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Skills

  • Fair Isaac Claims Advisor
  • Data analysis
  • ClaimsPro
  • Accident scene investigations
  • Legal Case Preparation for Claims
  • Automated Work Distributor (AWD)
  • Budget and Cost Allocation Management
  • Effective Communication with Claimants
  • Subrogation expert
  • Continuous process optimization

Work Experiences

  • Calculated the quantifiable features of method products.
  • Attained a 74% success rate in resolving contested cases.
  • Reconciled data in the direct collection system with the accounting system to address discrepancies.
  • Examined claim forms and other records to determine insurance coverage.
  • Audited improper billing practices.
  • Kept track of 4-clients' caseload for each quarter.
  • Looked at the data to see what the underlying principles were.
  • Assessed complex cases.
  • Authored and delivered claims reporting training materials, improving staff competence and increasing the team’s accuracy by 33%.
  • Authored claims reporting training materials.

Summaries

  • Accomplished Senior Workers' Compensation Adjuster with a reputation for reducing litigation and fostering better claimant relationships, cutting legal expenses by $16 yearly.
  • 11 years of experience in complex settlement negotiation.
  • Solid skills in formulating goals and strategies for resolving procedure claims.
  • Recognized on a regular basis for outstanding performance and contributions to the Insurance industry's success.
  • Collaborated cross-functionally with HR, legal, and medical departments.
  • Accelerated claim resolutions by 62%.
  • Strengths in process improvement and project management backed up by Insurance training.
  • Aimed at reducing disputes.
  • Complete knowledge of the claims process and cross-functional collaboration.
  • Achieved 47% fewer disputes.

Accomplishments

  • 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.
  • Documented and resolved framework which led to metric.
  • Successfully managed a portfolio of 4 high-exposure cases, ensuring compliance with state regulations while maintaining an average closure rate of 84%.
  • Provided expert analysis in over 5 complex workers' compensation claims that resulted in favorable decisions in 78% of cases.
  • Leveraged injury pattern analysis to proactively identify problematic claims early, achieving a 73% increase in first-year claim savings.
  • Assisted in complex, multi-injury cases, coordinating with legal and medical professionals to reduce claim cycle times by 3 days.
  • Utilized specialized knowledge in medical coding and terminology to challenge overbilling, saving the organization an average of $15 annually.
  • 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.
  • Authored, refined, and implemented improved claims auditing procedures, decreasing average claim processing time by 5 days.

Affiliations

  • Society of Human Resource Management
  • International Council of Nurses
  • Association of Information Technology Professionals
  • Society of Settlement Planners (SSP)
  • Workers' Compensation Certification Board Scrum Master
  • Society of Registered Safety Professionals (SRSP)
  • National Healthcare Anti-Fraud Association (NHCAA)
  • National Association of Subrogation Professionals (NASP)
  • Association for Supply Chain Management (APICS)
  • Association of Workplace Investigators (AWI)

Certifications

  • Microsoft Certified Systems Engineer (MCSE)
  • SHRM Certified Professional (SHRM-CP)
  • National Institute of Workers' Compensation Claims Arbitration (NIWCCA)
  • First Aid/CPR Certified
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Senior Claims Law Associate (SCLA)
  • Certified in Workers' Compensation (CWC)
  • ServSafe
  • Cisco Certified Network Associate (CCNA)
  • Certified Expert in Insurance Reserve Management (CEIRM)

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