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Skills

  • Excellent administrative abilities
  • Negotiation skills to reduce claim costs
  • Performance Tracking and Reporting
  • Attention to detail in document review
  • Effective Communication with Claimants
  • MS Office
  • Compliance with metric and regulatory standards
  • Customer service excellence
  • Problem-solving in Complex Claims
  • Disaster claims handling and crisis response

Work Experiences

  • Approved or denied claims based on analysis.
  • Oversaw the delivery of program project by procedure team, which resulted in method.
  • Aided adjusters in resolving complex claims.
  • Coordinated with body shops.
  • Collaborated with policyholders, providing clear explanations of their coverages and claims processes, increasing customer retention by 69%.
  • Answered phone calls from clients, vendors, and a variety of other callers looking for information.
  • Authored detailed claims investigation reports using data analysis and customer testimony, which supported legal defenses against process disputes.
  • Analyzed coverage details.
  • Looked for industry trends on social media and through online sources.
  • Collaborated with adjusters to expedite auto claims processing.

Summaries

  • Over 17 years of field experience.
  • Hardworking Auto Claims Processor with 12 years of telecommuting experience meeting customer needs.
  • Clear understanding of client relations and cross-functional collaboration as well as client relations training.
  • Over 2 years of experience obtaining information from policyholders and assisting with claim forms as an honest Insurance Clerk.
  • Strengths in risk assessment and performance reporting backed up by Miscellaneous training.
  • Filing, data entry, and keeping a clean and organized work environment are all skills I have.
  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate framework systems is one of my specialties.
  • Expert in all aspects of the insurance sales cycle, including prospecting and follow-up.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Costs were consistently reduced while profits were increased.

Accomplishments

  • Utilized process to track, review, and close claims within tight deadlines, increasing processing efficiency by 25%.
  • Implemented a claims audit process that highlighted and corrected compliance discrepancies within the first 11 months of operation.
  • Reduced loss ratio for auto claims by 23% by consistently identifying and addressing overpayments, fraud, and misallocations.
  • Implemented process efficiencies that cut down manual claim entry time by 36%, allowing for faster turnaround.
  • Resolved 18 high-value claims involving disputed coverage, reducing escalation and customer complaints by 21%.
  • Monitored and enforced adherence to state and federal insurance regulations, resulting in zero compliance violations during 11 audits.
  • Resolved complex auto claims involving coordination with multiple stakeholders, leading to timely settlements and avoidance of escalated disputes.
  • Reduced department’s claims backlog by 64% through the implementation of a streamlined prioritization system.
  • Provided detailed monthly performance reports to senior management, showing a 40% improvement in claims processing timelines.
  • Collaborated with external adjusters and vendors to ensure all claims were processed within SLA requirements, improving vendor compliance by 32%.

Affiliations

  • Life Office Management Association (LOMA)
  • Certified Insurance Service Representative (CISR)
  • Risk and Insurance Management Society, Inc. (RIMS)
  • Society of Claims Law Associates (SCLA)
  • Associate in Risk Management (ARM)
  • Project Management Institute
  • National Association of Independent Insurance Adjusters (NAIIA)
  • Rotary International
  • Property Liability Research Bureau (PLRB)
  • Casualty Actuarial Society (CAS)

Certifications

  • Advanced Claims Training Program Certification - Lakeside Partners
  • Ethics for Insurance Adjusters Certification metric
  • Advanced Property Loss Adjusting Certification - system
  • Claims Law Associate (CLA) - American Educational Institute (AEI)
  • CompTIA A+ Technician
  • Certified Professional Insurance Adjuster (CPIA) - Cedar Works
  • Certified Claims Professional (CCP) - process
  • Apple Certified Associate (ACA)
  • Auto Insurance Claim Software Certification - framework
  • Certified Public Accountant

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