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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims adjudication, team coordination, and regulatory compliance while providing technical guidance and training to ensure high-quality service delivery. Strong ability to analyze management reports and resolve complex claims issues effectively.
Highest-signal resume keywords
Claims Handling ExperienceTeam CoordinationRegulatory ComplianceTechnical GuidancePerformance Management
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AdjudicationQuality ReviewDocumentationManagement ReportingTraining and Coaching
Soft Skills
Interpersonal SkillsCommunication SkillsAttention to DetailOrganizational Skills
Tools & Technologies
MS Office SuiteExcelWordPowerPoint
Certifications & Qualifications
Professional Certifications
Industry Keywords
Claims ManagementRegulatory StandardsService DeliveryCustomer Expectations
About the role
Key responsibilities & impact- Responsible for coordinating the day to day activities of a team of claims employees
- Monitors team member’s workload, provides training, and monitors individual claim activities
- Provides technical/jurisdictional direction to reports on claims adjudication
- Ensures team members have the needed training and are in compliance with regulatory and company standards
- Responsible for the direction of the claims team to ensure consistent delivery of services that meet or exceed customer expectations and complies with regulatory and company standards
- Provides technical guidance to team members
- Resolves complaints, problems, and coverage questions
- Participates in management related duties including performance management, recruitment and selection of new hires
- Provides ongoing training and coaching to team members
- Ensures all receive communication of corporate/department policies and procedures
- Complies, reviews and analyzes management reports and takes appropriate action
- Performs quality review on claims in compliance with audit requirements, service contract requirements, and quality standards
- Ensures claim files are coded correctly and adequate documentation is made
Requirements
What you’ll need- Excellent interpersonal skills
- Ability to communicate technical and complex topics in a way that is understandable to those less experienced
- Strong aptitude for understanding technical solutions and learning/utilizing tools
- Intermediate knowledge of MS Office Suite (Excel, Word and PowerPoint)
- Strong attention to detail and organization
- Five years of claims handling experience
- Bachelor’s degree in related discipline
- A combination of education and experience may be accepted in lieu of a degree
- Professional certifications as applicable
Benefits
Comp & perks- Hybrid availability
- 401(k) with company match
- Health insurance
- Paid time off, holidays
- Volunteer time off
- Lifestyle Spending Account (LSA)
- Paternity leave
- Growth opportunities