Affinity Health Plan - Claims Manager Resume Example

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Professional Summary

Seasoned Manager with more than 10 years of experience in fast-paced claims managed care environment. Excellent proven leadership and troubleshooting skills. Track record of achieving exceptional results in directing and monitoring daily work activities of staff within the Claims Department  and collaborating with interdepartmental Executives, Directors and staff  to achieve organizational goals and standards

Savannah Hughes
XXXX XXXXXXXXX XXXXXX XXX XXX, New York, NY 10027 | (H) XXXXX XXXXXXXX | XXXXXXXXXXXXXXXXXXXXXXX
Skills
  • Proven Leader
  • Troubleshooting
  • Operation Monitoring
  • Critical Thinking
  • Judgment and Decision Making
  • Active Listening
  • Proficiency : FACETS, AMISYS, CLMFACTS, MACESS, ALTRUISTA, CCMS, MS OFFICE WINDOWS 
Experience
Claims Manager 03/2006 to 10/2014
Affinity Health Plan Bronx, NY
  • Directed, managed and evaluated work activities of claims resolution specialists, customer service representatives and production assistants to ensure they followed policies and procedures set forth by the organization.
  • Directed or conducted recruitment, hiring and training of personnel.
  • Developed and monitored the implementation  of revised and new claims and customer service processes.
  • Conducted monthly staff meetings and one:one sessions with direct reports to ensure updates and feedback was promptly and consistently shared.
  • Attended daily meetings to review departmental productivity statistics for each function and outstanding inventory. Staff assignments were determined based upon the outcome.
  • Consulted with other departments within the organization which impacted the optimum performance with the Claims Department. 
  • Maintained communication with executives and department heads by attending meetings and coordinating interdepartmental functioning.
  • Interacted with vendors to assure productivity, quality and overall performance standards and goals were met
  • Reviewed regulatory agency submission materials to ensure timeliness, accuracy, comprehensiveness, or compliance with regulatory standards.
  • Managed the prompt analysis and response to administrative appeals and written claim inquiries,
Supervisor 07/2003 to 03/2006
Healthcare Partners, IPA Garden City, NY
  • Supervised claims analysts to ensure they followed proper adjudication methods.
  • Reviewed daily and weekly inventory, lag and productivity reports with the Claims Director.
  • Addressed and ultimately resolved claims issues which analysts were unable to independently handle.
  • Performed weekly check runs and generation of related reports.
  • Review random and quality audit results to assure staff met organization standards.
Claims Supervisor Elder Plan Inc. Brooklyn, NY
Education
Business Management / Health Information Technology Borough Of Manhattan Community College - New York, NY

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About this resume

Claims Manager FROM New York , New York RESUME

This is a resume for a Claims Manager in New York, New York with experience working for such companies as Affinity Health Plan and Healthcare Partners. The grade for this resume is 0 and is one of hundreds of Claims Manager resumes available on our site for free. Use these resumes as templates to get help creating the best Claims Manager resume.

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School Attended
Borough Of Manhattan Community College