Supervisor Claims Resume Sample
Marcelino Lesch
936 Lonzo Groves,
Detroit,
MI
+1 (555) 379 7563
Work Experience
Supervisor Claims Manager
11/2017
-
PRESENT
Los Angeles, CA
- Monitors work progress and performance using service operational metrics and observations of staff to ensure and maintain the quality, quantity and time service of work produced by the department within established standards. Develops, implements and monitors quality assurance processes. Prepares and provides reports to management documenting the business results of the department
- Effectively represents the Claims department as a subject matter expert within and outside of the division/operation. Interacts frequently with key external customer and internal stakeholders. Effectively handles escalated issues for team
- Establish and maintain effective training programs
- Develops and demonstrates strong leadership skills in the areas of talent, tactical and strategic vision
- Manages the client implementation process for Manual Claims by documenting and establishing routine procedures for processing claims for new clients
- Coordinates with the Benefit Administration and Implementations teams as needed
- Assist clients (internal and external) in member service and reconciliation
- Supervise, monitor, track and direct day to day operations of staff
- Responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims
Supervisor Claims
08/2013
-
09/2017
Phoenix, AZ
- Maintain scorecard to manage the team's performance
- Coach and / or provide coaching to employees to on identified gaps in quality, performance or new processes
- Identify and develop career goals; assist employee development
- Identify skill development needs associated with career development opportunities
- Plans and distributes workloads to staff on a daily basis to maintain departmental standards
- Holds regularly scheduled staff meetings that are well-planned
- Maintains daily, weekly, monthly and yearly staff production reports
Asst Supervisor Claims
08/2006
-
04/2013
Los Angeles, CA
- Support on going initiatives with the Health Plans or internal projects and provide claims guidance
- Supervising, coaching, and developing claim staff
- Handle escalated claim and customer issues
- Telecommute is only available for current telecommuters who are meeting or exceeding their current metrics
- Assume accountability for ensuring individuals/team meet their performance metric goals, and support / adhere to improvement initiatives
- Supervise, monitor, track and direct day to day operations to staff (Supervisor to staff ratio up to 1:30)
- Assume accountability for ensuring individuals / team meets their performance metric goals, and support / adhere to improvement initiatives
- Provide expertise and/or general claims support to teams in reviewing, researching and processing claims
Education
American InterContinental University - LA Campus
2001 - 2006
Bachelor's Degree in Business
Professional Skills
- Excellent planning, communication, documentation, organization, analytical and problem solving abilities; Medical Terminology or medical billing experience
- Previous claims processing skills
- Managing diverse staff; execute corporate function effectively; ability to communicate professionally and with cultural sensitivity
- Experience analyzing and resolving customer problems in an office setting environment
- Coaching/ mentoring, supervisory, leadership or experience
- Experience managing or leading a team of 10-30 people to achieve high performance in a process driven environment
- Experience analyzing data and spotting trends or gaps that can be used to increase a team's efficiency
How to write Supervisor Claims Resume
Supervisor Claims role is responsible for reporting, research, microsoft, business, travel, insurance, analysis, compensation, integration, training.
To write great resume for supervisor claims job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Supervisor Claims Resume
The section contact information is important in your supervisor claims 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 Supervisor Claims Resume
The section work experience is an essential part of your supervisor claims 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 supervisor claims responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular supervisor claims position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Supervisor Claims resume experience can include:
- Strong process and proven analytical research skills
- Prior Supervisory and / or Team Lead experience
- Build relationships/collaborate at all levels, and effectively work in a virtual team environment
- Three to five years Claims processing experience; Claims processing knowledge required
- Claims experience in an office setting environment
- Health Insurance claims experience, required
Education on a Supervisor Claims Resume
Make sure to make education a priority on your supervisor claims resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your supervisor claims 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 Supervisor Claims Resume
When listing skills on your supervisor claims 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 supervisor claims skills:
- Microsoft PowerPoint experience (basic presentation creation skills)
- Excellent interpersonal communication skills to encourage, coach, support, and provide necessary feedback to agents
- Previous leadership/management skills/experience
- Intermediate skills on Lotus Notes, Microsoft Word, Excel, Power Point
- Communicate (written and orally) and work effectively with others
- Manage time effectively for self and others
List of Typical Experience For a Supervisor Claims Resume
1
Experience For Supervisor, Claims Resume
- Provides explanations and information to all levels of leadership on difficult issues
- Supervises, Coaches, provides feedback, to direct reports
- Participates in the development of short- and long-term goals and plans for his or her work group
- Communicates approved policies and procedures to subordinates and ensures compliance
- Develops them, evaluates their performance, and (when necessary) recommends their discipline and discharge
2
Experience For Supervisor, Claims Audit Resume
- Reviews associate productivity reports
- Maintains records related to work group performance, attendance, expenditures, and so forth
- Prepares or assists in the preparation of related reports
- Assist with the development, implementation and administration of incentive/motivational programs
- Complete all necessary reports to develop trend analysis; maintain daily, weekly, monthly, and yearly staff production reports
- Plan and distribute work loads to staff on a daily basis to maintain departmental standards
- Practice and adhere to regulatory guidelines
3
Experience For Asst Supervisor Claims Resume
- Implement teamwork to effectively involve all staff within the work unit and across the department to ensure integration and acceptance of expansion products within the Fidelis Care New York core business
- Answer questions, explain policies and procedures, share information and encourage use of claims documentation
- Participate in meetings with front line adjustors, leaders or business partners to share, discuss, and solution for question or error trends, as well as potential process improvements
- Conducts individual audits or other reporting by request
- Act as facilitator to resolve conflicts on team; seen as key team member on projects teams spanning more than own function
- Refer claims to investigators for further review
4
Experience For Supervisor Claims CRT Telecommute Resume
- Coordinate and supervise daily / weekly / monthly activities of a team members including setting priorities for the team to ensure task completion and performance goals are met
- Coordinate any claim backlog distribution for regular and overtime work both inter-departmentally and company wide
- Research quality issues and respond to error assessments
- Ensure all business processes are routinely monitored
- Recommend and design, if necessary, process improvements designed to improve accuracy, timeliness of process and/or eliminate manual effort
- Serves as a process expert
5
Experience For Supervisor Claims Manager Resume
- Forecast work effort needed to manage inventory to defined expectations
- Monitor and report production results
- Actively seek out best practices to support established goals
- Life product knowledge
List of Typical Skills For a Supervisor Claims Resume
1
Skills For Supervisor, Claims Resume
- Experience leading or supervising others
- Claims processing, healthcare, customer service, or supervisory/lead experience
- Healthcare medical claims processing experience
- Experience in project management with an understanding of project management methodologies and tools
- Previous experience working within Individual Claims
- UNET or Claims Processing systems experience
- Related work experience in HMO setting
- Experience in a leadership or supervisory role
- Experience as a supervisor or team lead
2
Skills For Supervisor, Claims Audit Resume
- Previous experience in a healthcare industry/role
- Experience in a supervisory role preferably within a production driven environment
- Experience in staff development required
- CSP Facets claims platform experience
- United Healthcare Community & State experience
- Business and / or Process Analyst experience
- Thorough knowledge and experience in enrollment guidelines
- COB, TPL and recovery experience
- Experience with CSP Facets
3
Skills For Asst Supervisor Claims Resume
- Demonstrates and Apply Knowledge of Internal Systems, Policies and Procedures
- Develop positive morale and team atmosphere to enhance employment experience of subordinates and positively impact associate engagement
- .Enhance communication via effective team meetings, huddles, and employee one on ones
- Working knowledge of Commercial, Medicaid and Medicare plans; Working knowledge regarding Coordination of Benefits
- Understanding of a variety of medical claims processing procedures
- Understanding of standard payment rules
- Intermediate proficiency with MS Word (creating documents), Excel (sorting and filtering spreadsheets), Outlook and PowerPoint (creating presentations)
4
Skills For Supervisor Claims CRT Telecommute Resume
- Directly supervises front-line employees; coaching, training, monitoring calls, and conducting performance reviews
- Provide expertise and / or general claims support to teams in reviewing, researching, negotiating, and entering claims
- Handle multiple tasks simultaneously with frequent interruptions, working under deadlines, creative thinking, making decisions based on incomplete information
- Work within the operating hours of the site; and occasional weekend, based on business needs
- Familiar with Health Care Processes involving claims or customer service
5
Skills For Supervisor Claims Manager Resume
- Medical terminology training desired
- Seasoned insurance background with a thorough understanding of life, health, pension, annuity products, agency systems and supplemental distribution sales
- Claims processing knowledge
- Proficiency in Microsoft Office: Excel, Word, Access; Outlook. Facets, Excel, CPT, HCPCS, and ICD-10 Coding
- Thorough knowledge of RBRVS, CPT and ICD-9 coding, HCPC and medical terminology
- Recommends the hiring of subordinates
- Identifies and remediates inefficiencies in current reporting
- Monitor and manage daily inventories to ensure adequate staffing and resources are available
6
Skills For Supervisor, Claims Client Resume
- Subject matter expert for benefit plan and claims processing issues, implementation of new groups and products, and transition meetings
- Report and maintaining inventory volumes
- Review processing results and work with direct reports to remediate roadblocks
- Hours of operation between 6am - 6pm
- Experience with Microsoft Word (creating, editing and saving documents, Excel (creating and editing spreadsheets), Outlook (creating, editing and organizing files)
- Intermediate proficiency in MS Word and Excel (creating documents, editing, merging data in Word; creating spreadsheets, editing, pivot tables, v-lookups in Excel.)
- Experience processing claims on FACETS
- Experience with PBM (Pharmacy Benefit Management)
- Experience with Microsoft Word (creating documents/templates /lists), Microsoft Excel (data entry, sorting/filtering), Microsoft Outlook (send/receive email, create tasks, update calendar, set out of office), and Microsoft PowerPoint (creation and presentation)
7
Skills For Supervisor Claims Crt-telecommute Resume
- Leadership/supervisory experience
- Intermediate proficiency in MS Word and Excel (creating documents, editing, merging data in Word; creating spreadsheets, editing, pivot tables, v - lookups in Excel.)
- Proficient in Microsoft Office Products (Outlook, Word, Excel) - Microsoft Word (create / edit / read documents), Excel (create / edit / read spreadsheets), Outlook (create / edit / read emails)
- Coaching, Supervisory, or Managerial experience
- Experience in inventory management with production and quality goals
- Moderate proficiency with computers and Windows PC applications, which includes the ability to learn new and complex computer system applications
- Proficiency within Microsoft Excel (filter, sort, create and edit spreadsheets)
- Proficiency within Microsoft Word (create and edit documents)
8
Skills For Supervisor, Claims Quality / Claims Audit Resume
- Knowledge of Medicare Part D compliance requirements and regulations
- Intermediate level of proficiency with Microsoft Word, Microsoft Excel, and Microsoft PowerPoint (Microsoft Word - creating and editing word documents), (Microsoft Excel - creating and editing spreadsheets, sorting, and filtering), and Microsoft PowerPoint (creating presentations)
- Knowledge of Medicaid and Medicare policies and regulations required
- Multi-task in a fast pace ever changing environment, this includes ability to understand multiple products and multiple levels of benefits within each product
- Exceptional communication skills with the ability to build key relationships at all levels within the site
- Experience in a claims environment
- Support and mentor peers to advance development opportunities
- Moderate proficiency with a computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
- Moderate proficiency with Microsoft Word (create and edit), Microsoft Excel (formulas, filter, create, edit, and pivot tables), and Microsoft Outlook (create, edit emails, manage calendar, with meeting invites - be able to create and accept)
9
Skills For Supervisor Claims Resume
- Experience managing or leading a team of 10-30 people to achieve high performance in a process driven environment
- In a Supervisory role
- Intermediate in Microsoft Word (create workflows, edit doc's) and Excel (V-look-ups, filters)
- Extensive knowledge of medical and/or hospital claims
- Principles and practices of medical management with emphasis on authorization processes
- Identify to analyze and resolve complex claims issues
- Correctly interpret HMO benefits and contractual provisions
- Handle large volumes of claims
- Meet deadlines and productions standards
10
Skills For Supervisor, Claims Resume
- Experience with Word, Excel & Outlook. Word - Create Correspondence and work within templates. Excel - Data Entry, Sort/filter, work within tables, V Lookups, Pivot Tables, utilize formulas. Outlook - email and calendar management
- Manages performance through assessing strengths and development needs of team members
- Proficiency in Facets, CPT, HCPCS and ICD-10 Coding, required
- Deep knowledge of Claims Processing, required
- Addresses unacceptable performance in a constructive and timely manner
- Supports employee professional development and career goals and provides employee recognition and appreciation
- Proficiency in Microsoft office- Excel, Word, PowerPoint, Outlook required
- Develops plans to meet short-term and long-term objectives
- Supervise, monitor, track and direct day to day operations of staff(Supervisor to staff ration up to 1:30) and hold staff accountable to individual and team metrics
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