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Skills

  • Fraud detection and prevention protocols
  • Supervision
  • Maintain industry benchmarks in closure timing
  • Adherence to initiative
  • Cross-functional communication with legal, medical, and rehabilitation teams
  • Communications
  • MS Office
  • Regulatory compliance
  • Accident benefits claim management
  • Identifying and managing high-risk claims

Work Experiences

  • Analyzed independent medical opinions.
  • Assessed conflicting medical reports to mitigate inflated recovery timelines, successfully reducing company liability on multiple high-value claims.
  • Collaborated with initiative customers to determine their needs and deliver program service.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Collaborated with rehabilitation therapists and insurers to develop tailored recovery plans, leading to a 80% quicker return to work rates for claimants.
  • Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
  • Achieved a refuse rate of 27%.
  • Reviewed original investigation reports and documents to address secondary concerns.
  • Collaborated with medical examination providers.
  • Achieved a 42% quicker return to work rates for claimants.

Summaries

  • Oversee 12 cases per month with care.
  • Accident Benefits Adjuster with a sharp eye for detail.
  • Achieved consistent operational success by reducing fraud settlements by $10 through meticulous case investigation and enforcement of stringent detection protocols.
  • With strong case management and relationship-building abilities, I am meticulous, systematic, and highly experienced.
  • Achieved favorable outcomes in 15% of cases.
  • Empathy, dependability, and enthusiasm for customer satisfaction.
  • Clear understanding of data analysis and strategic planning as well as budget management training.
  • Accident benefits expert.
  • Accident Benefits Adjuster with 10 years of successful data analysis and team leadership experience.
  • Listening to customers, meeting productivity goals, and staying current on company offerings are all skills she possesses.

Accomplishments

  • Partnered with external occupational therapists to facilitate modified return-to-work arrangements, decreasing time loss by 42% over two years.
  • Implemented a data-driven approach to claims analysis, bringing down the average claim lifecycle by 15 days.
  • Orchestrated early interventions in complex claims, closing 8 high-risk files with a 81% success rate over two years.
  • Coordinated with multidisciplinary teams including legal and medical professionals to deliver customized rehabilitation plans, aiding in a 83% higher claimant satisfaction rate.
  • Regularly liaised with case management professionals to review complex cases, securing a 24% decrease in relapse claims.
  • Documented and resolved method which led to category.
  • Trained 9 junior adjusters on case management protocols, reducing processing times and errors by 66%.
  • Introduced a claimant outreach program that improved feedback scores by 39% and increased overall retention.
  • Monitored and adjusted reserves on high-value cases, minimizing claim leakage by 62%.
  • Achieved PMP that enhanced analytical and evaluative skills, leading to a 42% improvement in claim budget accuracy.

Affiliations

  • Key Member, Health & Benefits Conference Committee in 2023
  • Society of Women Engineers
  • Active Member in Automation of Claim Underwriting Process Group with Brightline
  • Accredited Member, Society of Registered Professional Adjusters (SRPA)
  • Association for Supply Chain Management (APICS)
  • Participant, American Educational Institute (AEI) for Senior Claims Law Associate (SCLA)
  • International Council of Nurses
  • Society of Human Resource Management
  • Member, Self-Funded Insurance Education Association (SIEA)
  • Lions Club

Certifications

  • Ontario Independent Adjusters Association (OIAA) Membership
  • Certified Case Manager (CCM)
  • Professional Liability Insurance Adjuster Certification
  • CompTIA Security+
  • Property and Casualty Insurance License
  • Certified Business Analysis Professional (CBAP)
  • Associate in Claims (AIC)
  • Professional Development in Accident Compensation Claims – 2023
  • Ontario Auto Insurance Adjuster Certification
  • Certified Professional Service Provider (CPSP) – Accident and Health Insurance

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