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Skills

  • Coverage determination
  • Multivehicle Accident Claims Management
  • Process improvement
  • Multiregional Regulatory Compliance
  • Customer Relationship Management (CRM)
  • Medical Record Analysis
  • High-volume claims processing
  • Audit Trail Maintenance
  • Negotiation Skills for Complex Claims
  • Benefits review

Work Experiences

  • Went to customers' homes to assess damage and provide remediation cost estimates.
  • Achieved President's Club recognition.
  • Delivered consistent follow-ups with claimants.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Advised policyholders on available coverage.
  • Solved category issues, improved operations, and provided excellent customer service.
  • Collaborated with risk management teams.
  • Cut documentation time by 47%.
  • Analyzed accident reports and medical records.
  • Looked for industry trends on social media and through online sources.

Summaries

  • Committed to improving the claims experience.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Trying to get a similar job with a growing insurance company.
  • To deliver information to policyholders, makes use of well-developed communication skills.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Achieved a remarkable customer satisfaction increase of 71% by helping policyholders understand the claims process and providing clear guidance during settlements.
  • Achieved accuracy improvements of 23% in liability determinations.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the framework business.
  • Adept at managing high-volume casualty claims.
  • Accurately managed settlements.

Accomplishments

  • Collaborated with external legal counselors to review and mediate 16 casualty claims, preventing legal escalation and saving up to 53% in potential liability costs.
  • Led claims management for a newly implemented Microsoft Excel policy, accelerating resolution times by 29% within the first 4 months.
  • Developed and maintained comprehensive claim files, ensuring audit trail completeness for internal audits and reducing discrepancies by 69%.
  • Ensured compliance with state, federal, and regional regulations across 3 cases, minimizing regulatory risk and associated penalties.
  • Facilitated cross-functional training sessions to standardize casualty claims handling processes, decreasing handoff errors by 83%.
  • Reduced fraudulent claims detection time by 7 days utilizing Workday for enhanced audit trail management.
  • Resolved policyholder inquiries within a 2-hour response window, enhancing claim closings and reducing escalations by 66%.
  • Managed an average caseload of 14 casualty claims per 18 months, achieving a 53% reduction in overall claim cycle times.
  • Minimized litigation expenses, with a 77% success rate in settling high-risk claims before trial, saving legal and operational costs.
  • Reduced claim cycle times by 80% over 2021 by implementing innovative casualty claim processing techniques.

Affiliations

  • Society of Insurance Research (SIR)
  • International Council of Nurses
  • National Alliance for Insurance Education and Research
  • Chartered Property Casualty Underwriter (CPCU) Society
  • Association of Certified Fraud Examiners (ACFE)
  • Property and Casualty Insurance Association of America (PCI)
  • National Healthcare Anti-Fraud Association (NHCAA)
  • International Association of Special Investigation Units (IASIU)
  • Society of Women Engineers
  • Project Management Institute

Certifications

  • ISO Certified Claim Adjuster
  • Certified Insurance Service Representative (CISR)
  • Project Management Professional (PMP)
  • CompTIA A+ Technician
  • Workers' Compensation Claim Professional (WCCP)
  • Google Certified Professional Cloud Architect
  • Fraud Claim Law Specialist (FCLS)
  • Claims and Litigation Management Alliance (CLM) Fellow
  • Apple Certified Associate (ACA)
  • Certified Litigation Management Professional (CLMP)

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