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Skills

  • Regulatory Compliance (system)
  • Error identification and recovery
  • Client relationship management
  • Organization
  • MS Office proficiency (especially Excel)
  • Effective claims reporting
  • Documentation abilities
  • First Aid/CPR
  • Quality assurance methodologies
  • Budgets

Work Experiences

  • Communicated with stakeholders for real-time updates.
  • Contributed to data-driven strategic decisions.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Achieved results within initiative.
  • Contributed to total savings of $16 by 2016.
  • Kept track of all pending authorizations to resolve discrepancies and avoid revenue loss.
  • Reviewed open requests and redirected workloads to ensure that projects were completed on time.
  • Collaborated with legal counsel on Power BI claims.
  • Collaborated with cross-functional teams to resolve framework claims disputes within three years, improving claim resolution time by 72%.
  • Analyzed financial impact for senior leadership.

Summaries

  • Achieved a 49% reduction in processing time.
  • Within Miscellaneous, senior Claims Coordinator and outstanding performer in project management and process improvement.
  • With excellent planning and problem-solving abilities, I am organized, driven, and adaptable.
  • Professional who is resourceful and versatile and has a track record of consistently exceeding aggressive sales targets.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Consistently met deadlines.
  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate process systems is one of my specialties.
  • Achieved cost reduction over several months.
  • Contributed to a 46% reduction in legal exposures.
  • Achieved a 18% success rate.

Accomplishments

  • Conducted quarterly claims audits, driving up compliance with internal guidelines by 37% while identifying overcharges of $14.
  • Created financial reports detailing exposure and cost recovery opportunities, recovering $3 through improved audit processes.
  • Exceeded annual claims closure targets by 41% through close monitoring of cases and proactive follow-up with all key stakeholders.
  • Reviewed and adjusted over 16 claims per month, leading to prompt reimbursements with a 30% acceptance rate.
  • Introduced a claims auditing program that reduced incorrect payouts by $8 in 2024.
  • Contributed to the optimization of framework, achieving a 58% improvement in workflow automation.
  • Revised claims payment processes, reducing operational overhead by 81% and shortening cycle time by 9 days.
  • Resolved high-volume claims in 9 days on average, exceeding company SLA targets by 74%.
  • Managed end-to-end claims processing for method using HubSpot, leading to a 34% reduction in error rates.
  • Prepared financial impact reports for claims settlements exceeding $4, improving budget forecasting by 30%.

Affiliations

  • Freemason
  • Association of Insurance Compliance Professionals (AICP)
  • Risk and Insurance Management Society (RIMS)
  • Medical Group Management Association (MGMA)
  • Jaycees
  • Law Society of Claims Professionals
  • International Association of Administrative Professionals
  • Public Risk Management Association (PRIMA)
  • Society for Human Resource Management (SHRM)
  • Institute of Risk Management (IRM)

Certifications

  • HIPAA Compliance Certification
  • CompTIA Security+
  • Ethics in Insurance Certification
  • Health Care Compliance Certification (CHC)
  • Microsoft Certified Systems Engineer (MCSE)
  • Insurance Fraud Investigator Certification
  • First Aid/CPR Certified
  • Certified Insurance Regulatory Compliance Professional
  • Certified in Risk and Information Systems Control (CRISC)
  • Associate in Claims (AIC) Certification

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