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Skills

  • Audit process enhancement
  • Loss Mitigation Techniques
  • Organization
  • Customer service
  • Claims backlog reduction
  • Litigated claims defense strategy
  • Legal claim collaboration
  • Health care services coordination
  • Contract and policy documentation
  • Customer communication proficiency

Work Experiences

  • Assessed catastrophic injury claims, negotiated settlements, and ensured accurate reserve setting for claims exceeding $10.
  • Looked for industry trends on social media and through online sources.
  • Collaborated with the legal department on litigated claims, contributing to successful defense strategies in 12 complex cases.
  • Collaborated with the legal department on litigated claims.
  • Adjusted policies based on bodily injury claim trends.
  • Audit records weekly to ensure bodily injury claims were processed accurately and in compliance with program guidelines.
  • Achieved an average resolution rate of 35%.
  • Achieved zero audit findings over 18 months.
  • Analyzed medical records and bills to assess injury severity and required treatments, leading to more accurate claim assessments.
  • Collaborated with system customers to determine their needs and deliver method service.

Summaries

  • Empathy, dependability, and enthusiasm for customer satisfaction.
  • By applying all policies fairly, she is adept at balancing business and customer interests.
  • Achieved 35% reduction in claim payouts.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the metric business.
  • Achieved 24% improvement in satisfaction.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Adept at reviewing settlement demands.
  • Adaptable and knowledgeable in resolving discrepancies.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Clear understanding of performance reporting and quality assurance as well as data analysis training.

Accomplishments

  • Implemented a new bodily injury claims workflow process that reduced claim resolution time by 42% within two years, contributing to improved customer satisfaction.
  • Assisted in drafting policy language specifically tailored to mitigate bodily injury exposure for high-profile clients, reducing potential liabilities by 18.
  • Presented complex bodily injury claims findings to stakeholders, ensuring alignment on settlement strategies and reducing overall processing delays by 66%.
  • Spearheaded cross-departmental collaboration resulting in the reduction of bodily injury claims expense by 9 within one year.
  • Reduced external legal consultation reliance by 71%, controlling claims expenses by equipping internal teams with advanced training.
  • Managed a caseload of 17 claims simultaneously, ensuring adherence to state regulations and timely settlements that saved 18 in potential litigation costs.
  • Provided expert claims handling advice to regional branches, improving consistency across all offices with a 27% decrease in claim mismanagement cases.
  • Standardized documentation for large-loss injury claims, expediting internal reviews by 69% and reducing errors across departments.
  • Reduced claim payout by 16% in 2017 through effective negotiation strategies with plaintiffs' attorneys.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.

Affiliations

  • Claims and Litigation Management Alliance (CLM)
  • Association of Professional Insurance Women (APIW)
  • American Board of Independent Medical Examiners (ABIME)
  • American Educational Institute (AEI) - Claims Law Program
  • International Risk Management Institute (IRMI)
  • Jaycees
  • American Medical Informatics Association
  • National Association of Independent Insurance Adjusters (NAIIA)
  • Medical Claims Professional Development Network (MCPDN)
  • International Association of Claims Professionals (IACP)

Certifications

  • Medical Billing and Coding Specialist system
  • Claims and Litigation Management (CLM) Fellowship
  • Associate in Reinsurance (ARe)
  • Certified Insurance Data Analyst (CIDA)
  • Microsoft Certified Systems Engineer (MCSE)
  • Senior Claim Law Associate (SCLA)
  • Casualty Claim Law Associate (CCLA)
  • Salesforce
  • CompTIA A+ Technician
  • Certificate in Healthcare Risk Management (CHRM)

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