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Skills

  • Legal case collaboration for liability disputes
  • Investigative techniques for fraud prevention
  • Insurance policy interpretation and application
  • Operational improvement
  • Advanced claims software proficiency (HubSpot, QuickBooks)
  • Analytical problem-solving strategies
  • Fraud Detection and Investigation
  • Relationship development
  • Quality assurance in claims processing
  • Root cause analysis in claims investigation

Work Experiences

  • Collaborated with legal experts to assess liability.
  • Balanced a caseload of 9 claims.
  • Collaborated with local legal teams.
  • Determined liability as outlined in the coverage and assessed documentation from police and healthcare providers to understand the damages incurred.
  • Collaborated with the IT team to upgrade claims processing software, shortening the lifecycle of claims by 56% days.
  • Assessed damages for Salesforce claims.
  • Achieved results within 2019.
  • Achieved savings in 2016.
  • Achieved savings of $11 for the company.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.

Summaries

  • Analyzed trends to improve efficiency.
  • Achieved resolution rates 68% faster than department averages.
  • Achieved timely settlements.
  • Achieved $13 in savings through expert fraud investigations and a thorough understanding of personal injury and workers' compensation cases.
  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Clear understanding of quality assurance and process improvement as well as risk assessment training.
  • Astute insurance professional with 8+ years of experience assessing properties, determining liabilities, and negotiating settlements.
  • Accomplished in negotiating settlements for large loss claims, securing $11 in savings across 9 cases with favorable outcomes in 2023.
  • Claims Adjustor with 13 years of successful cross-functional collaboration and data analysis experience.

Accomplishments

  • Developed workflow automation strategies, resulting in a decline in claims backlogs by 70% within the first 3 months.
  • Significantly reduced claims costs by identifying and mitigating excessive or inflated medical bills within workers’ compensation claims.
  • Trained and mentored a team of junior adjustors in specific strategies for faster claims resolution; improved team output by 16% in under 13 months.
  • Recovered $16 through detailed subrogation processes to boost recovery rates across multiple lines of insurance claims.
  • Co-developed a fraud detection protocol that reduced fraudulent claims by 36% through rigorous data monitoring and adjusted processes.
  • Collaborated with team of 12 in the development of initiative.
  • Contributed to team efforts that reduced overall claim cycle time by 9 days, significantly improving operational efficiency.
  • Balanced a caseload of 10 claims per month while consistently maintaining a quality score above 71%.
  • Utilized Microsoft Excel to streamline claims documentation and reporting, reducing human error and auditing rejections by 72%.
  • Reduced complaint resolution time from 4 days to 13 days, raising customer satisfaction scores by 39% through a new streamlined communication process.

Affiliations

  • Association for Supply Chain Management (APICS)
  • Global Association of Risk Professionals (GARP)
  • Society of Insurance Research (SIR)
  • American Educational Research Association (AERA) – Risk Management Division
  • Lions Club
  • International Association of Special Investigation Units (IASIU)
  • Risk and Insurance Management Society, Inc. (RIMS)
  • Association of Information Technology Professionals
  • Professional Liability Underwriting Society (PLUS)
  • Institute of Risk Management (IRM)

Certifications

  • Property Technical Certification (PTC) – Meridian
  • SHRM Certified Professional (SHRM-CP)
  • Fraud Claims Law Specialist (FCLS) - Harbor & Co.
  • CompTIA A+ Technician
  • Associate in Risk Management (ARM) - Harbor & Co.
  • Chartered Property Casualty Underwriter (CPCU) - Harbor & Co.
  • Certified Vehicle Damage Appraiser (CVDA) - Northwind
  • Certified Claims Professional (CCP) - Ironclad Systems
  • Certified Risk Manager (CRM) - Lakeside Partners
  • Certified Public Accountant

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