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Skills

  • Conflict resolution
  • Customer communication
  • Valuation knowledge
  • Public speaking
  • Team training and development
  • Process implementation
  • Extremely organized
  • Clerical support
  • Data analysis
  • Staff development

Work Experiences

  • Handled metric calls about framework processes from customers and other stakeholders.
  • Calculated the quantifiable features of program products.
  • Was in charge of directing and coordinating the field investigation team's investigations.
  • Metric helped me achieve $235,000.
  • Kept track of 9-clients' caseload for each quarter.
  • Investigated potentially fraudulent claims that claims representatives had initiated.
  • Examined claim forms and other records to determine insurance coverage.
  • Worked with the claims department and industry anti-fraud organizations to resolve claims.
  • Conducted in-depth interviews with witnesses and claimants to gather facts and information.
  • Local, state, and federal agencies provided me with documents, clearances, certificates, and approvals.

Summaries

  • Framework are well-understood.
  • Top-producing salesperson and industry expert in Miscellaneous.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the system business.
  • Criminal investigation, insurance fraud, and surveillance are all part of his background.
  • Strong understanding of claimant intake processes, record documentation, and fraud investigation protocols.
  • Negotiates fair and thorough resolutions to all claims in a peaceful manner.
  • Costs were consistently reduced while profits were increased.
  • Strong conflict resolution and negotiation skills, as well as excellent reporting and research abilities.
  • Among his accomplishments is the creation of a metric app for use in the category industry.
  • Accomplished Claims Administrator.

Accomplishments

  • Recommended
  • Assisted in the implementation of initiative, streamlining claims handling processes and reducing processing time by 52%.
  • Represented
  • Researched
  • Proposed
  • Increased
  • Reduced
  • Documentation: Wrote and edited documents to keep staff informed on policies and procedures.
  • Developed training modules on claims fraud prevention, increasing detection by 25% over the span of 7 months.
  • Trained

Affiliations

  • Injury & Disability Claims Management Network
  • Legal and Regulatory Compliance Professionals Forum
  • National Association of Social Workers
  • Association for Computing Machinery
  • Health Care Compliance Association (HCCA)
  • Chartered Insurance Institute (CII)
  • Project Management Institute
  • Toastmasters
  • Risk and Insurance Management Society (RIMS)
  • Certified Compliance & Ethics Professional (CCEP)

Certifications

  • Insurance Data Specialist (IDS) - initiative
  • CompTIA Network+
  • National Alliance Certified Insurance Counselor (CIC)
  • Certified Customer Service Representative (CCSR) - standard
  • ServSafe
  • SHRM Certified Professional (SHRM-CP)
  • Fraud Claims Law Specialist (FCLS) - metric
  • Regulatory Compliance Management Certification (RCM) - process
  • Property Claims Law Associate (PCLA) - system
  • Salesforce

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