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Skills

  • Process automation
  • Business operations
  • Process improvement
  • Customer satisfaction
  • Workflow Optimization
  • CRM Systems
  • Territory Sales Experience
  • Account management
  • Positive learning process
  • Microsoft Office

Work Experiences

  • Established
  • Kept track of everything.
  • Responded quickly to customer concerns and resolved standard issues using performance reporting and cross-functional collaboration.
  • Raised the stakes.
  • Quickly identified problems and alerted Claims Clerk to any potential project delays.
  • Transported Microsoft Excel to 18 months customer locations.
  • Used Salesforce to accurately enter data into a batch ticketing system.
  • Had planned ahead.
  • Got better.
  • Provided management with process updates on renewal progress, at-risk renewals, and renewal forecasts.

Summaries

  • dependable self-starter looking for a position as a customer resolution specialist with a forward-thinking company.
  • Service-driven
  • Articulate
  • Expertise in overseeing product development from concept to completion, including packaging design, marketing, and promotional materials.
  • Focused on customer service
  • I worked on films that screened at Asians on Film Festival, Boston International Film Festival, Tri-Cities Fantastic Fest, and Mile High Horror Film Festival, among others.
  • Customer service specialist with 14 years of system experience who is dedicated and detail-oriented.
  • Leadership skills that have been demonstrated to drive enterprise optimization goals and improve organizational operations.
  • For future mailings and newsletters, the database has been updated with updated addresses and other alumni contact information.
  • Dependable and courteous self-starter and team player seeking to apply previous experience to a procedure position with a forward-thinking organization.

Accomplishments

  • Documented and resolved program which led to system.
  • Collaborated with adjusters and other stakeholders to resolve disputed claims, achieving a 51% resolution rate on contested cases.
  • Developed an in-depth understanding of medical and insurance terminology, ensuring accurate and efficient processing of specialized claims.
  • Validated and input claimant information into Salesforce system, decreasing record-keeping errors by 40%.
  • Resolved 60% of escalated customer claims related to medical billing errors, contributing to maintaining service level agreements (SLAs).
  • Investigated 3 fraudulent claims, saving the company approximately $66,000 in avoided payouts and maintaining compliance with industry regulations.
  • Proactively communicated with 10 external vendors and legal teams during legal disputes, ensuring timely and accurate settlements.
  • Achieved a 37% reduction in claim denials by implementing an enhanced eligibility verification process.
  • Collaborated with team of 12 in the development of metric.
  • Reduced claim processing time by 42% through the identification of bottlenecks and the automation of repetitive tasks.

Affiliations

  • Professional Liability Underwriting Society (PLUS)
  • Chartered Insurance Institute (CII) – Member
  • International Association of Claims Professionals (IACP)
  • International Association of Adjusting Professionals (IAAP)
  • Association of Information Technology Professionals
  • Society of Women Engineers
  • Health Care Compliance Association (HCCA)
  • Association for Supply Chain Management (APICS)
  • National Healthcare Anti-Fraud Association (NHCAA)
  • Society of Insurance Research (SIR)

Certifications

  • Claims Handling and Processing Certification, Ironclad Systems
  • Accredited Health Claims Assistant (AHCA), Northwind
  • Professional in Insurance Regulation (PIR), NAIC
  • Electronic Claims Specialist Certification, Beacon Labs
  • Health Insurance Associate (HIA) - initiative
  • Certified Insurance Examiner (CIE), The Insurance Regulatory Examiners Society
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Public Accountant (CPA)
  • Project Management Professional (PMP)
  • Certified Public Accountant

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