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Skills

  • Process improvement
  • Risk Assessment
  • Casualty Claims Management
  • Customer retention strategies
  • Supervision
  • Regulatory compliance
  • First Aid/CPR
  • Customer service excellence
  • Team building
  • Liability determinations

Work Experiences

  • Answered 16 calls per the past year to help customers with their questions and concerns.
  • Collaborated with adjusters, legal teams, and claimants.
  • Identified insurance coverage limitations with a thorough examination of claims documentation and related records.
  • Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
  • Caught over 3 outliers.
  • Achieved a 18% accuracy rating in claims evaluations.
  • Oversaw claim negotiations within a $3 budget and assisted in successful litigation for complex issues.
  • Reviewed original investigation reports and documents to address secondary concerns.
  • Conducted agent and claimant interviews to review questionable claims to correct omissions and errors.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.

Summaries

  • Oversee 18 cases per month with care.
  • Achieved high client satisfaction.
  • Adept Claims Adjustment Specialist.
  • Achieved a settlement rate reduction of 17% in 2021.
  • Achieved top marks in customer retention.
  • Achieved high settlement accuracy.
  • Accomplished Claims Adjustment Specialist.
  • Empathy, dependability, and enthusiasm for customer satisfaction.
  • Astute insurance professional with 15+ years of experience assessing properties, determining liabilities, and negotiating settlements.
  • Within Miscellaneous, senior Claims Adjustment Specialist and outstanding performer in workflow optimization and performance reporting.

Accomplishments

  • Implemented customer feedback loops to improve communication throughout the claim process, resulting in a 49% increase in customer satisfaction scores.
  • Reviewed 3 complex casualty claims and made coverage determinations that aligned with both policy terms and state-specific regulations.
  • Led initiative to integrate category resulting in reduced claim processing errors and a 72% increase in claim throughput.
  • Monitored and addressed compliance with local, state, and federal regulations specific to liability and claims adjustment protocols.
  • Consulted with legal counsel regarding claims worth over $10, ensuring compliance with both state and federal regulations, minimizing litigation exposure.
  • Resolved product issue through consumer testing.
  • Successfully negotiated settlement amounts in 20% of cases within company guidelines, with minimal overturns on contested claims.
  • Collaborated with team of 7 in the development of procedure.
  • Collaborated with underwriters and customer service teams to resolve coverage disputes, lowering dispute resolution time by 41% and maintaining service quality.
  • Reviewed and processed over 16 claims per month, resulting in a 74% increase in efficiency using streamlining techniques.

Affiliations

  • Professional Insurance Agents Association (PIA)
  • International Council of Nurses
  • International Association of Special Investigation Units (IASIU)
  • Property and Liability Resource Bureau (PLRB)
  • Healthcare Fraud Prevention Partnership (HFPP)
  • Society of Women Engineers
  • Freemason
  • American Marketing Association
  • International Association of Administrative Professionals
  • Jaycees

Certifications

  • CompTIA Network+
  • Accredited Claims Adjuster (ACA) License
  • Advanced Claims Handling Certification by program
  • Property and Casualty (P&C) Insurance License
  • Anti-Fraud Professional Certified (AFPC)
  • Workers' Compensation Claims Professional (WCCP)
  • Certified Professional Public Adjuster (CPPA)
  • First Aid/CPR Certified
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Business Intelligence Professional (CBIP) for Claims Management

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