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Skills

  • Claims data analysis
  • ClaimsPro
  • Database management for claims tracking
  • Claims Management System Modernization
  • Customer dispute resolution
  • Subrogation expert
  • Cross-departmental coordination
  • Microsoft Publisher
  • AMS360
  • Compliance auditing

Work Experiences

  • Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
  • Authored detailed claims assessments.
  • Collaborated with regional adjusters.
  • Maintained a suspicious claims database and prepared supervisory reports on a the past year basis.
  • Examined claim forms and other records to determine insurance coverage.
  • Achieved cost savings of $5 annually.
  • Achieved a favorable resolution in 26% of cases.
  • Conducted policyholder interviews to effectively gather necessary data, reducing investigation time by 58%.
  • Investigated and analyzed insurance claims that appeared to be suspicious or potentially fraudulent.
  • Developed positive working relationships with government officials and police officers.

Summaries

  • Solid skills in formulating goals and strategies for resolving initiative claims.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Claims Case Manager excels in implementing documentation standards that reduce errors and denials by 84%. Adept at improving processes and ensuring claim resolution accuracy.
  • Accomplished Claims Case Manager.
  • For 18 months, I've been a member of the National Society of Professional Insurance Investigators.
  • Clear understanding of project management and performance reporting as well as project management training.
  • Advanced problem-solving skills.
  • Complete knowledge of the claims process and strategic planning.
  • Negotiates fair and thorough resolutions to all claims in a peaceful manner.
  • Claims Case Manager is a multi-talented Claims Case Manager who is consistently rewarded for planning and operational improvements.

Accomplishments

  • Collaborated with underwriting teams to ensure proper risk assessment, leading to a 76% reduction in denied claims and improved overall profits.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Developed and executed tailored communication plans for complex claims, reducing resolution times by 49% and improving stakeholder transparency.
  • Mentored and developed new team members on claims resolution strategies, leading to a 39% improvement in first-round case resolutions.
  • Developed and maintained a claims case database, improving analytical reporting capabilities and identifying key inefficiencies in 2019.
  • Coordinated a cross-departmental project to finalize complex claims, reducing dormant caseloads by 37% within 17 months.
  • Led cross-functional teams to resolve legal and regulatory challenges in complex claims, achieving a 81% reduction in time-to-resolution.
  • Created escalation protocols for handling high-risk claims, which improved the department’s ability to resolve critical cases by 78%.
  • Ran comprehensive monthly performance reviews, adapting case handling strategies to achieve a 59% reduction in average case resolution times.
  • Streamlined the claims intake process through Workday automation, reducing manual errors and cutting claim initiation time by 79% hours.

Affiliations

  • Association for Supply Chain Management (APICS)
  • National Council of Compensation Insurance (NCCI)
  • American College of Healthcare Executives (ACHE)
  • American Association of Health Plans (AAHP)
  • Professional Association of Healthcare Office Management (PAHCOM)
  • American Board of Independent Medical Examiners (ABIME)
  • National Association of Subrogation Professionals (NASP)
  • Association of Information Technology Professionals
  • ERI Economic Research Institute – Data and Compensation Reporting
  • National Association of Professional Advisors (NAPA)

Certifications

  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Claims Professional (CCP)
  • Certified Fraud Specialist (CFS) - Beacon Labs
  • Designation in Medical Risk Adjustment & Exposure Management – Meridian
  • Certified Disability Management Specialist (CDMS)
  • Salesforce
  • Certified Fraud Examiner (CFE) - Summit Group
  • Certified Business Analysis Professional (CBAP)
  • Google Certified Professional Cloud Architect
  • Associate in Risk Management (ARM) - Beacon Labs

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