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Skills

  • Process improvement strategies
  • Problem resolution
  • CCTV
  • Operational improvement
  • Backlog reduction strategies
  • Time management and prioritization
  • MS Office
  • Security systems
  • Relationship development
  • Planning and coordination

Work Experiences

  • Management recognized me for providing outstanding customer service.
  • Developed a reputation for punctuality and hard work.
  • Achieved results over 18 months.
  • Coordinated vendor services, such as emergency repair, cleaning companies, and contractors, to ensure that customer claims were handled efficiently.
  • Worked with others to brainstorm new category possibilities.
  • Achieved an average customer satisfaction rating of 33%.
  • Answered 11 phone calls per 6 months to assist customers.
  • Kept my standard knowledge up to date by doing stakeholder engagement and strategic planning.
  • Authored operational guidelines for the team.
  • Achieved a 77% improvement in claims response satisfaction.

Summaries

  • ServiceNow and Power BI experts with exceptional interpersonal skills.
  • Senior Customer Claims Representative with more than 8 years of experience working for insurance companies with a strategic mindset.
  • Adept Senior Customer Claims Representative.
  • Framework, program, and procedure are all available.
  • Results-oriented Healthcare professional with project management, vendor management, and quality assurance strengths.
  • Adaptable Senior Customer Claims Representative.
  • Ability to recognize procedure issues and integrate method solutions to achieve procedure.
  • Achieved performance goals.
  • Student pursuing a Healthcare degree who is eager to contribute developed knowledge in the role of Senior Customer Claims Representative.
  • Achieved a 15% customer satisfaction rating.

Accomplishments

  • Delivered comprehensive customer service training that increased claim resolution accuracy and achieved a customer satisfaction rate of 30%.
  • Implemented a real-time data analytics solution to streamline claims assessments, leading to improved claims accuracy and a 62% reduction in disputes.
  • Performed trend analysis on historical claims data, proactively addressing common causes of delays, leading to a 35% increase in claims processing speed.
  • Strengthened relationships with insurance carriers, achieving a 18% higher rate of favorable outcomes for complex and disputed claims.
  • Led incident response efforts for high-value claims, successfully negotiating 18 high-stakes settlements and avoiding litigation.
  • Designed and led training programs for staff on updated claims policies, resulting in a department-wide compliance boost of 73%.
  • Coordinated closely with external regulatory bodies, ensuring that all claims were processed within compliance guidelines, reducing regulatory infractions by 15%.
  • Worked closely with third-party vendors and external stakeholders to identify claims management bottlenecks, reducing disputed claim resolution time by 8 days.
  • Developed a continuous process improvement initiative focused on claims accuracy, resulting in fewer rejected claims and a 54% boost in overall claim validity.
  • Streamlined reporting workflows with external auditors, resulting in a 50% faster claims verification process.

Affiliations

  • Graduate, Advanced Leadership Course for Claims Managers, Brightline, 2021
  • Certified Legal Principles Claims Specialist (CLP), 2016
  • Licensed Independent Adjuster, Phoenix, 2021
  • Participant, Customer Experience and Claims Resolution Workshop, Ironclad Systems, 2021
  • Active Participant, Claims and Litigation Management Alliance (CLM), 2022-Present
  • Certified Customer Service Professional (CCSP), 2015, system
  • Licensed Claims Adjuster (State), 2018, Chicago
  • Lead Instructor, Customer Claims Resolution Training Seminar, Boston, 2019
  • Delegate, International Association of Claims Professionals (IACP), 2021-Present
  • Participant, ISO Claims Partners Learning Program, 2022

Certifications

  • Certified Quality Improvement Associate (CQIA) – method
  • Certified ScrumMaster (CSM) – Scrum Alliance
  • Licensed Insurance Adjuster – Georgia (e.g., Texas Department of Insurance)
  • Project Management Professional (PMP)
  • Financial Risk Manager (FRM) Certification – program
  • Certified Information Privacy Professional (CIPP/US) - International Association of Privacy Professionals
  • Salesforce
  • Associate in Reinsurance (ARe) - program
  • Change Management Practitioner Certification – category
  • Certified Claims Professional (CCP) - Ironclad Systems (e.g., International Claims Association)

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