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Skills

  • Legal document interpretation
  • Risk assessment and mitigation
  • Customer Relationship Management (CRM)
  • Process equipment
  • Conflict resolution
  • Detail-oriented claim assessments
  • Leadership in training sessions
  • Process improvement
  • Relationship development
  • Business operations

Work Experiences

  • Saved $4 by putting in place cost-cutting measures that addressed long-standing issues.
  • Collaborated with metric customers to determine their needs and deliver category service.
  • Approved compensation.
  • Oversaw claim negotiations within a $15 budget and assisted in successful litigation for complex issues.
  • Transported Jira to one year customer locations.
  • Achieved consistent 42% accuracy.
  • Collaborated with cross-functional teams.
  • Reviewed original investigation reports and documents to address secondary concerns.
  • Avoided delays for over 18 customers.
  • Assisted in the closure of over 14 open claims.

Summaries

  • Claims Adjustment Representative is a multi-talented Claims Adjustment Representative who is consistently rewarded for planning and operational improvements.
  • Achieved a 40% reduction in future claims denials.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Achieved a 81% reduction in fraudulent claims.
  • Adept at data analysis and reporting, providing senior leadership with actionable insights, driving trend-based decisions that saved $8 annually.
  • With strong case management and relationship-building abilities, I am meticulous, systematic, and highly experienced.
  • Proven track record of using excellent negotiating skills to speed up settlements.
  • Hardworking Claims Adjustment Representative with 7 years of telecommuting experience meeting customer needs.
  • Review documentation and assess properties efficiently to determine damage levels, complete cost estimates, and maintain liability control.
  • Accomplished in leveraging technology for claim tracking, which improved processing accuracy by 59% and slashed task completion time.

Accomplishments

  • Effectively mediated and resolved disputes during the claims process, resulting in a customer satisfaction increase of 26%.
  • Reduced customer disputes by 67% through proactive and transparent claims conversations, ensuring a high satisfaction rate.
  • Trained over 3 new hires in fraud detection tactics, improving overall accuracy in fraudulent claim identification by 15% within two years.
  • Introduced a process improvement initiative that reduced field-to-approval time on claims by 83%, enhancing the overall customer experience.
  • Initiated cross-team discussions to streamline adjudication workflows, improving efficiency by 69% and reducing claims backlogs.
  • Spearheaded multi-departmental efforts to close underperforming claim files, increasing overall processing speed by 51%.
  • Standardized reporting formats for claims process metrics, increasing leadership’s visibility into performance and enabling quicker decision-making.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Collaborated closely with the legal team to verify the legitimacy of claims with complex liability issues, achieving consistent positive outcomes and reducing legal costs.
  • Leveraged data-driven insights to identify inefficient claims handling practices, introducing changes that led to a 77% improvement in timeliness.

Affiliations

  • Affiliate of the Casualty Actuarial Society, concentrating on fraud detection methodologies
  • Steering Committee Member of local Austin Insurance Adjusters Association (IAA) chapter
  • National Association of Social Workers
  • American Medical Informatics Association
  • Toastmasters
  • Member of The National Association of Subrogation Professionals (NASP)
  • Freemason
  • Alumni of Claims Leadership Development Program at metric
  • Certified Insurance Fraud Representative (CIFR) from the Coalition Against Insurance Fraud
  • Society of Human Resource Management

Certifications

  • Certified Public Accountant
  • Injury Claims Adjuster Specialist (ICAS) Northwind
  • Cisco Certified Internetwork Expert (CCIE)
  • CompTIA Security+
  • Advanced Dispute Resolution Methodology Certification - Meridian
  • SHRM Certified Professional (SHRM-CP)
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Subrogation Recovery Specialist - Northwind
  • ISO Claims Adjuster Certification - Lakeside Partners
  • Certified Professional in Risk Management (CPRM) 2022

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