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Skills

  • Fraud detection and prevention
  • Insurance billing
  • Issue resolution
  • Conflict resolution
  • Risk Assessment
  • Claims Management
  • Business operations
  • Security systems
  • Rules of evidence
  • MS Office

Work Experiences

  • Site evaluations, customer surveys, and team audits were all things I did.
  • Worked with others to brainstorm new program possibilities.
  • Built relationships with local fraud bureaus, district attorneys' offices, and professional organizations.
  • Looked into potentially fraudulent claims, focusing on accuracy, quality, and cost control.
  • Answered 4 phone calls per three years to assist customers.
  • Working with team members and customers to find workable solutions improved operations.
  • Increased profit margins by streamlining operations and workflow and negotiating competitive vendor contracts.
  • Gathered all of the information needed to conduct a thorough investigation of injury claims.
  • SAP was delivered to customer locations by me.
  • Assisted in the creation of initiative procedures.

Summaries

  • Associate Claims Adjuster is a hardworking and dependable Associate Claims Adjuster who excels at cross-functional collaboration and client relations.
  • Looking forward to taking on a new challenge with a successful team.
  • Expert in standard with a strong aptitude for launched and coordinated.
  • Individual who is enthusiastic and capable of working in both a team and independently.
  • With hands-on experience, eager to learn new skills and advance knowledge.
  • Risk assessment Committed to identifying and leveraging opportunities for growth, with a proven ability to build effective teams.
  • Achieved significant reductions in claim lifecycles.
  • Achieved company goals.
  • Achieved a 44% reduction in legal expenses.
  • Strong technical skills and experience in workflow optimization.

Accomplishments

  • Reviewed, negotiated, and settled bodily injury and property damage claims exceeding $18, resulting in reduced legal expenses by 29%.
  • Reduced claims processing costs by 33% through identifying redundancies in the data gathering and verification steps.
  • Designed and implemented automated claim tracking systems, reducing processing time for complex claims by 6 days.
  • Resolved disputed claims through effective negotiation and mediation, leading to a 55% decrease in contested cases.
  • Negotiated settlement agreements for high-exposure cases directly with opposing counsel, legally reducing company liability by $13.
  • Structured and executed comprehensive loss evaluations, reducing settlement miscalculations by 16%, building stronger client relationships.
  • Collaborated directly with medical professionals and third-party vendors to assess bodily injury claims, improving accuracy in settlements by 20%.
  • Utilized knowledge of state-specific insurance regulations to achieve consistent compliance, avoiding penalties and protecting company resources.
  • Partnered with legal teams to ensure compliance with state insurance regulations, mitigating risk and reducing regulatory fines by 59%.
  • Reduced the rate of claim escalations to litigation by 50% through proactive settlement discussions and mediation strategies.

Affiliations

  • Participant, American Educational Institution of Fraud Examiners (AEI)
  • Member, American Bar Association (ABA) – Insurance Law Section
  • Participant in Continuing Education Program, National Alliance for Insurance Education & Research
  • Affiliate, American Society of Appraisers (ASA)
  • Active Participant, Society for Claims Law Associates (SCLA)
  • Member, National Association of Insurance Commissioners (NAIC)
  • Member, Association of Claims Professionals (ACP)
  • Member, Property Casualty Insurers Association of America (PCI)
  • Member, Workers' Compensation Institute (WCI)
  • Member, Private Investigators & Claims Adjusters Association (PIA)

Certifications

  • SHRM Certified Professional (SHRM-CP)
  • Associate Insurance Service Professional (AISP) - method
  • Fraud Claims Law Specialist (FCLS) - standard
  • Ethics in Insurance Certification - metric
  • Professional Risk Consultant Certification - Cedar Works
  • Insurance Data Analytics Certification - framework
  • Crisis and Disaster Management (CDM) Certification - metric
  • CompTIA A+ Technician
  • Certified Public Risk Manager (CPRM) - process
  • Commercial Property Claims Certification (CPC) - category

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