of Experience
- Experience in managing Call/Contact Centres, as well as working with outsourced service providers.
- Experience in call center metrics with the ability to analyze performance and drive through efficiencies.
- Excellent communication skills, written and verbal.
- Experience in a Managed Care environment as a Supervisor, Sr. Claims Analyst, or Claims Coordinator.
- Extensive knowledge of reimbursement methodologies specific to Facility and Professional Claims.
- Extensive knowledge of Claims Auditing Software
- Knowledge of DRG Payment, Grouper/Pricers
- Experience with delegation Oversight (Health Plan, CMS)
- Excellent communication skills
- Knowledge of enrollment, eligibility, and utilization review processes.
- Knowledge of industry standards
- Specific to CMS and TDI.
3. BA in Risk Management and Insurance with 5 years of Experience
- Experience in developing business strategy and executing on transformational changes whilst ensuring that existing business priorities continue to be delivered.
- Ability to influence and collaborate effectively with senior managers and multiple stakeholder groups across the organization to develop and execute change road maps.
- Experience assessing technology solutions and implementing changes / new solutions working in partnership with vendors and internal IT.
- Experience in developing quality monitoring controls that use data to assess claims quality that can be applied down to the business unit and individual claims handler in a scalable way
- Strong analytical skills and comfortable with the use of data to drive business outcomes.
- Experience in delivering a multi-line claims QA program
- Understanding of processes and best practices that provide a robust control framework
- Experience in using/reporting from different audit tools and implementing process improvements.
- Experience in developing best practices that can be applied by claims teams globally using the CAPDAN approach.
- Understand the improvement opportunities identified and be credible with key claims stakeholders & managers.
- A track record of driving continuous business improvement.
- Strong people management skills with an ability to engage and lead a team.
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