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Skills

  • Leadership in cross-functional teams
  • MS Office
  • Problem resolution
  • Insurance Mediation Expertise
  • Attention to Detail in Claims Documentation
  • First-call Resolution
  • Team leadership and development
  • Metric equipment
  • Team management
  • Auto Claims Adjusting for Healthcare

Work Experiences

  • Achieved customer satisfaction scores of 83% or higher.
  • Achieved customer satisfaction scores of 70% or higher by attentively handling complex claims and providing clear communication throughout the claim lifecycle.
  • Assisted in the resolution of disputed claims.
  • Solved category issues, improved operations, and provided excellent customer service.
  • Achieved successful settlements in 55% of cases.
  • Achieved a 40% rise in claims satisfaction rates.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Assumed full ownership of the claims adjustment process, from investigation to resolution, contributing to a 28% improvement in the overall closure rate in several months.
  • Collaborated with internal audit teams.
  • Achieved a 81% reduction in unresolved disputes.

Summaries

  • Consistently drove a 77% reduction in claim resolution times.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the framework business.
  • Addressed claim escalations.
  • Achieved a 73% success rate in favorable resolutions.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Senior Claims Service Adjuster with exceptional customer service, time management, and service coordination skills.
  • Achieved 40% or higher customer satisfaction scores.
  • Boosted transparency within the organization.
  • Avoided costly fines.
  • Recognized on a regular basis for outstanding performance and contributions to the Healthcare industry's success.

Accomplishments

  • Managed a portfolio of 10 high-value claims, successfully recovering over $5 in settlements within three years.
  • Spearheaded initiatives to review underinsured property claims, boosting reserves by $16 while ensuring compliance with policy coverages.
  • Managed detailed documentation, setting the foundation for litigation success, reaching favorable judgments in 66% of cases.
  • Identified and resolved system bottlenecks through root cause analysis, improving claims throughput by 32% over 6 months.
  • Enhanced operational efficiency by developing a new claims tracking system, decreasing turnaround time by 54%.
  • Led the resolution of 8 complex claims, contributing to a departmental success rate of 69% in 2020.
  • Partnered with IT to customize claims software, cutting processing times by 21% and enhancing user interface for the adjusters.
  • Achieved 31% compliance with regulatory standards by conducting internal audits and ensuring timely enforcement of policies.
  • Spearheaded negotiations on 16 disputed claims, leading to settlements that saved the company over $4.
  • Improved team claims handling performance metrics by 51% through rigorous training and process enhancements.

Affiliations

  • Certified Insurance Fraud Specialist (CIFS)
  • American Adjusters Association (AAA) Volunteer Group
  • Lions Club
  • American Bar Association - Tort Trial and Insurance Practice Section (TIPS)
  • Society of Women Engineers
  • Society for Human Resource Management (SHRM) – Insurance Section
  • Association of Claims Executives (ACE)
  • National Association of Professional Insurance Adjusters (NAPIA)
  • Local Chamber of Commerce Insurance Committee standard
  • Risk and Insurance Management Society (RIMS)

Certifications

  • Google Certified Professional Cloud Architect
  • Fraud Claims Law Specialist (FCLS)
  • Cisco Certified Network Associate (CCNA)
  • ISO Claims Outcome Advisor (COA) Certification
  • Certified Negotiation Expert (CNE) for Insurance Adjusters
  • QuickBooks Certified for Insurance Adjusters
  • Insurance Data Management Association (IDMA) Certification
  • Associate in Risk Management (ARM)
  • Project Management Professional (PMP)
  • Certified Casualty Claim Adjuster (CCCA)

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