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Skills

  • Automobile appraisals
  • Benefit coordination
  • Critical Thinking and Problem Solving
  • Claims Auditing
  • Property adjusting
  • Asbestos claims
  • Administrative support
  • Invoice generation
  • Insurance fraud expertise
  • Property claims

Work Experiences

  • Collaborated with insurance providers.
  • Increased profit margins by streamlining operations and workflow and negotiating competitive vendor contracts.
  • Worked with others to brainstorm new framework possibilities.
  • Provided excellent service and attention when dealing with customers face-to-face or over the phone.
  • Coordinated field reviews and worked with underwriting on loss reserves and risk assessment.
  • Collaborated with insurance providers to resolve disputed claims within a 11-day window, reducing appeals by 53%.
  • Achieved a 38% reduction on disputed claims.
  • Saved money by developing functional solutions to process problems.
  • Achieved a 58% improvement in team productivity.
  • Worked closely with law enforcement and testified in criminal cases.

Summaries

  • Strong technical skills and experience in process improvement.
  • Achieved substantial cost savings.
  • Knowledge of Tableau in depth, as well as stakeholder engagement and team leadership abilities.
  • Excellent problem-solving skills and a positive attitude.
  • Achieved a 40% reduction in appeals.
  • Achieved a 58% decrease in claim denials.
  • Ability to recognize initiative issues and integrate process solutions to achieve category.
  • ServiceNow and Power BI experts with exceptional interpersonal skills.
  • Method and category have a proven track record.
  • Senior Medical Claims Examiner with risk assessment and process improvement abilities.

Accomplishments

  • Partnered with legal counsel to recover $15 through subrogation on improperly adjudicated claims in 2021.
  • Refined the health plan's out-of-network claim adjudication policy, reducing variance from expected paid amounts by 69%.
  • Created standardized claim adjudication processes across multiple carriers, cutting processing time by 17 days.
  • Designed and launched an innovative claims reporting dashboard that decreased departmental reporting delays by 16 hours.
  • Reduced claim processing times by 13 days by enhancing claim verification and documentation workflows, leading to a 61% increase in accuracy and efficiency.
  • Investigated and resolved complex claims involving multi-carrier coordination, reducing over-payment incidences by 55%.
  • Completed a comprehensive review of claims data, identifying subrogation opportunities that recouped over $6 in liabilities.
  • Championed an initiative to automate claims workflow, reducing departmental manual review workload by 24%.
  • Optimized out-of-network claims adjudication by streamlining verification processes, reducing denials by 27% year-over-year.
  • Co-developed online training modules on benefit coordination, increasing team's efficiency in adjudicating multi-carrier claims by 18%.

Affiliations

  • Member, American College of Healthcare Executives (ACHE), Membership since 2019
  • Member, Professional Liability Underwriting Society (PLUS), specializing in medical malpractice risk evaluation metric
  • Certified HIPAA Professional (CHP), Certification attained in 2021, Health Care Compliance Association (HCCA)
  • Certified in Advanced Benefit Plan Analytics, standard Completed in 2018
  • Guest Lecturer, Industry Seminar on Handling Medical Malpractice Claims, Raleigh, 2022
  • Member, National Association of Health Underwriters (NAHU), focusing on benefit coordination and consumer representation
  • Officer, Healthcare Reimbursement Association (HCRA), program, promoting reimbursement education and best practices
  • Volunteer Speaker, Annual Insurance Claims Conference, Topic: Management of High-Cost Treatments 2020
  • Attendee, HIPAA Compliance Workshop, Meridian 2023
  • Certified Professional Coder (CPC), American Academy of Professional Coders (AAPC), Certification obtained in 2024

Certifications

  • Project Management Professional (PMP)
  • Healthcare Financial Professional Certificate - Healthcare Financial Management Association (HFMA)
  • Annual Process Documentation Certification - Northwind
  • Health Claims Specialist Certification (HCS) - American Academy of Professional Coders (AAPC)
  • HealthCare Claims Professional (HCP) Certificate - International Claim Association (ICA)
  • Certified Compliance & Ethics Professional (CCEP) - program
  • Association for Project Management (APM)
  • Workers’ Compensation Professional (WCP®) - American Society of Workers' Compensation Professionals
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Professional Healthcare Auditor (CPHA) - AAPC

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