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Skills

  • Dispute resolution through mediation and arbitration
  • Comprehensive injury evaluation matrix development
  • Client relationship management
  • Automated Work Distributor (AWD)
  • Familiar with fraud statutes
  • Claims stakeholder communication
  • Bodily injury claims investigation
  • Subrogation expert
  • Microsoft Word
  • Collaboration with external experts (medical examiners, legal professionals)

Work Experiences

  • Kept track of 9-clients' caseload for each quarter.
  • Worked with the claims department and industry anti-fraud organizations to resolve claims.
  • Achieved results over 2022.
  • Fixed metric codes so that system claims could be properly classified.
  • Achieved Outstanding Service Award for quick resolution of injury claims.
  • Achieved a 40% boost in overall claim efficiency.
  • Testified on behalf of agency as part of criminal and civic proceedings.
  • Conducted in-depth interviews with witnesses and claimants to gather facts and information.
  • Authored detailed analysis reports on significant injury claims, incorporating medical, legal, and financial information to guide case resolution strategies.
  • Assessed subjective bodily injury reports.

Summaries

  • Expert at creating profitable and high-quality processes.
  • Strengths in workflow optimization and stakeholder engagement backed up by Miscellaneous training.
  • Claims Adjuster with a passion for helping others and a knack for coming up with novel solutions to problems.
  • Achieved settlements that saved the company $17.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Closed over 3 cases efficiently.
  • Criminal investigation, insurance fraud, and surveillance are all part of his background.
  • Negotiates fair and thorough resolutions to all claims in a peaceful manner.

Accomplishments

  • Collaborated with internal legal and medical professionals to expedite case resolution, reducing average case duration by 4 days.
  • Developed a standardized process for bodily injury severity assessment, leading to a 63% decrease in claim investigations length.
  • Delivered expert testimony in court proceedings for high-stakes bodily injury cases, contributing to favorable outcomes in 79% of cases.
  • Developed and presented monthly performance reports to senior management, identifying cost-saving opportunities in bodily injury claims.
  • Saved 17 in insurance reserves by implementing fraud prevention guidelines for bodily injury cases.
  • Applied predictive data analytics to forecast bodily injury claim trends, cutting future reserving errors by 85%.
  • Provided technical mentorship to 6 new adjusters, increasing team assessment accuracy by 33% within 2020.
  • Reduced bodily injury claims over-reserving by 23% through the introduction of advanced predictive risk models.
  • Resolved 11 client disputes through mediation, resulting in a client satisfaction rating of 77%.
  • Trained junior claims adjusters on bodily injury assessment, which increased team productivity by 33%.

Affiliations

  • Society of Human Resource Management
  • American Medical Informatics Association
  • Chartered Insurance Institute (CII)
  • American Bar Association (ABA) - Tort Trial & Insurance Practice Section
  • Society of Insurance Fraud Investigators (SIFI)
  • National Council of Self-Insurers (NCSI)
  • Society of Women Engineers
  • American College of Legal Medicine (ACLM)
  • American Marketing Association
  • American Association of Legal Nurse Consultants (AALNC)

Certifications

  • Insurance Adjuster Certification – Arizona
  • Associate in General Insurance Certification (AINS) – Vantage
  • Medical Billing & Coding Certification – Lakeside Partners
  • Microsoft Certified Systems Engineer (MCSE)
  • General Insurance Certification (INS) – process
  • Certified Disability Management Specialist (CDMS) – metric
  • CompTIA Network+
  • Ethics in Insurance Professional Certification – Northwind
  • Chartered Property Casualty Underwriter (CPCU) - Ironclad Systems
  • Associate in Claims (AIC) - Lakeside Partners

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