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Skills

  • Claims lifecycle management
  • Organization
  • Prior authorization processing
  • Compliance with industry standards (standard)
  • Data security and privacy adherence (system)
  • Key account management
  • Customer dispute resolution
  • Customer service
  • Insurance coverage verification
  • Error Reduction Strategies

Work Experiences

  • Developed claim adjustment strategies.
  • Achieved a 40% boost in valid policy submissions.
  • Transported Tableau to several months customer locations.
  • Built strong client relationships, resulting in a 31% increase in renewal rates within the first 13 months.
  • Followed strict procedures to safeguard sensitive patient data, such as medical records and payment information.
  • Acted as a liaison between claimants and outside vendors, improving service coordination and satisfaction rates by 34%.
  • Consistently achieved claims approval rate of 83% through precise documentation and timely follow-ups.
  • Adjusted team workloads.
  • Decreased manual intervention by 75%.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.

Summaries

  • Adept at training junior team members, resulting in a department-wide productivity increase of 80% through structured mentorship and training in Jira.
  • Achieved a 69% yearly increase in processed claims.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Achieved a 42% reduction in errors.
  • Within Miscellaneous, senior Claims Advisor and outstanding performer in workflow optimization and budget management.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Claims Advisor is a multi-talented Claims Advisor who is consistently rewarded for planning and operational improvements.
  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate method systems is one of my specialties.
  • Claims Advisor with 12 years of successful cross-functional collaboration and budget management experience.
  • Boosted departmental performance by 65% %.

Accomplishments

  • Implemented a claim tracking system that enabled a 62% faster customer follow-up, improving post-claim consultation ratings.
  • Leveraged Microsoft Excel to streamline claims processing, leading to a 58% improvement in claims approval speed.
  • Documented and resolved system which led to metric.
  • Trained staff on updated insurance compliance for Columbus, improving overall adherence to regulatory standards by 35%.
  • Collaborated with key stakeholders to develop new claim evaluation criteria, minimizing claim processing discrepancies by 65%.
  • Increased operational efficiency by implementing Microsoft Excel for claims processing, reducing data entry time by 34%.
  • Consistently exceeded client expectations by adhering to insurance compliance protocols for Raleigh, resulting in a 51% reduction in compliance issues.
  • Led a cross-functional team in the resolution of high-priority claims, reducing overall claims processing time by 5 days.
  • Decreased claim cycle time for Adobe Creative Suite by 7 days through workflow optimization and technology improvement using HubSpot.
  • Assumed responsibility for high-risk claims, successfully achieving a 46% reduction in claim settlement durations.

Affiliations

  • International Association of Special Investigation Units (IASIU)
  • International Council of Nurses
  • National Association of Social Workers
  • Institute of Risk Management (IRM)
  • American Institute for CPCU and Insurance Institute of America (AICPCU/IIA)
  • Society of Claims Law Associates (SCLA)
  • Certified Claims Professional Accreditation Council (CCPAC)
  • National Subrogation Strategies Association
  • Society of Women Engineers
  • Property Liability Research Bureau (PLRB)

Certifications

  • Health Claims Certification (HCC) – Harbor & Co.
  • Xactimate Certification – Level framework – Power BI
  • Workers' Compensation Certified (WCC) – Oregon
  • Certified Legal Principles Claims Specialist (CLPCS)
  • Certified Claims Professional (CCP)
  • CompTIA Network+
  • Certified Business Analysis Professional (CBAP)
  • Certificate in Insurance Fraud Detection – Lakeside Partners
  • Accredited Claims Adjuster (ACA) – Cedar Works
  • Certified Fraud Examiner (CFE) - Summit Group

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