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Skills

  • Account management
  • Organization
  • Customer service
  • Relationship development
  • Data-driven decision making
  • Supervision
  • Previous claims system migration leadership
  • Implementation of claims management software
  • Operational improvement
  • Liability claims management

Work Experiences

  • Conducted negotiations with providers to settle disputes, improving overall contractual adherence by 53%.
  • Collaborated with the finance department.
  • Communicated with stakeholders to ensure real-time updates on claims statuses, improving transparency and satisfaction across 7 accounts.
  • Kept track of all pending authorizations to resolve discrepancies and avoid revenue loss.
  • Achieved a 40% satisfaction rate.
  • Looked for industry trends on social media and through online sources.
  • Achieved overturned decisions on 74% of contested claims.
  • Achieved an average reduction of 51% in payout costs.
  • Collaborated closely with underwriters to identify at-risk claims populations, reducing potential loss exposure by $16.
  • Conducted negotiations with providers.

Summaries

  • Experienced metric Insurance Specialist with a track record of managing large caseloads in high-pressure situations.
  • Strengths in vendor management and team leadership backed up by Miscellaneous training.
  • Consistently met deadlines.
  • Empathy, dependability, and enthusiasm for customer satisfaction.
  • Applied standard operating procedures to cut legal risks by 65%.
  • Bringing 16 years of insurance experience to the table.
  • Achieved a settlement success rate of 22%.
  • Claims Coordinator with 3 years of experience, dedicated to providing personalized, courteous service.
  • Collaborative and detail-oriented Claims Coordinator.
  • Effective at managing phone calls, emails, letters, and in-person requests for assistance while adhering to initiative regulations and method department guidelines.

Accomplishments

  • Exceeded annual claims closure targets by 41% through close monitoring of cases and proactive follow-up with all key stakeholders.
  • Negotiated with third-party vendors and legal counsel, settling claims valued at $2, reducing legal exposure by 56%.
  • Resolved product issue through consumer testing.
  • Contributed to the optimization of framework, achieving a 58% improvement in workflow automation.
  • Reviewed claims documentation for adherence to Ohio regulatory standards, ensuring compliance levels of 65%.
  • Facilitated communication between claimants, third-party administrators, and initiative to resolve disputes without litigation in 44% of cases.
  • Revised claims payment processes, reducing operational overhead by 81% and shortening cycle time by 9 days.
  • Developed training materials on budget management, improving compliance and reducing processing errors by 24%.
  • Designed and implemented standard for claims processing, reducing average claims cycle time by 23% days.
  • Reduced operational costs by $5 through effective negotiation and resolution of third-party medical claims.

Affiliations

  • Society of Women Engineers
  • Medical Claim Professionals Network (MCPN)
  • American Marketing Association
  • Workers' Compensation Institute (WCI)
  • American Society of Safety Professionals
  • International Institute of Loss Adjusters (IILA)
  • Jaycees
  • Lions Club
  • Certified Claims Professional Accreditation Council (CCPAC)
  • Certified Professional Coder (CPC) through AAPC

Certifications

  • Cisco Certified Internetwork Expert (CCIE)
  • Salesforce
  • Health Care Compliance Certification (CHC)
  • AHIMA Certified Health Data Analyst (CHDA)
  • Compliance Certification for IME Professionals (CIME)
  • Certified Professional in Healthcare Quality (CPHQ)
  • Data-driven Claims Process Improvement Certification
  • Certified in General Insurance (CGI)
  • SHRM Certified Professional (SHRM-CP)
  • Chartered Property Casualty Underwriter (CPCU)

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