Claims Manager Resume Sample
Naomie Williamson
50758 Odell Plaza,
Detroit,
MI
+1 (555) 579 0719
Work Experience
Claims Manager
10/2017
-
PRESENT
Phoenix, AZ
- Multi-line claim background with knowledge of CGL, Auto, Property and Workers’ compensation claims management experience
- Coordinates investigation firm and/or attorneys in their investigation of PCR’s claims and lawsuits
- Sequesters all evidence on PCR’s, claims, and lawsuits
- Obtains information relative to Answers to interrogatories, Requests for Admissions, Motions to compel, Requests for Production, subpoenas, and any other legal documentation regarding PCE’s, claims and/or lawsuits
- Works closely with Director relating to communication with patients, families, visitors, etc. to negotiate early resolution of PCR’s within the direction of HCII
- Review medical records and/or any hospital documentation relative to a request by a third party and review the request for legal authenticity with Director’s approval
- Communicates with the employee health/injury coordinator and other appropriate individuals within the facility for follow-up and action on worker’s compensation claims and employee safety issues. Works with the employee health/injury coordinator to coordinate identification, evaluation and trending of risk exposures
- Individual Leadership: Demonstrates confidence in own skills, knowledge and ability and opportunities for personal growth and ability to accept and adapt change
- Tracks monthly/quarterly/YTD Summary Reports by broker as activity for UNFI to customers and suppliers process to ensure 100% of suppliers have COI’s that meet UNFI standards
Senior Claims Manager
10/2012
-
05/2017
Boston, MA
- Communicates and resolves complaints via telephone and email from insured’s or their representatives, agents, adjusters, examiners, contractors, etc.,
- Compile, analyze, present and interpret financial and statistical information
- Proven ability to organize and manage time in order to meet time-sensitive deadlines
- Exemplary professional and tactful negotiation and persuasion skills
- Develops strategic, operational and tactical business plans to achieve desired business goals for responsible units
- Reviews and directs service operation performance to meet or exceed business goals
- Builds and maintains collaborative relationships and alliances with internal and external customers including but not limited to Employer and Provider Groups, Members, Marketing, Finance and Client Services IT and Compliance to achieve business goals
- Meets regularly with internal partners to determine service requirements and expectations for overall satisfaction
Global Claims Manager
05/2008
-
09/2012
Houston, TX
- Provides reporting and project support to management as needed
- Recruits, attracts, develops, motivates and manages a high caliber of talent
- Fosters confidence and trust with client base
- Understand and manage expense budget, as well as the incremental per unit costs associated with production environments
- Identifies and implements process improvements on multiple systems or units within the business unit
- Maintains a positive work environment that supports self-directed teams; provides a structure to optimize the experience, skill, knowledge and capability of the teams
- Rewards employees based on contribution and performance
Education
Strayer University - Orlando East Campus
2003 - 2007
Bachelor's Degree in Business
Professional Skills
- Strong computer skills and ability to navigate multiple applications, including strong Microsoft Office skills for Excel, Word, PowerPoint and Outlook
- Experience in an environment that requires strong analytical and communication skills
- Able to apply natural curiosity, utilize excellent investigative skills, demonstrate initiative, motivate self and work with little or no supervision
- Excellent analytical, problem solving, time management and decision making skills
- Excellent Microsoft Office, presentation, MS Visio, MS Excel, P6 & MS planning tool skills
- Excellent PC skills (Excel, Word, Power Point)
- Demonstrate sound judgment and reasoning skills necessary to manage claims
How to write Claims Manager Resume
Claims Manager role is responsible for analytical, leadership, claims, microsoft, interpersonal, technical, excel, analysis, reporting, organizational.
To write great resume for claims manager job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Claims Manager Resume
The section contact information is important in your claims manager 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
- Telephone number
Work Experience in Your Claims Manager Resume
The section work experience is an essential part of your claims manager 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 manager 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 manager position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Claims Manager resume experience can include:
- Strong, analytical, problem-solving and decision-making skills; ability to exercise good judgment
- Strong Strong data analysis skills and ability to utilize data to drive results
- Experience in effectively following up on recommendations from technical claims adults and continuous file handling improvement
- Manage Claims Team to ensure that claims are being prioritized and handled effectively and efficiently
- Excellent communication and interpersonal skills and a positive attitude
- Handle multiple tasks and deadlines Strong organizational and task completion skills
Education on a Claims Manager Resume
Make sure to make education a priority on your claims manager resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your claims manager 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 Manager Resume
When listing skills on your claims manager 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 manager skills:
- Able to apply excellent written and oral communication skills, listen actively, express opinions effectively and convey information appropriately
- Able to utilize excellent interpersonal skills to deal effectively with differences in people
- Excellent communication skills required to effectively articulate complex issues to colleagues, business leaders and external stakeholders
- Superior problem solving and analytical skills, balanced with strong decision making abilities (experience with data analysis an asset)
- Strong leadership and management skills and direct supervisory experience. Ability to motivate and lead others to achieve individual and team objectives
- Excellent Leadership and good communication skills are essential
List of Typical Experience For a Claims Manager Resume
1
Experience For Senior Claims Manager Resume
- Excellent communication skills in English both verbal / written
- Excellent technical skills and knowledge of claims
- Demonstrated experience in operations support role in development of creative solutions to operating challenges
- Computer proficiency in Microsoft Office (Word, Excel suite skills and PowerPoint)
- Collaborate and communicate effectively at all levels of the organization and with external partners
- Advanced analytical skills, with the ability to exercise self-direction and initiative, and make decisions in a fast paced changing work environment
- Effectively interview and hire prospective Claims Associates
- Prioritize and coordinate claims processing, fact finding, liability determination, fraud investigation, payment processing and settlement
2
Experience For Group Claims Manager Resume
- Flexibility for meeting multiple demands and ability to utilize and effective time management planning process
- Claims experience adjudicating first party property and time element claims, including at least 3 years in a Claims Supervisory capacity
- Recent residential mortgage servicing experience as a team manager/supervisor
- Experience working with banner and corporate senior management
- Experience in facilitating successful claim cost containment programs
- Oversee an effective and appropriate cascade of relevant information to team members, including business strategy and objectives
- Strong independent judgment and decision making required
- Claims or functional area experience
3
Experience For Global Claims Manager Resume
- Computer proficiency in all Microsoft Office products with a strong emphasis on Excel
- Monitors case loads and assignments to ensure appropriate and effective case loads
- Demonstrated ability to realize company cost containment opportunities
- Experience of working in the Middle East, preferably within the Kingdom of Saudi Arabia,
- Strong team player in a multinational and cross-functional team
- Demonstrated ability to work independently, and in conjunction with team members at all levels of the organization
- Demonstrated ability to think strategically, and execute operationally and tactically
- Lead operational activity of the department, manage and prioritize own and departmental workloads in accordance with local target requirements
4
Experience For Assistant Claims Manager Resume
- Build and maintain a positive and supportive team environment that encourages staff motivation and effectiveness
- Claim avoidance and defence experience in managing complex construction claims in EPC/ EPCM environment
- Experience conducting contract compliance audits
- Manage changing priorities in a fast-paced environment and ensure deadlines are met
- Strong personal presence to interface with top management of other businesses, representing Lockton in the highest professional manner
- Demonstrated understanding of when to proceed alone and when to involve other Lockton Associates
- Proven ability to handle management issues including, but not limited to, Associates, projects and resources
5
Experience For Bodily Injury Claims Manager Resume
- Strong Understanding of personal and commercial insurance risk management concepts and when they are useful to clients
- Responsible for maintaining good records and retention of documents in accordance with Alstom retention policy
- Managing team including; workload and resource allocation, providing technical oversight, coaching and development
- Maintaining necessary reporting and controls across the team and managing litigation strategy on largest/complex claims
- Supporting underwriting teams and partners in connection with claim trends, marketing and business development and retention activities
- Driving continuous improvement and learning in the Claims team and actively supporting short- and long-term improvement initiatives
- Managing and training group of 4-6 individual contributors handling cyber/technology/media and Insurance Agent broker claims
- Administering and servicing own portfolio of clients’ claims
- Analysing and interpreting multi line report data on Excel to target efficiencies and improvements
6
Experience For Branch Claims Manager Resume
- Working with Accounting Services to accrue for WIP and forecast performance over a 12 month period
- Managing senior customers/stakeholders within the business and understanding how the wider operation relates to the Claims Department
- Monitoring of claim reserves and case administration for entire book of claims, including settlement and reserve strategies
- Ensuring full compliance with all stipulated global and local operating protocols, procedures and policies, service standards and regulatory compliance
- Understanding of alternative dispute resolution techniques
- Managing escalations or technical referrals from the POD structure through both a regular case drop in session and a referral process
- Working knowledge of Windows applications, general computer hardware and software and Microsoft Office Suite
- Working knowledge of business and financial acumen
7
Experience For Casualty Claims Manager Resume
- Partnering with key distribution partners and accounts to establish Claims’ value and service proposition
- Handling financial and professional lines primary and excess claims
- Working knowledge of quota share treaties
- Handling of claims and recoveries for Dry and Reefer cargo
- Broadening internal/external stakeholder communication where required, as (LOB) technical claims expert and thought leader
- Responsible for requesting, creating/preparing, updating/revising, reviewing, testing, finalizing/approving, conduct training
- Coordinates interdepartmental communications on property claim processing and reimbursements, including resulting accounting treatment
- Review and understand incoming documentation distributing & tracking as necessary
- Understand and ensure adherence to Human Resource policies, integrating and developing tactical solutions for managing absence levels and performance issues
8
Experience For Specialty Claims Manager Resume
- Oversee daily operation of Specialty Department, including total responsibility for managing the department’s operating budget
- To ensure the pricing and underwriting teams fully understand the effect of a client’s claims practices and philosophies on risk assessment and pricing
- Manages and directs staff, supporting professional growth by providing education, training and appropriate resources
- Applied working knowledge of claims adjusting and handling best practices; general knowledge of crop market trends
- Performs periodic review of existing claims to provide adjuster guidance in the handling of a claim
- Assists City Attorneys with the handling of litigated claims including active participation in mediation and settlement negotiations
- Conduct performance evaluations, facilitate technical and career development training and assist with on-boarding new colleagues
- Responsible to identify and provide developmental opportunities through coaching and mentoring
- Either holds Diploma Life and Disability Claims or willing to work towards achieving it
9
Experience For Subrogation Claims Manager Resume
- Maintain a positive work environment for direct management reporting staff, ranging from 5-7, with line staff of up to 200
- Works with various departments, including Human Resources, Legal and Accounting along with Sr. Director on high profile cases to resolve/mitigate damages
- Monitor need for supplemental training needs on an ongoing basis
- Provide planning and direction to the daily operations of the coding and clinical staff
- Serve as SME to staff for all coding inquiries with ability to provide resolution based on industry standard coding guidelines and references
- Maintain a high-quality relationship with policyholders, associations and agents by maintaining frequent contact and being responsive to their needs
- Partners with Tarkett internal teams (sales, customer service, marketing, quality, technical services) to acquire information resulting in settlement of claims
- Investigate significant resident events, collaborating with internal departments, as appropriate, while ensuring confidentiality and attorney/client privilege
- Assist in identifying current and/or potential billing issues
10
Experience For Field Claims Manager Resume
- Responsible for assisting safety department, accounting, or administrative functions as they relate to claims and incidents
- Participate in compiling exposure data and completing applications required for the Company’s various insurance policy renewals
- Assist Director in managing our Company’s Subcontractor Insurance tracking process
- Assist and update Underwriting, Brokers, Risk Managers and Reinsurers in their queries as to specific claims or claim handling for Cyber/Tech claims
- Direct TPA audit process and guidelines including managing annual contract negotiations
- Ensures claims processing is consistent with applicable policies, regulations, procedures and department guidelines for assigned area(s) of responsibility
- Develop and implement programs to improve claim reporting accountability so Keystone’s risk can be measured
- In-depth knowledge of workers’ compensation claims handling process
List of Typical Skills For a Claims Manager Resume
1
Skills For Senior Claims Manager Resume
- Proven leadership and problem-solving skills, including resolving unusual and complex internal and external issues
- Demonstrable negotiating skills, tactful and effective handling of internal/external stakeholders
- Demonstrated high analytical and problem-solving skills, including research and investigation
- Demonstrated strong relationship-building, partnering, negotiating and influencing abilities
- Manage a field claims team by setting expectations and goals, leading training to develop technical claims skills and communicating with adjusters
- Experience in coding and demonstrated knowledge in the principles and practices of ICD-9 / ICD-10 and CPT coding
- Experience in health claims processing with 2+ years experience directly managing people
2
Skills For Group Claims Manager Resume
- Serves as clinical resource to staff, exercising considerable judgment, problem solving skills, and professional knowledge
- Demonstrates a solid understanding of insurance law as it relates to claims
- Represent the City through strong and effective negotiations while maintaining the City's high customer service standard
- Law graduate with proven legal experience in shipping and/or logistics
- Relevant work experience, including supervisory experience
- Extensive prior experience in managing a claims team
- Experience in handling claims across Italy with good relationships with local counsel and adjusters
- Able to work independently with sound decision making skills
- Critical thinking skills to build efficiencies and automation
3
Skills For Global Claims Manager Resume
- Working experience in customer services / insurance industry, preferable with experience in individual health / employee benefits
- Organizational, planning and conflict management skills
- Effectively manage one’s own time and the time of others
- Influence claims and non -claims stakeholders to effectively direct claims strategy
- Management experience with 5+ years of claims management experience
- Be able to effectively coach, mentor and develop team members
- Effectively implement and maintain processes and workflows to meet the needs of internal and external customers
4
Skills For Assistant Claims Manager Resume
- Proven strong track record in team management
- Understanding of strategy and ability to implement effective tactical plans and governance structures
- Experience of writing market presentations, developing client specifications and tendering insurance programmes within demanding timescales
- Experience drafting change order requests or other claims for amounts in excess of $50MM, including development of supporting documentation
- Experience in owning and driving user acceptance testing and business adoption
- Experience coaching, mentoring and providing feedback
- Experience in Property/Casualty insurance claims handling with a focus on managing and overseeing TPAs, preferably in the Program space
- Passionate about delivering an outstanding customer experience
- Good at managing upwards and keeping senior management appraised
5
Skills For Bodily Injury Claims Manager Resume
- Solid understanding of commercial property/casualty TPA & personal insurance claims handling
- Seven or more years experience in Casualty claims, including supervision and handling of large, complex cases
- Experience using a variety of automated claims processing systems
- Experience having worked in health plan or HMO setting ideal
- Strong background in adjusting/supervising claims
- Strong understanding of claims processing and the construction business
6
Skills For Branch Claims Manager Resume
- Skill in developing training modules relevant to the company’s business operations
- Claims experience working in the Workers’ Compensation field & 3-5 years working with TPA’s
- Solid understanding of Insurance Laws and how they relate to claims
- Develop excellent working relationships with a variety of internal and external stakeholders
- Good knowledge and understanding of Insurance Claims division or Insurance Industry
- Excellent customer service focus, including the ability to manage potentially contentious interactions
- Strong knowledge & understanding of insurance market and clients in country
- Able to respond well to changing priorities and react flexibly
7
Skills For Casualty Claims Manager Resume
- Able to demonstrate an extensive knowledge of the policies and procedures associated with claim handling processes
- Skilled in working with various Risk Management Information Systems to document claim activity and maintenance of a claim diary system
- Prioritize and complete multiple, competing tasks
- Experience managing budgets, process improvement, and quality assurance
- Experience in coding
8
Skills For Specialty Claims Manager Resume
- Senior level supervisory / managerial experience in medical claims and coding
- Experience in training work comp, Mod projections and verification of Mod rates
- Excellent problem solving and data analysis ability
- Experience in handling Property Treaty Reinsurance claims would be beneficial
- Experience with working within a Claims environment
- Experience in a leadership role, managing staff and processes
9
Skills For Subrogation Claims Manager Resume
- Proven understanding of construction/risk management industry
- Experience in Medical Claims Processing
- Florida 520 or 620 All-Lines Adjusters’ License in good standing
- Work under deadline pressures and handling multiple priorities
- Eight years experience in healthcare and/or operational analysis including the business process improvement discipline
- Establish and maintain effective working relationships with federal, state and local officials and employees
- Experience managing a combination of in house and virtual staff
- Qualified solicitor with private practice experience and a current practising certificate
- Claims experience preferably within a broking or reinsurance / direct claim environment
10
Skills For Field Claims Manager Resume
- Good understanding of policies, contracts and the commercial aspects
- Experience in handling reinsurance/direct claims, both proportional and non-proportional
- Casualty claims administration and risk management experience at or for or supporting the claims function for an institution of higher education
- Work independently and demonstration of strong work ethic and multitasking abilities
- Experience in handling motor hull, personal accident and health claims beneficial
List of Typical Responsibilities For a Claims Manager Resume
1
Responsibilities For Senior Claims Manager Resume
- Review field claims of $100,000; effectively resolve escalated claims issues
- Thoroughly understanding the claims recovery model to ensure the team and wider department operate in a lean, efficient and complaint manner
- Develop, recommend and implement strategic programs and procedures that encourage customer loyalty, company profitability and cost effective productivity
- Establish strong relationships with counterparts of Client and Contractor
- Conducting briefings and meetings with insureds’ legal advisors
- Work with underwriters supporting policy construction and drafting, reporting claim trends, data analysis, and risk assessments
- Audit adjuster expense vouchers by performing random field audits and tracking individual adjuster activity
- Develop, present and follow through with adjuster training and presentations; assist in the development of field training presentations
- Develops and provides onsite training related to workers’ compensation
2
Responsibilities For Group Claims Manager Resume
- Able to process mapping and evaluate metrics to continuously improve results
- Judge escalated issues affecting direct reports, provide resolution or escalate further
- Develop and lead the claim avoidance and defense management strategies, protecting Kinder Morgan’s commercial interests
- To have a goal orientated and highly tactical mind-set when handling complex and sometimes confrontational relationships
- Develops and recommends global claim processes, monitoring compliance of same
- Develops and provides training as needed throughout the organization
- Prepares claims data for semi-annual actuarial analysis and works with accounting to resolve differences
- Monitors and ensures departmental claim processing controls for SOX compliance related to insurance reserves
3
Responsibilities For Global Claims Manager Resume
- Accountability for day to day operations including inventory management and quality
- Serve as SME during implementation initiatives to ensure project deliverables and milestones are met
- Represent Claim Department during internal/external presentations
- 5) Perform quarterly and yearly review of claim reserves with Corporate Accounting and Actuary
- Analyze claim data and provide detailed claims reporting, technical disposition and acceptance letters
- Provide trend reporting by product type, plant and issue
4
Responsibilities For Assistant Claims Manager Resume
- Prepares and issues monthly report cards to vendors outlining their overall performance and level of compliance with
- Create new claims entries and update all open/ongoing claim events in Sunrise’s proprietary claims database
- Sets and creates alignment and buy-in within the operation on key success factors and goals, ensuring objectives align to broader claims functional goals
- Compile data such as loss runs from the TPA’s risk system, company information and other sources for quarterly and ad hoc Risk Management status reports
- Develops and maintains project-specific Workers’ Compensation claims manual and related processes and procedures. Implements improvements based on lessons learned, legislative changes or Court decisions, and client operating imperatives
- Assists with subcontractor CCIP enrollment and provides workers’ compensation orientation to subcontractors
- Provides leadership to a team of field representatives who conduct physical inspections of damaged automobiles. Responsible for ensuring team member compliance with state regulations. Through strong performance management practices, provides feedback, coaching and skill/knowledge development to respective team members
- Experience in leading field representatives
- 520 or 620 All-Lines Adjusters’ License with the State of Florida
5
Responsibilities For Bodily Injury Claims Manager Resume
- Help develop and execute the strategies of the client
- Promote and foster Willis Towers Watson culture
- Manage the appropriate level of resources available
- Be a visible sign of professionalism and direction for the client and team
- Participate in meetings and provide ideas and strategies that strengthen the practice
- Ensures and enables staff to maintain a connection with the customer by understanding and meeting their needs; serves the customer with empathy; and follows up to ensure that customer needs have been met
- Build trust, gain support and influence others
6
Responsibilities For Branch Claims Manager Resume
- Travel at 50% of time
- Utilizes data to analyze workers’ compensation and general liability claim costs, trends and cost savings resulting from claim management processes and services. Designs or modifies cost management initiatives in response to data results
- Prepare and present executive ready presentations
- Outstanding interpersonal skills to effectively establish and maintain effective business relationships at all levels of the company and in the business community
- Proven ability for team management and strong leadership, including ability to implement efficient work processes, problem prevention identification and resolution skills
- Comply with regulations and requirements
- Manage and increase the effectiveness and efficiency of Client Services through improvements to each function as well as coordination and communication between support and business functions
7
Responsibilities For Casualty Claims Manager Resume
- Increase the effectiveness and efficiency of Client Services through improvements to each function (Processing, Reporting, Analysis, Audits and Team building) as well as coordination and communication between functions
- Auditing of external subrogation vendors and TPA’s
- Comply with Medicaid regulations and requirements
- Ensure team performance meets quality & timeliness thresholds stipulated by client agreements, internal guidelines & regulatory authorities
- Monitor individual and team workloads, reallocate across resources as necessary, to achieve productivity targets
- Act as referral point for complicated and contentious claims or issues, maintain oversight, and delegate or deploy resources as necessary
- Lead and/or contribute to recruitment process
8
Responsibilities For Specialty Claims Manager Resume
- Contribute to and manage the impact and delivery of change
- Supporting the Head of Claims and Insurance by delivering against an agreed performance target through effectively managing a team of skilled lawyers in the Claims team and maximising recoverable claims
- Analysing performance across various areas of business and evaluating whether there is scope for a more effective operating model in respect of legal claims work
- Working alongside a Claims Business Partner to ensure instances of damage are reported into the team promptly and that all referred work is reviewed and pursued in an efficient manner
- Confidently presenting claims data and discussing large opportunities with a range of customers from non-legal backgrounds
- Providing technical claims / evidential training to the wider business, predominantly systems and reporting to field operations. Also from time to time supporting with training including Customer Services / Complaints, H&S, Wayleave, Street Works etc
9
Responsibilities For Subrogation Claims Manager Resume
- Travelling, where required, in support of claims activity (maximum one day a week out of the office)
- Recognizes opportunities for technical and industry training as part of a personal and professional development program
- Handles and directs resolution of problems, complaints and general public relation ('customer service') issues which arise concerning claims service
- To oversee the on-going development of RGA UK’s claims philosophy
- Interact with Safety Department, Legal, Risk, Accounting, Human Resources, Operational supervisors and management
- Responsible for salary administration recommendations that are directly linked to individual performance
- Utilizes technology and talent management to increase efficiency and scalability to support corporate growth and service initiatives
10
Responsibilities For Field Claims Manager Resume
- Oversee the operational and technical work of the team and implement claim handling best practices to coordinate consistent handling of our company’s largest exposure claims
- Work with employees on performance management by setting cascading goals, giving and receiving feedback, documenting and delivering performance reviews, addressing performance issues, creating and implementing development plans while conforming to policies and other internal procedures
- Actively participate in interview and selection of new personnel and assist with other staffing decisions
- Direct resolution of problems, complaints, and general public relation issues which arise concerning claims service
- Maintain current knowledge of changes in respective area and help develop and implement policies and procedures which impact claims processing
- Owns the development and performance of the Non-Complex Bodily Injury operation or multiple smaller operations; applying functional operating principles to remove barriers to success. Continuously develops talent by creating opportunities for direct reports to grow and strengthen new skills
- Strong leadership skills; ability to work with minimal direction/supervision
- Excellent interpersonal skills and the ability to interact with clients and employees at all levels
- Proven ability to effectively delegate tasks as appropriate
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