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claims supervisor resume example with 17+ years of experience

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Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Professional Summary

I have been in the Manual Claims for the past 10+ years, and due to my professionalism and determination, I grew withing the claims team. I was promoted to Supervisor and enjoy mentoring my team for growth and development. I also enjoy the reporting I do, as I was given several Analyst task/duties this past year to assist and help in areas needed. I am self motivated and would like to learn more at the analyst level.

Accomplishments


  • Used Microsoft Excel to develop inventory tracking spreadsheets and my teams progress
  • I work with Excel for reporting and documentation. Supervised team of 12 staff members under me.
  • I had taken the pharmacy certification exam and passed, as well as continuing to take the coursed needed to renew.
  • I have tasked with training the offshore team as well as California team processors.
  • I have earned several spot awards for willingness to take on new tasks, as well as maintaining an exceptional attendance record.
Skills
  • Customer Retention
  • Project Requirements
  • Claims Evaluations
  • Proactive and Focused
  • Prioritizing and Planning
  • Claims Understanding
  • Adaptable to Changing Conditions
  • Staff Recruitment and Hiring
  • Self-Motivated and strong work ethic
  • Team Training Oversight
  • Root Cause Analysis / reporting analyst
  • Team Goals and inventory
Work History
06/2021 to Current Claims Supervisor Chubb | Sacramento, CA,
  • Monitored team performance, enforcing compliance with corporate claims processes and procedures.
  • Use problem solving and research to ensure quality and metrics.
  • Determined proper course of action for claims processing.
  • Investigated, evaluated and adjusted multi-line claims in accordance with standards and laws.
  • Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
  • Established and enforced internal controls, workflows and policies for tracking, reconciling and reporting on claim reporting.
  • Recruited, interviewed, hired and trained employees and implemented mentoring program to promote positive feedback and engagement.
  • Support Senior Processors with special projects and additional job duties.
  • Resolved escalated member/client issues and attend meetings to ensure member/client satisfaction
  • Collaborate with other departments to reduce errors and ensure quality and consistency.
  • Oversaw high-volume inventory to ensure metrics and performance guarentees are met.
09/2019 to 06/2021 Senior Claims Representive Community Trust Bancorp, Inc. | Phelps, KY,
  • Act as a mentor/trainer, to other team members and provide processing and training support to the team.
  • Process claims accurately and efficiently be following detailed directives.
  • Work and resolve escalated claim issues though the Service Now tool.
  • Enter loads and data entry/ perform test claims.
  • Communicated effectively with staff members of operations, Account Manager, finance and clinical departments.
  • Acted as SME (subject matter expert), answering internal and external questions and inquiries. Working the inbox and Service Now tasks.
  • Process and review escalated claims that need special handling.
  • Checked documentation for accuracy and validity on updated systems.
02/2009 to 09/2019 Pharmacy Claims Processor OptumRx | City, STATE,
  • Evaluated accuracy and quality of data entered to process pharmacy claims.
  • Followed up with claims that may need a call out for additional information in order to process.
  • Collaborated with department to ensure claims are processed and completed timely. Checking with my direct supervisor to ensure aged claims are worked as a priority.
  • Established positive and trusting relationships with my team. Assisting with special projects and reaching out to the offshore team, as a mentor.
02/2001 to 02/2005 Head Teller Cloverbelt Credit Union | City, STATE,
  • Verified amount of cash in cash drawer against day's receipts, quickly identifying errors.
  • Completed highly accurate, high-volume money counts via both manual and machine-driven approaches.
  • Assisted customers with setting up or closing accounts, completing loan applications and signing up for new services.
  • Replenished ATM funds in empty canisters prior to validation process.
  • Mentored newly hired team members on appropriate responses to patron questions.
  • Identified potential needs through observation, questioning and listening.
  • Provided customers with appropriate literature on banking products and services.
  • Received car loan, home loan and other payments and posted to accounts.
  • Introduced customers to other bank team members to help meet financial needs.
  • Counted, verified and handled bank deposits and armored car transactions.
  • Executed wire transfers, stop payments and account transfers.
  • Established rapport with new clients to increase satisfaction and loyalty.
  • Calculated fees due, interest and change for customer transactions.
  • Balanced bank accounts for members and businesses
Education
Expected in 1980 to to Associate of Science | Marathon County University, Wausau , GPA:
Expected in 06/1977 to to High School Diploma | Wausau East, Wausau, GPA:

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Resume Overview

School Attended

  • Marathon County University
  • Wausau East

Job Titles Held:

  • Claims Supervisor
  • Senior Claims Representive
  • Pharmacy Claims Processor
  • Head Teller

Degrees

  • Associate of Science
  • High School Diploma

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