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Skills

  • Interior water damage background
  • Fair Isaac Claims Advisor
  • Policy development
  • Process improvement
  • Driven
  • Risk Assessment
  • Automated Work Distributor (AWD)
  • Analytical
  • Award-winning sales professional
  • Mediation and conflict resolution

Work Experiences

  • Organized method data in order to finish system files.
  • Checked the data entered into the agency management system for accuracy and quality.
  • Compiled damage, payment, and policy coverage summaries.
  • Used negotiating and problem-solving skills to resolve complaints and grievances.
  • Photographs and statements were examined.
  • Kept track of the status of all open insurance claims.
  • Investigated claims and incident data in order to provide solutions and resolve issues.
  • Mentored a group of 10 new brokers.
  • Was a role model for excellent customer service and diagnostic sales techniques.
  • Achieved a 74% success rate.

Summaries

  • Negotiator and salesperson with a lot of guts.
  • Process are well-understood.
  • Clear understanding of client relations and project management as well as process improvement training.
  • Exceptional communication and team-building abilities.
  • Insurance agent with experience in financial accounting and cost estimation.
  • Provides exceptional customer service to policyholders and handles over 2 caseloads per month.
  • Design and development of successful framework embedded software applications in the past.
  • Complete knowledge of the claims process and budget management.
  • Senior Claims Adjuster with a strong commitment to thoroughly investigating, evaluating, and negotiating process claims on behalf of policyholders.
  • Proven track record of using excellent negotiating skills to speed up settlements.

Accomplishments

  • Integrated a customer feedback mechanism that increased satisfaction ratings by 71% within 3 months.
  • Increased sales 4% over the past year.
  • Successfully investigated and resolved 18 claims discrepancies, preventing payout of fraudulent claims valued at $4.
  • Expanded book of business for property and casualty insurance for small business owners, and commercial and residential accounts from $5 to $14 million.
  • Co-led a technology initiative that integrated Jira, leading to a 64% reduction in manual claims processing errors.
  • Collaborated with cross-functional teams to secure settlements on 14 multimillion-dollar claims with up-to-date knowledge of insurance regulations and policies.
  • Approved policies up to $17.
  • Drove departmental metrics alignment, boosting productivity by 18% and cutting operating costs by $12 annually.
  • Developed comprehensive training on fraud detection and claims procedures, reducing fraudulent payouts by $15 over 2 months.
  • Developed long-term strategies with legal teams to resolve complex disability and workers’ compensation claims following industry best practices.

Affiliations

  • Lions Club
  • Professional Liability Underwriting Society (PLUS) – Member contributing to discussions on risk mitigation in professional liability claims.
  • Freemason
  • American Bar Association (ABA) – Attended insurance law workshops to strengthen legal skills in dispute resolution and liability claims.
  • America's Health Insurance Plans (AHIP) – Completed Six Sigma to enhance claims adjudication and fraud prevention skills.
  • National Association of Insurance Commissioners (NAIC) – Active participant in 2016, focusing on regulatory frameworks and compliance in claims handling.
  • International Association of Administrative Professionals
  • Society of Insurance Research (SIR) – Presented on fraud detection tactics and the implementation of data-driven KPIs in claims departments.
  • Council on Litigation Management (CLM) – Published articles on the implementation of technology to fast-track simple claims.
  • National Council on Compensation Insurance (NCCI) – Certification in workers' compensation claims strategies.

Certifications

  • Method license
  • Health Claims Examiner Certification – American Health Information Management Association (AHIMA)
  • Certified Insurance Data Analyst (CIDA)
  • Associate in Risk Management for Public Entities (ARM-P)
  • Certified Business Analysis Professional (CBAP)
  • Cisco Certified Internetwork Expert (CCIE)
  • Senior Claims Law Associate (SCLA)
  • Certified Public Accountant (CPA)
  • CompTIA Network+
  • Professional in Insurance Fraud (PIF) Certification

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