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Skills

  • Insurance industry experience
  • Claims review cycle time reduction
  • Customer service
  • Settlement Negotiation
  • Claims Auditing
  • Great mathematical skills
  • Business operations
  • Continuous process improvement
  • Communications
  • Claims processing software (SAP)

Work Experiences

  • Accelerated ramp-up time by 84%.
  • Established proof of loss by reviewing medical records and launching or conducting investigations into disputed claims.
  • Collaborated with legal teams to assess liability for complex claims, contributing to a 38% win rate in contested cases.
  • Was in charge of processing and recording new policies and claims.
  • Communicated with clients, distributed mail, and scanned documents as part of my administrative duties.
  • Collaborated with insurance adjusters.
  • Assessed liability for complex claims.
  • Preparing correspondence, maintaining records, managing databases, and distributing incoming correspondence were some of my general office duties.
  • Adjustments, premiums, and refunds were all calculated by me.
  • Existing policies were modified, updated, and processed by me.

Summaries

  • Claims Administration Processor with 6 years of successful strategic planning and vendor management experience.
  • Filing, data entry, and keeping a clean and organized work environment are all skills I have.
  • Hardworking Claims Administration Processor with 14 years of telecommuting experience meeting customer needs.
  • Over 12 years of experience obtaining information from policyholders and assisting with claim forms as an honest Insurance Clerk.
  • Within Miscellaneous, senior Claims Administration Processor and outstanding performer in risk assessment and data analysis.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Clear understanding of team leadership and budget management as well as project management training.
  • Achieved 100% accuracy during a recent audit.
  • Achieved a 32% claim recovery rate.
  • Achieved a 58% improvement in overall efficiency.

Accomplishments

  • Led process improvement initiatives that improved claim resolution rates by 59%, contributing to a 7 increase in customer satisfaction scores.
  • Collaborated with underwriters to resolve complex insurance claims, expediting high-priority cases over $4 by 82%.
  • Trained new hires in claims processing systems, reducing onboarding time by 73% and increasing team competency.
  • Managed claims intake and documentation using Adobe Creative Suite, resulting in improved data integrity and a 42% reduction in processing delays.
  • Reduced claim processing errors by 35% through the implementation of an automated quality-check system within the claims workflow.
  • Collaborated with team of 8 in the development of procedure.
  • Processed and documented high-complexity claims for standard insurance products, achieving 21% accuracy during internal auditing.
  • Resolved product issue through consumer testing.
  • Refined claims processing workflows resulting in a 61% reduction in processing time for high-priority claims.
  • Reviewed 7 closed claims to provide feedback for continuous process improvement, ultimately improving departmental accuracy metrics by 60%.

Affiliations

  • Insurance Regulatory Examiners Society (IRES)
  • American Society of Workers’ Comp Professionals (AMCOMP)
  • American Health Information Management Association (AHIMA)
  • Claims and Litigation Management Alliance (CLM)
  • Association of Information Technology Professionals
  • Accredited Claims Adjuster Program
  • National Healthcare Anti-Fraud Association (NHCAA)
  • Institute for Healthcare Improvement (IHI)
  • National Risk Retention Association (NRRA)
  • International Claim Association (ICA)

Certifications

  • Certified Disability Management Specialist (CDMS)
  • SHRM Certified Professional (SHRM-CP)
  • Salesforce
  • Medical Loss Management Certification
  • CompTIA Security+
  • Certified Health Insurance Specialist (CHS)
  • Certified Fraud Examiner (CFE)
  • Certified Professional in Healthcare Risk Management (CPHRM)
  • Cisco Certified Internetwork Expert (CCIE)
  • National Medicare Training Program by Lakeside Partners

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