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Skills

  • Fair Isaac Claims Advisor
  • CCC EZNet
  • Relationship building
  • Fraud detection and prevention
  • Emerging coverage
  • Premium financing
  • Microsoft Office Suite
  • Data analysis and reporting
  • Policy coverage expert
  • Cross-functional team collaboration

Work Experiences

  • Conducted fact-gathering interviews with claimants and witnesses.
  • Compiled damage, payment, and policy coverage summaries.
  • Organized method data in order to finish system files.
  • Achieved Excellence Award for meeting performance goals.
  • Ensured that all filed hazard and special hazard claims were properly managed.
  • Worked with the claims department and industry anti-fraud organizations to resolve claims.
  • Completed metric files for the release of insurance claim payment.
  • Evaluated leads obtained through cold calling, lead databases, and direct referrals.
  • Created new initiative applications for departments that work together.
  • Checked the data entered into the agency management system for accuracy and quality.

Summaries

  • Clear understanding of client relations and project management as well as process improvement training.
  • Among his accomplishments is the creation of a framework app for use in the metric industry.
  • Complete knowledge of the claims process and budget management.
  • Criminal investigation, insurance fraud, and surveillance are all part of his background.
  • Senior Embedded Software Engineer with extensive experience in all phases of software development.
  • Licensed Broker with 8 years of experience in auto, home, and life insurance, as well as a track record of customer retention and growth.
  • Reliable and trustworthy.
  • Claims Examiner with extensive experience in the program claims industry.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Claims Examiner with 3 years of successful stakeholder engagement and risk assessment experience.

Accomplishments

  • Facilitated 7 client consultations weekly, providing guidance on policy intricacies, driving a 80% improvement in claim resolution understanding among customers.
  • Provided in-depth analysis and evaluation of 12 high-complexity claims, increasing resolution speed by 24% while adhering to federal regulations.
  • Reduced customer escalations by 36% by piloting a proactive communication strategy within the claims resolution team.
  • Reduced average claims processing time by 30% through the implementation of automation software and optimized workflow strategies.
  • Received PMP in claims fraud detection and partnered with the fraud investigations unit to proactively mitigate risk factors.
  • Expanded book of business for property and casualty insurance for small business owners, and commercial and residential accounts from $5 to $14 million.
  • Integrated a customer feedback mechanism that increased satisfaction ratings by 71% within 3 months.
  • Instrumental in the adoption of a digital claims platform that increased processing efficiency by 47% across operations.
  • Reduced outstanding claims backlog by 46% through the design of a new tracking system, cutting resolution times by 3 days.
  • Led the review of denied claims, reversing 59% of the initial denials, thus improving customer satisfaction and retention.

Affiliations

  • National Auto Insurance Claims Association (NAICA) – Active conference speaker focused on efficiency improvements through claims technology.
  • American Risk and Insurance Association (ARIA) – Contributed to research on advanced statistical methods for claims accuracy improvements.
  • Workers’ Compensation Institute (WCI) – Participated as a speaker discussing streamlined resolution processes using automation.
  • International Insurance Society (IIS) – Joined leadership track in 2019, focusing on global insurance policy and claims processing improvements.
  • National Alliance for Insurance Education and Research – Completed category, which improved high-volume claims processing methods.
  • American Bar Association (ABA) – Attended insurance law workshops to strengthen legal skills in dispute resolution and liability claims.
  • American Society of Safety Professionals
  • Society of Insurance Compliance Professionals (SICP) – Earned Lean, boosting competencies in regulatory compliance in claim management.
  • Council on Litigation Management (CLM) – Published articles on the implementation of technology to fast-track simple claims.
  • Association of Information Technology Professionals

Certifications

  • CompTIA A+ Technician
  • Medicare Claims Review Certification
  • Legal Principles Claims Specialist (LPCS)
  • Method license
  • Certified Professional Coder (CPC) - American Academy of Professional Coders
  • Cisco Certified Network Associate (CCNA)
  • Associate in Reinsurance (ARe)
  • Certified Risk Compliance Professional (CRCP)
  • ServSafe
  • Certified Business Analysis Professional (CBAP)

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