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Skills

  • Budgets
  • Fraud detection and prevention
  • Conflict de-escalation techniques
  • Claims resolution and adjudication
  • Detail-oriented documentation review
  • Supervision
  • Mentoring and training teams
  • Relationship development
  • Data-driven decision making
  • Digital document management and archiving

Work Experiences

  • Assisted policyholders within one year.
  • Collaborated with case managers.
  • Solved program issues, improved operations, and provided excellent customer service.
  • Communicated with clients and adjusters.
  • Collaborated with the legal team on complex liability claims, achieving favorable settlements in 62% of dispute cases.
  • Achieved a President's Club for exceeding quality metrics.
  • Coordinated investigation efforts with fraud detection teams, contributing to the recovery of $3 through proven fraudulent claim defenses.
  • Decreased error rates by 61%.
  • Created claim inquiry databases.
  • Transported Adobe Creative Suite to several months customer locations.

Summaries

  • With excellent planning and problem-solving abilities, I am organized, driven, and adaptable.
  • Achieved a 62% reduction in claims processing time.
  • Adaptable Claims Generalist Associate with 15 years of experience.
  • Achieved a 16% reduction in error rates.
  • Adept at collaborating with cross-functional teams.
  • Accomplished Claims Generalist Associate with proven success improving client satisfaction by 26% through effective claims handling processes. Reduced claim processing time from two years to two years per claim via automation.
  • Achieved a 24% increase in claim approval rates.
  • Aiming to advance team collaboration.
  • Achieved a 41% improvement in processing efficiency and accuracy.
  • Experienced initiative Insurance Specialist with a track record of managing large caseloads in high-pressure situations.

Accomplishments

  • Reduced payment processing delays by establishing a stricter timeline for claims adjusters and collaborating with the finance department, decreasing late payments by 73%.
  • Updated claim filing procedures to reflect evolving compliance requirements for procedure, reducing compliance violations by 38%.
  • Implemented an automated queue system to prioritize claim reviews, reducing workload distribution delays and increasing output by 44%.
  • Collaborated with various departments (underwriting, quality control) to optimize interdepartmental communication for quicker claims processing, reducing total turnaround time by 38%.
  • Maintained an exceptional accuracy rate on claims processing, achieving 83% more correct claim resolutions than the team average.
  • Created regular summaries and briefings for upper management, showcasing critical metrics such as claims denied/approved ratios, resulting in better resource allocation.
  • Created a detailed guide for new hires on claims processing protocols and procedures, increasing early-stage efficiency by 67%.
  • Initiated a new procedure for resolving outliers in claims data, enhancing data quality and reducing claim approval errors by 25%.
  • Managed complex claims investigations, including medical claims, resulting in a 64% reduction in fraudulent claims over several months.
  • Reduced the workload of the claims team by 85% through the introduction of automation in document tracking and verification.

Affiliations

  • National Association of Public Insurance Adjusters (NAPIA)
  • Claims and Litigation Management Alliance (CLM)
  • Associate in Claims Designation from The Institutes (AIC)
  • Society for Benefit-Cost Analysis (SBCA)
  • The Southeast Claims Management Association
  • National Underwriter Professional Development Network (PDRN)
  • American Society of Workers' Compensation Professionals (AMCOMP)
  • American Insurance Association (AIA)
  • Georgia Insurance Adjusters Association
  • Project Management Institute

Certifications

  • Chartered Property Casualty Underwriter (CPCU) - The Institutes
  • SHRM Senior Certified Professional (SHRM-SCP)
  • ServSafe
  • Certified Healthcare Insurance Professional (CHIP) – category
  • Certified Professional in Insurance Services (CPII) – initiative
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Business Analysis Professional (CBAP)
  • Associate in Claims (AIC) - method
  • Cisco Certified Network Associate (CCNA)
  • Certified Call Center Manager (CCCM) – system

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