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Skills

  • Compliance with state and local regulations
  • Documentation abilities
  • Claim processing
  • Customer service
  • MS Office
  • Advanced knowledge of initiative
  • Data analysis for claims
  • Operational improvement
  • Onboarding program development
  • Relationship development

Work Experiences

  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Awarded the Innovation Award for best performance in claims resolution.
  • Achieved a 63% increase in processing accuracy.
  • Analyzed root causes of unresolved claims, proposing actionable strategies to resolve complications and boosting settlements by $13.
  • Conducted frequent audits on claims to identify inconsistencies, resulting in 13 cases of fraud prevention and recovery savings of $14.
  • Kept patient finances, records, and health statuses confidential.
  • Boosted client satisfaction scores by 63%.
  • Achieved a customer satisfaction rate of 46%.
  • Reviewed open requests and redirected workloads to ensure that projects were completed on time.
  • Accelerated handling time by 58%.

Summaries

  • Assisted upper management in decision-making.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • As a highly organized Claim Associate, repeatedly exceeded expectations by managing high-volume caseloads and ensuring reliable and accurate client communication.
  • Achieved 40% improvement in team accuracy.
  • Claim Associate with proven expertise in fraud detection and prevention, consistently uncovering fraudulent claims and recovering savings of $2 annually.
  • Achieved a 56% satisfaction rate among clients.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the program business.
  • Hardworking Claim Associate with 12 years of telecommuting experience meeting customer needs.
  • Claim Associate with 13 years of successful process improvement and team leadership experience.
  • Accomplished Claim Associate.

Accomplishments

  • Effectively resolved escalated disputes involving complex policy provisions, reducing prolonged conflict resolution times by 66%.
  • Managed an average of 8 claims per day, consistently meeting 6 months-specific performance benchmarks for processing accuracy.
  • Resolved product issue through consumer testing.
  • Facilitated a team project that led to the recovery of 17 in overpayments after a meticulous audit of historic claims.
  • Authored updated policies for claim review protocols, ensuring compliance with state and federal regulations in 2022.
  • Streamlined workflow processes, resulting in reducing claim processing time by 40%.
  • Negotiated claim settlements with 3 clients, achieving a satisfaction increase of 44%.
  • Collaborated with IT to troubleshoot software malfunctions that had been causing delays in payout, improving processing speed by 66%.
  • Designed and deployed SAP-based automation that cut claim reassessment timelines by 79%.
  • Volunteered to spearhead the reconciliation of high-risk claims, resolving 13 high-priority cases in under three years.

Affiliations

  • National Association of Public Insurance Adjusters (NAPIA)
  • Society of Women Engineers
  • Society for Human Resource Management (SHRM) - Workers' Compensation Branch
  • Association for Supply Chain Management (APICS)
  • Society of Human Resource Management
  • Associate in Claims (AIC) Certification Program
  • American Bar Association - Tort Trial and Insurance Practice Section (TIPS)
  • Freemason
  • International Claim Association (ICA)
  • Society of Insurance Research (SIR)

Certifications

  • Apple Certified Associate (ACA)
  • Certified Claims Professional (CCP) - Summit Group
  • Specialist in Insurance Fraud Detection (SIFD) – Cedar Works
  • Certified Customer Service Professional (CCSP) - Harbor & Co.
  • Customer Satisfaction and Retention in Insurance – Harbor & Co.
  • Total and Partial Loss Claims Training – metric
  • CompTIA Security+
  • Microsoft Certified Systems Engineer (MCSE)
  • Professional in Insurance Regulation (PIR) – metric
  • Multiline Claims Adjuster Certification – Washington

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