Sean Hayes
Goshen,OH
Summary
Dynamic Senior Claim Specialist with extensive experience in managing complex insurance claims and fostering team collaboration. Known for strong customer relationship management and conflict resolution skills, contributing to improved claim resolution rates and enhanced client satisfaction.
Overview
1
1
Certification
22
22
years of professional experience
Work History
Senior Claim Specialist
Great American Insurance Group - Trucking Division
Cincinnati, Ohio
04.2004 - 08.2026
- Manage litigation with coverage and defense firms across the United States
- Processed complex insurance claims for diverse policyholders, ensuring accuracy and compliance.
- Collaborated with underwriters to assess risk factors and determine claim eligibility, enhancing accuracy in claims processing.
- Determined liability, compensability, and benefits due on each claim.
- Monitored compliance with applicable laws, regulations, and policies related to insurance claims processing.
- Analyzed claims data trends to identify process improvement opportunities, contributing to streamlined operations.
- Analyzed claim trends and patterns to identify potential fraud or abuse.
- Created reports detailing the status of outstanding claims for management review.
- Processed payments accurately and efficiently according to established guidelines.
- Resolved customer inquiries in a timely manner, while maintaining high levels of customer service.
- Communicated with clients to clarify claim details and resolve inquiries.
- Guided junior staff on best practices for effective claims handling.
- Trained new employees on claims management systems and procedures.
- Established relationships with external stakeholders, including medical providers and attorneys, to facilitate timely resolution of outstanding claims.
- Reviewed medical records for accuracy and completeness according to established guidelines.
Education
Bachelor of Arts - Communications
University of Cincinnati
Cincinnati, OH05-1988
Skills
- Regulatory compliance
- Legal compliance
- Risk assessment
- Fraud analysis
- Declaratory Judgment, 1st and 3rd party litigation experience
- Customer relationship management
- Team collaboration
- Conflict resolution
Certification
- CPCU designation
Timeline
Senior Claim Specialist
Great American Insurance Group - Trucking Division
04.2004 - 08.2026
Bachelor of Arts - Communications
University of Cincinnati