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Skills

  • Planning and coordination
  • Operational efficiency
  • Communications
  • Xactimate specialist
  • Process improvement
  • Auto-adjudication rule configuration
  • Supervision
  • Insurance fraud expertise
  • Analytical
  • Report writing

Work Experiences

  • Auto-detected fraudulent claims.
  • Interviews were conducted, detailed information was gathered, and field investigations were completed.
  • Automated the generation of performance reports.
  • Working with team members and customers to find workable solutions improved operations.
  • Looked at the initial reports of loss and the underlying file material to see if the claim was legitimate.
  • Kept my standard knowledge up to date by doing stakeholder engagement and cross-functional collaboration.
  • Achieved $5 cost savings.
  • Site evaluations, customer surveys, and team audits were all things I did.
  • Achieved President's Club for process efficiency.
  • Championed a major upgrade initiative for claims processing systems, which improved system uptime by 6%.

Summaries

  • Achieved 81% faster claims settlement timelines.
  • Multilingual and fluent in German and French, with a strong grasp of cultural differences.
  • Student pursuing a Miscellaneous degree who is eager to contribute developed knowledge in the role of Claims Automation Process Specialist.
  • Communicative and team-oriented, with Microsoft Excel expertise.
  • Accomplished leader in automating repetitive claims tasks, handling an additional 2 claims monthly, allowing for focused attention on higher-priority cases.
  • Strong technical skills and experience in budget management.
  • Comprehensive claims adjustment knowledge, with a focus on auto appraisals and CCC pathway estimations.
  • Achieved 6% reduction in system downtime.
  • Adept at integrating feedback mechanisms.
  • Team leadership in initiative settings and cross-functional collaboration in process improvement settings.

Accomplishments

  • Leveraged API automation to integrate disparate claims management tools, cutting claim-handling times by 9 hours across multiple departments.
  • Spearheaded a digital transformation initiative that cut claims processing time by 48% and improved customer satisfaction ratings.
  • Reduced claims processing time for high-priority cases by implementing intelligent task routing, which cut response time by 7 days.
  • Collaborated with compliance teams to introduce automated audit tracking, leading to Innovation Award for regulatory excellence in 2018.
  • Led cross-functional teams to implement AI-driven automation in the claims division, boosting process efficiency by 77% within 2 months.
  • Led claims automation process redesign efforts, successfully reducing error rates by 30% and ensuring a smoother workflow across departments.
  • Developed and executed an automation strategy that integrated SAP, reducing the time required for claims submission by 16 hours per week.
  • Partnered with technology vendors to implement scalable automation solutions, decreasing overall claims processing expenses by 22%.
  • Championed automation of claims processing tasks, resulting in a 64% faster claims cycle time while reducing manual errors.
  • Automated compliance checks for claims, reducing regulatory processing time by 18% and ensuring Six Sigma standards were met.

Affiliations

  • Member, Network for Automation in Insurance Claims Solutions, Atlanta, 2020
  • Active Member, Data Compliance and Automation Specialists Network (DCASN), 2019 – Present
  • Member, International Automated Claims Taskforce (IACT), focusing on error reduction strategies, 2015 – 2024
  • Keynote Speaker, National Claims Process & Automation Conference, 2019, Topic: Optimizing Claims with Automation
  • Automation Process Specialist Member, Institute for Robotic Process Automation & AI (IRPA AI), 2016 – Present
  • Certified Robotics Process Automation Developer, Blue Prism, with focus on claims adjudication automation, 2019
  • Professional Member, Institute of Enterprise Automation for Claims, 2017 – Present
  • Certified Member, Digital Claims Processing Network, specialized in claims automation innovations, 2018
  • Member, Association for Information and Image Management (AIIM), supporting claims process digitalization, 2024 – 2019
  • Participant, American Claims Excellence Network (ACEN), specializing in implementation of automation solutions, 2023 – 2018

Certifications

  • Certified Claims Professional (CCP) - Summit Group
  • Certified Advanced RPA Developer – UiPath
  • CompTIA Network+
  • Amazon Web Services (AWS) Certified Associate – Cloud Practitioner
  • Certified Business Process Professional (CBPP) from the Association of Business Process Management Professionals (ABPMP)
  • SAP Certified Application Associate
  • Certified Claims Analytics Professional (CCAP) – Ironclad Systems
  • Enterprise Architect Certified Professional by The Open Group (TOGAF)
  • Insurance Automation Specialist Certification – system 2017
  • Certified Workflow Automation Specialist – procedure 2019

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