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Skills

  • Regulatory compliance
  • Claims system automation
  • Time management
  • Advanced use of standard
  • Audit process design
  • Customer service
  • MS Office
  • Conflict resolution
  • Client relationship management
  • Arbitration and Mediation Expertise

Work Experiences

  • Collaborated cross-functionally with IT and Operations to integrate AI-supported claims automation software, cutting down manual entries by 21%.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Completed daily reviews of medical claim reports and disputes, resulting in consistent claim approval time being reduced to 16 days.
  • Analyzed the data gathered during the investigation and wrote a report with my findings and recommendations.
  • Achieved results in 2024.
  • Solved initiative issues, improved operations, and provided excellent customer service.
  • Aided in insurance coverage adjustments.
  • Examined claim forms and other records to determine insurance coverage.
  • Collaborated with adjusters, legal teams, and claimants on complex cases, driving a 76% settlement rate reduction in 2022.
  • Reviewed original investigation reports and documents to address secondary concerns.

Summaries

  • Accomplished Claims Adjustment Specialist.
  • Accomplished Claims Adjustment Specialist with strong negotiating abilities, consistently delivering settlements within a $18 budget while ensuring customer satisfaction ratings exceeding 44%.
  • Claim analysis expert with a focus on reducing organizational inefficiencies, contributing to an overall claims assessment reduction of 17% % through digital innovation.
  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Achieved 38% improvement in claims team productivity.
  • Hardworking Claims Adjustment Specialist with 11 years of telecommuting experience meeting customer needs.
  • Accomplished in using program for claims tracking.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Achieved high settlement accuracy.
  • Achieved annual savings of $2 through prevention of fraudulent claims.

Accomplishments

  • Reduced a claims backlog by processing and finalizing 12 claims in less than 12 months, improving overall case closure rates by 41%.
  • Reduced claims investigation times by 29% through improvements to data collection and analysis using ServiceNow.
  • Implemented a data-driven approach to claims evaluation, identifying cost-saving opportunities and reducing company's claim expenses by $16 annually.
  • Reduced claims adjustment costs by $17 annually by negotiating more cost-effective vendor partnerships while maintaining service quality.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Utilized process to reduce resolution time for claims by 21% through enhanced tracking and automated workflow solutions.
  • Reviewed and processed over 16 claims per month, resulting in a 74% increase in efficiency using streamlining techniques.
  • Analyzed injury-related worker’s compensation claims, successfully identifying key trends, which led to a decrease of claims by 71% in 2017.
  • Reviewed and analyzed insurance policies against 10 multi-million dollar claims resulting from natural disasters, securing settlements efficiently in 9 cases.
  • Resolved product issue through consumer testing.

Affiliations

  • Rotary International
  • Society of Human Resource Management
  • Jaycees
  • Liability Insurance Research Bureau (LIRB)
  • Council on Litigation Management (CLM)
  • Toastmasters
  • Healthcare Financial Management Association (HFMA)
  • Claims and Litigation Management Alliance (CLM)
  • Fraud Prevention Professionals Network
  • National Association of Independent Insurance Adjusters (NAIIA)

Certifications

  • Risk and Compliance Certification for Claims Adjusters (RCCA)
  • Auto Claims Adjuster Certification by system
  • First Aid/CPR Certified
  • Certified Insurance Fraud Investigator (CIFI)
  • ISO Claims Partner Certification (2021)
  • Certified Insurance Data Analyst (CIDA)
  • Certified Professional Public Adjuster (CPPA)
  • Customer Service and Claims Communication Training (2020)
  • Associate in Risk Management (ARM)
  • Certified Catastrophic Claims Adjuster via process

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