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Skills

  • Security systems
  • Project management
  • Supervision
  • Problem resolution
  • Backlog reduction strategies
  • Team management
  • Business operations
  • Fraud identification
  • Process improvement
  • Process improvement strategies

Work Experiences

  • Coordinated vendor services, such as emergency repair, cleaning companies, and contractors, to ensure that customer claims were handled efficiently.
  • Collaborated closely with team members to meet project deadlines, develop solutions, and deliver project requirements.
  • Developed a reputation for punctuality and hard work.
  • Collaborated with insurance adjusters and external stakeholders to support complex claims, reducing dispute resolution time by 15 days.
  • Provided exceptional customer service to all clients by effectively communicating information and actively listening to concerns.
  • Assisted in the creation of process procedures.
  • Achieved highest claims resolution satisfaction rate.
  • Adjudicated claims involving a broad range of issues.
  • Management recognized me for providing outstanding customer service.
  • Worked with others to brainstorm new category possibilities.

Summaries

  • With hands-on experience, eager to learn new skills and advance knowledge.
  • With over 6 years of experience reviewing claims and determining coverage, I am highly trained and successful.
  • Strategic thinker with expertise in client relations.
  • Achieved a 16% reduction in errors.
  • Expert in category with a strong aptitude for spearheaded and streamlined.
  • Proven track record of motivating improved to achieve team, individual, and management goals.
  • Quality assurance in category settings and quality assurance in data analysis settings.
  • Communicative and team-oriented, with HubSpot expertise.
  • Active leader with excellent communication and collaboration skills.
  • ServiceNow and Power BI experts with exceptional interpersonal skills.

Accomplishments

  • Collaborated with legal and external audit teams to address claims escalations, achieving a 35% increase in compliance adherence over the past year.
  • Created a feedback loop between customers and claim adjusters to continuously improve claims handling expectations, resulting in a 46% decrease in recurring claim disputes.
  • Led incident response efforts for high-value claims, successfully negotiating 18 high-stakes settlements and avoiding litigation.
  • Led team training on a new claims management system, elevating accuracy rates and leading to a 36% improvement in claims processing time.
  • Strengthened relationships with insurance carriers, achieving a 18% higher rate of favorable outcomes for complex and disputed claims.
  • Reduced claim dispute escalations by 37% by introducing a new communication protocol between claims adjusters and customers.
  • Designed and led training programs for staff on updated claims policies, resulting in a department-wide compliance boost of 73%.
  • Monitored industry trends and applied findings to reduce average claims processing time by 75%, improving customer satisfaction and operational efficiency.
  • Redesigned claims workflows to integrate with the latest compliance software, enhancing regulatory adherence by 64%.
  • Executed a department-wide audit of claims files, improving regulatory compliance by 80% and reducing potential legal exposure.

Affiliations

  • Licensed Independent Adjuster, Phoenix, 2021
  • Certified Legal Principles Claims Specialist (CLP), 2016
  • Course Completion, Fraud Detection & Prevention in Claims, Tableau, 2016
  • Member, National Association of Insurance Commissioners (NAIC) initiative
  • Member, Society of Claims Law Associates (SCLA), 2019-Present
  • Licensed Claims Adjuster (State), 2018, Chicago
  • Participant, Customer Experience and Claims Resolution Workshop, Ironclad Systems, 2021
  • Member, Risk Management Society (RIMS), 2015-Present
  • Member, Association for Claims Professionals (ACP), 2019-Present
  • Lead Instructor, Customer Claims Resolution Training Seminar, Boston, 2019

Certifications

  • Advanced Open Claims Expert (AOCX) – category
  • Professional Risk Manager (PRM) - metric
  • First Aid/CPR
  • ServSafe
  • Certified Healthcare Financial Professional (CHFP) – process
  • Certified Public Accountant (CPA)
  • Certified Information Privacy Professional (CIPP/US) - International Association of Privacy Professionals
  • Business Process Management Professional (BPMP) – program
  • American Academy of Financial Management (AAFM)
  • Advanced Certification in Commercial Claims – program

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