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Skills

  • AI-Based Claims Management Software Implementation
  • Cost reduction through process improvement
  • Magnify Predictive Targeting System
  • Automated Work Distributor (AWD)
  • Effective Communication with Claimants
  • Accident scene investigations
  • Insurance policy coverage knowledge
  • Microsoft Word
  • Large Case Management Experience
  • Dispute resolution techniques

Work Experiences

  • Assisted in the launch of new risk management strategies.
  • Calculated the quantifiable features of method products.
  • Analyzed historical claims trends to assist in the launch of new risk management strategies, leading to a 76% increase in premium absorption.
  • Testified on behalf of the agency in criminal and civil proceedings.
  • Achieved Innovation Award for excellence in claims handling with a 22% success rate in resolving contested cases in mediation.
  • Achieved an annual settlement success rate of 29% %.
  • Reconciled data in the direct collection system with the accounting system to address discrepancies.
  • Investigated claims and incident data in order to provide solutions and resolve issues.
  • Fixed initiative codes so that standard claims could be properly classified.
  • Assessed complex cases.

Summaries

  • Expert at creating profitable and high-quality processes.
  • Within Insurance, senior Senior Workers' Compensation Claims Adjuster and outstanding performer in quality assurance and stakeholder engagement.
  • Achieved reductions through strategic settlements.
  • Achieved a 30% improvement in file handling timeliness.
  • Achieved a 67% reduction in litigated cases.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Negotiates fair and thorough resolutions to all claims in a peaceful manner.
  • Recognized on a regular basis for outstanding performance and contributions to the Insurance industry's success.
  • Achieved a 48% reduction in claim closure time.
  • 11 years of experience in complex settlement negotiation.

Accomplishments

  • Led successful negotiations with claimants, attorneys, and insurance representatives, reducing settlement costs by 83%.
  • Implemented a claims handling audit system that reduced payment errors by 48% and streamlined case management.
  • Played a pivotal role in developing a fraud detection training program company-wide, leading to the identification of 2 fraudulent claims in just 18 months.
  • Led fraud detection strategies that resulted in uncovering 2 fraudulent claims and preventing payouts exceeding $5.
  • Provided expert analysis in over 5 complex workers' compensation claims that resulted in favorable decisions in 78% of cases.
  • Documented and resolved framework which led to metric.
  • Collaborated with medical providers to ensure accurate injury classifications, reducing disputed medical claims by 76%.
  • Initiated a new quality control initiative targeting late claims handling, which led to a 15% improvement in timely reporting and claim settlements.
  • Successfully handled a portfolio of 12 workers' compensation cases, maintaining a resolution rate of 73% within the past year.
  • Identified inconsistencies in medical billing through careful review, preventing fraudulent payments and saving over $4 in claims.

Affiliations

  • Society of Settlement Planners (SSP)
  • National Healthcare Anti-Fraud Association (NHCAA)
  • National Risk Retention Association (NRRA)
  • American Marketing Association
  • Occupational Safety and Health Administration (OSHA) Alliance Program
  • Jaycees
  • Association of Information Technology Professionals
  • American Insurance Association (AIA)
  • American Institute for Chartered Property Casualty Underwriters (CPCU)
  • Board of Certified Safety Professionals (BCSP)

Certifications

  • ServSafe
  • Microsoft Certified Systems Engineer (MCSE)
  • Senior Claims Law Associate (SCLA)
  • Professional in Human Resources (PHR)
  • CompTIA Network+
  • Professional Claims Adjuster (PCA)
  • Cisco Certified Network Associate (CCNA)
  • Associate in Risk Management (ARM)
  • Certified Fraud Examiner (CFE)
  • SHRM Certified Professional (SHRM-CP)

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