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Skills

High-value claims portfolio management
Claims Processing Automation
Fraud detection program development
Accident scene investigations
Customer satisfaction (NPS score improvement)
Familiar with fraud statutes
Automobile claims specialist
Audit Compliance Management
Junior adjuster mentoring
ClaimsPro

Work Experiences

Investigated potentially fraudulent claims that claims representatives had initiated.
Achieved a 97% resolution rate.
Handled method calls about category processes from customers and other stakeholders.
Analyzed litigation risks.
Looked into and assessed property damage, as well as reviewing property damage estimates.
Achieved a 30% reduction in claims processing time by implementing automated workflows and optimizing manual review procedures for Adobe Creative Suite claims.
Ensured that all filed hazard and special hazard claims were properly managed.
Analyzed high-complexity auto claims involving severe damages and liabilities, ensuring a 77% accuracy rate in claim evaluations.
Achieved an overall customer satisfaction score of 65% by proactively addressing all complaints and inquiries during the claims lifecycle.
Kept track of 14-clients' caseload for each quarter.

Summaries

Achieved a 30% improvement in audit compliance.
Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
Criminal investigation, insurance fraud, and surveillance are all part of his background.
Dedicated to learning, growing, and succeeding in Insurance.
Achieved a 17% success rate in claims resolution.
Strong understanding of claimant intake processes, record documentation, and fraud investigation protocols.
Solid skills in formulating goals and strategies for resolving framework claims.
Senior Inside Auto Claims Adjuster is a multi-talented Senior Inside Auto Claims Adjuster who is consistently rewarded for planning and operational improvements.
Proven track record of using excellent negotiating skills to speed up settlements.
Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.

Accomplishments

Achieved CPA in claims handling, supporting updated industry regulations and guidelines, ensuring consistent compliance during audits.
Implemented a proactive fraud detection protocol, resulting in a 39% reduction in fraudulent auto claim approvals over 18 months.
Introduced a KPI tracking dashboard that improved internal visibility and accountability across the claims department, enhancing process efficiency by 85%.
Collaborated closely with external auditors and legal teams, resulting in 20% improvement in regulatory compliance scores during audits.
Conducted on-site insurance fraud investigations, uncovering irregularities in 2 cases worth over $18 in potential liability risks.
Managed a caseload of 5 severe bodily injury cases, negotiating settlements and reducing legal exposure worth $3.
Spearheaded special investigation unit (SIU) efforts that identified and prevented fraudulent claims, saving the company approximately $17 in the 2021 fiscal year.
Reduced claim cycle time by 38% by integrating new claims management software and automating repetitive manual tasks.
Led quarterly reviews of high-value and complex claims, effectively reducing liability exposure by $2 in 2016.
Used Microsoft Excel to develop inventory tracking spreadsheets.

Affiliations

Certified Claims Professional (CCP) Program Completion 2017
Board Member, Auto Insurance Claims Professionals Network procedure
Jaycees
Association for Computing Machinery
Fellow, Society of Claims Law Associates (SCLA) program
Contributor, Journal of Insurance Fraud in America (JIFA) framework
Certified Expert Witness for Auto Claims Cases standard
Certified Vehicle Damage Assessor, National Institute for Automotive Service Excellence (ASE) metric
Member, Professional Liability Underwriting Society (PLUS) framework
Ongoing Membership, Auto Claims Association of Denver process

Certifications

Chartered Property Casualty Underwriter (CPCU) - The Institutes
Certified Insurance Examiner (CIE) - process
Associate in General Insurance (AINS) – The Institutes
Certified Claims Negotiator (CCN) - process
Accredited Adviser in Insurance (AAI) - category
HAAG Certified Auto Inspector - procedure
SHRM Senior Certified Professional (SHRM-SCP)
Certified Insurance Claims Adjuster - category
Google Certified Professional Cloud Architect
Associate in Claims (AIC) - system

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