How to Be Claims Manager - Job Description, Skills, and Interview Questions

Nov 20, 2020 / 5 Minutes Read / By Albert

How to Become

Professional Organizations

FAQ

Links

The role of a Claims Manager is both demanding and rewarding. They are responsible for managing the process of reviewing, resolving, and settling claims made against an organization or government entity. This involves investigating and evaluating the facts of the case and making decisions about the validity of the claim, amount of compensation to be paid, and ensuring the timely resolution of claims.

The successful management of claims by the Claims Manager can have a significant impact on the financial stability and reputation of the organization, as well as providing a sense of satisfaction that comes from successfully resolving complex legal disputes. Poorly managed claims can result in financial losses, legal battles, and negative publicity, all of which can have a damaging effect on the organization's bottom line.

Steps How to Become

Obtain a Bachelor's Degree. In order to become a claims manager, you will need to have a minimum of a bachelor's degree in a related field such as business administration, finance or accounting.
Consider Pursuing a Master's Degree. Although not a requirement for becoming a claims manager, obtaining a master's degree in a related field may give you an edge in the job market.
Gain Work Experience. Most employers require a claims manager to have at least three to five years of related work experience. Some employers may require more depending on the size and complexity of the organization. This work experience may include working as a claims adjuster, customer service representative or insurance investigator.
Obtain Professional Certifications. Many employers prefer to hire claims managers who have professional certifications such as Associate in Claims (AIC) or Chartered Property Casualty Underwriter (CPCU).
Learn About the Company. Before you apply for the job, do your research and learn as much as you can about the company. This will help you with the interview process and make you stand out from other applicants.
Apply for the Job. Once you're ready, start applying for jobs that match your qualifications and experience. Pay attention to details and make sure your application is complete and accurate.
Prepare for the Interview. Make sure you prepare for the job interview by reviewing potential questions and preparing answers. It's also important to look professional and be confident during the interview.
Start Your Career. Once you have secured the job, start your career as a claims manager. You will need to build your knowledge and skills to effectively manage the claims process. This may include attending seminars and taking continuing education courses.

In order to remain updated and capable as a Claims Manager, it is necessary to devote time to staying abreast of changing regulations, industry trends, and technological advances. Staying current on these topics is essential to ensure that claims are processed quickly and efficiently while also ensuring compliance with laws and regulations. Furthermore, utilizing new technologies and developing an understanding of data analytics can help Claims Managers make well-informed decisions on risk assessment and management.

Finally, building relationships with adjusters, carriers, and other industry professionals can help Claims Managers keep up to date on the latest developments in the insurance industry. By taking the time to stay informed and invest in the necessary skills, Claims Managers can become more agile and capable in their roles.

You may want to check Insurance Consultant, Underwriting Technician, and Claims Examiner for alternative.

Job Description

Develop and implement claims management policies and procedures.
Monitor and review claims processing to ensure accuracy and compliance with laws, regulations, and policies.
Ensure timely investigation, evaluation, and resolution of claims.
Negotiate settlements and prepare litigation when necessary.
Manage communication with claimants, attorneys, and other parties involved in the claims process.
Analyze and audit claims data for trends and anomalies.
Manage external vendors and consultants as needed.
Maintain an in-depth knowledge of applicable laws and regulations pertaining to claims management.
Perform risk management functions to minimize potential losses.
Prepare reports and presentations for management.

Skills and Competencies to Have

Strong understanding of legal principles and processes related to claims management.
Excellent organizational and analytical skills.
Ability to communicate effectively with all levels of personnel.
Knowledge of insurance and risk management principles and practices.
Ability to exercise sound judgment when making decisions.
Ability to work independently with minimal supervision.
Proficiency in the use of computers, including database management and word processing programs.
Excellent problem solving and conflict resolution skills.
Strong customer service skills.
Ability to work under tight deadlines and handle multiple tasks simultaneously.

Claims management is a critical skill that all professionals in the insurance industry must possess. Effective claims management requires an in-depth understanding of the legal process, an understanding of customer needs, and the ability to effectively coordinate between various stakeholders. It is essential to ensure that the customer receives the best possible outcome in terms of coverage and compensation.

Claims managers must also be able to identify potential fraud, keep up to date on current laws and regulations, and have strong communication and negotiation skills. Negotiating settlements with claimants and insurers can be a challenging task, and a claims manager must be able to successfully navigate these negotiations to obtain a satisfactory result. Claims managers must also be able to effectively manage the documentation and paperwork associated with each claim, as well as the financial aspects of each claim.

Without effective claims management, insurance companies will be unable to provide their customers with the coverage and compensation they deserve.

Insurance Claims Adjuster, Insurance Loss Control Specialist, and Underwriting Assistant are related jobs you may like.

Frequent Interview Questions

What experience do you have with claims management?
How would you rate your organizational and time management skills?
What strategies have you employed to reduce claim costs?
Describe a difficult claim you had to manage and how you overcame it.
How do you maintain accurate and up-to-date records of claims?
What is your experience with customer service and dealing with clients?
How would you handle a dispute between a customer and an insurer?
What challenges do you anticipate in this role?
What methods do you use to stay current with industry trends and developments?
Describe your experience with auditing and assessing claims for accuracy and compliance.

Common Tools in Industry

Case Management Software. This software allows claims managers to track and manage cases, set timelines, assign tasks, and store related documents. (eg: Zendesk)
Document Management System. This software helps claims managers to organize, store, and access documents related to claims. (eg: SharePoint)
Analytics Software. This software allows claims managers to identify trends in claims data and determine the root cause of certain claims. (eg: Tableau)
Cloud Storage. This software enables claims managers to store and share large files securely over the internet. (eg: Dropbox)
Video Conferencing Software. This software allows claims managers to communicate with stakeholders remotely. (eg: Zoom)
Automation Software. This software automates repetitive tasks, allowing claims managers to focus on more important tasks. (eg: Zapier)

Professional Organizations to Know

American Association of Claims Management (AACM)
National Association of Professional Insurance Agents (PIA)
Professional Liability Underwriting Society (PLUS)
Risk and Insurance Management Society (RIMS)
Chartered Institute of Loss Adjusters (CILA)
International Association of Claims Professionals (IACP)
National Association of Independent Insurance Adjusters (NAIIA)
International Insurance Institute (III)
International Risk Management Institute (IRMI)
American Society of Employers (ASE)

We also have Insurance Coverage Attorney, Claims Processor, and Insurance Program Manager jobs reports.

Common Important Terms

Liability. The legal responsibility of an individual or organization to pay for damage caused to another individual or organization.
Coverage. The insurance that covers the risk of a person or organization being held liable or financially responsible for an event.
Deductible. The amount of money an insured party must pay out-of-pocket before the insurance company will cover any of the remaining costs.
Claim Form. A form used to submit a claim to an insurance company.
Claim Adjuster. An individual who evaluates and processes insurance claims, often working with claimants to resolve disputes.
Claim Settlement. The resolution of an insurance claim in which the insurer agrees to provide payment or other compensation to the claimant.
Fraud Detection. The process of identifying fraudulent activities by assessing submitted claims to determine if they are valid and properly documented.
Litigation Support. The assistance given by legal professionals to help insurance companies protect their interests in court proceedings.

Frequently Asked Questions

Q1: What is Claims Manager? A1: Claims Manager is an online platform that provides businesses with automation and streamlined processes for managing claims, tracking payments and monitoring financial performance. Q2: What type of entities can use Claims Manager? A2: Claims Manager can be used by insurers, brokers, and other financial service providers. Q3: What are the benefits of using Claims Manager? A3: Claims Manager provides businesses with automated processes, improved accuracy, better visibility into data, and streamlined operations. Q4: How many users can Claims Manager accommodate? A4: Claims Manager can accommodate up to 1,000 users. Q5: What type of financial data can Claims Manager track? A5: Claims Manager can track claims data, payment data, and other financial metrics such as revenue, profitability, and costs.