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Skills

  • Customer dispute resolution
  • Vendor relationship management
  • Claims System Evaluation
  • Fair Isaac Claims Advisor
  • Microsoft Office Suite
  • ClaimsPro
  • High-Liability Investigation
  • Stakeholder collaboration
  • Insurance software expertise (Tableau)
  • Cost Savings Analysis & Reporting

Work Experiences

  • Analyzed the data gathered during the investigation and wrote a report with my findings and recommendations.
  • Investigated claims and incident data in order to provide solutions and resolve issues.
  • Was in charge of directing and coordinating the field investigation team's investigations.
  • Handled standard calls about procedure processes from customers and other stakeholders.
  • Testified on behalf of the agency in criminal and civil proceedings.
  • Looked at the data to see what the underlying principles were.
  • Achieved an President's Club for outstanding claim resolution.
  • Analyzed historical claims data.
  • Fixed category codes so that standard claims could be properly classified.
  • Looked into and assessed property damage, as well as reviewing property damage estimates.

Summaries

  • Accomplished in investigating and resolving fraudulent claims, saving the company $9 in misallocated payouts annually.
  • Claims Examiner with extensive experience in the initiative claims industry.
  • Achieved improvements through cross-functional collaboration.
  • Award-winning professional recognized for efficient claim resolutions in 2015.
  • Adept at complex data analysis.
  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Expert at creating profitable and high-quality processes.
  • Collaborative team player with exceptional stakeholder coordination skills, reducing claim processing timelines by 16 days and strengthening organizational workflows.
  • Achieved over $16 in annual claims-related expense savings.
  • Strengths in vendor management and workflow optimization backed up by Miscellaneous training.

Accomplishments

  • Led cross-functional teams to resolve legal and regulatory challenges in complex claims, achieving a 81% reduction in time-to-resolution.
  • Actively participated in complex case roundtables with senior management, providing recommendations that led to expedited closure of 16% stagnant claims.
  • Achieved a 46% improvement in client satisfaction by managing expectations and maintaining clear communication throughout the claim lifecycle.
  • Reviewed and restructured high-exposure claims, resulting in reduced litigation expenses by 23%.
  • Collected and analyzed claims data to uncover systemic issues, subsequently implementing corrective action that decreased recurring claim patterns by 69%.
  • Streamlined the claims intake process through Workday automation, reducing manual errors and cutting claim initiation time by 79% hours.
  • Analyzed post-settlement feedback and integrated findings into continuous process improvements, enhancing overall claims efficiency by 61%.
  • Developed new continuity workflows in collaboration with marketing, resulting in a 34% increase in claims processing efficiency.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Presented detailed cost-benefit analyses to upper management, securing approval for process improvements that resulted in program savings of 10 annually.

Affiliations

  • Lions Club
  • National Association of Independent Review Organizations (NAIRO)
  • International Association of Insurance Professionals (IAIP)
  • Society of Financial Examiners (SOFE)
  • Institute for Healthcare Improvement (IHI)
  • Certified Professional in Healthcare Quality (CPHQ) Certification
  • National Advisory Committee on Insurance (NACI)
  • Society of Insurance Claims Professionals (SICP)
  • Claims and Litigation Management Alliance (CLM)
  • Healthcare Financial Management Association (HFMA)

Certifications

  • Apple Certified Associate (ACA)
  • Certified Specialist in Managed Care (CSMC)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Disability Management Specialist (CDMS)
  • ISO ClaimSearch Certification
  • CompTIA A+ Technician
  • Senior Professional in Insurance (SPI) – Chicago
  • Certified Workers' Compensation Professional (CWCP)
  • Certified Fraud Examiner (CFE) - Summit Group
  • Associate in Claims (AIC) - Meridian

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