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Claims Data Analyst resume examples

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Skills

  • Workers’ compensation claims
  • Conflict resolution in claims disputes
  • MS Office
  • Change management in claims processing policies
  • Operational improvement
  • Database management
  • CCTV
  • Business intelligence (BI) dashboard creation
  • Cross-functional team collaboration
  • Compliance with data privacy regulations

Work Experiences

  • Achieved 78% revenue impact.
  • Applied knowledge of CPA methodologies to develop risk models that reduced claims overpayments by 30%.
  • Audited claims closing processes, identifying workflow inefficiencies and reducing average settlement time by 58% days.
  • Saved money by developing functional solutions to procedure problems.
  • Built relationships with local fraud bureaus, district attorneys' offices, and professional organizations.
  • Coordinated field reviews and worked with underwriting on loss reserves and risk assessment.
  • Advised senior executives on claims cost control strategies.
  • Answered 14 phone calls per two years to assist customers.
  • Worked closely with law enforcement and testified in criminal cases.
  • Interviews were conducted, detailed information was gathered, and field investigations were completed.

Summaries

  • Achieved 56% faster claims processing times.
  • Ability to recognize standard issues and integrate system solutions to achieve metric.
  • Communicative and team-oriented, with Workday expertise.
  • Analytical and detail-oriented Claims Data Analyst with an outstanding ability to design, maintain, and optimize SQL queries, reducing analysis times by 38% and driving actionable insights for senior management.
  • Advised senior leadership on risk minimization strategies.
  • Comprehensive claims adjustment knowledge, with a focus on auto appraisals and CCC pathway estimations.
  • Working with stakeholders and corporate teams is a breeze for this strong relationship builder.
  • Adept at enforcing data privacy compliance.
  • Adept Claims Data Analyst with hands-on experience improving department efficiency by 73%, driving fraud detection improvements, and ensuring compliance with data privacy laws for 11 high-stakes clients.
  • Claims Data Analyst with process improvement and cross-functional collaboration abilities.

Accomplishments

  • Partnered with external vendors to integrate third-party data for trend analysis, resulting in 17 in new product development opportunities.
  • Co-led a cross-departmental initiative to overhaul the business intelligence platform, significantly improving the accuracy and speed of claim analysis reports.
  • Collaborated closely with the compliance team to ensure claims processing adhered to local and national data privacy standards, mitigating regulatory risks.
  • Exceeded accuracy expectations by conducting thorough data audits and ensuring 61% compliance with internal risk and claims management protocols.
  • Developed business rules to automate repetitive claims data entry processes, reducing data submission errors by 21%.
  • Developed real-time dashboard reporting in Tableau that provided actionable insights to senior management, driving data-based decision-making.
  • Compiled claims performance data into automated reports using advanced Excel features, reducing manual operations and saving 46% time per month.
  • Identified and resolved claims discrepancies within insurance datasets, leading to improved accuracy and minimized processing errors by 70%.
  • Advanced claims validation processes through predictive modeling techniques, improving accuracy in claim verification by 56%.
  • Acted as a data subject matter expert during a company-wide migration to method, ensuring claims data integrity throughout the transition.

Affiliations

  • Alumni, Health Insurance Technology & Analytics Leadership Program
  • Volunteer, Claims Processor and Data Analyst Training Seminar Leader at Summit Group
  • Certified, Lean Six Sigma for Data Analysts in Health Insurance Claims Processing
  • Member, Society of Insurance Research (SIR), Claims Data Special Interest Group
  • Member, Institute of Industrial and Systems Engineers (IISE), Data-Driven Decision-Making Division
  • Certified, Claims Analytics Professional through initiative
  • Certified, Microsoft Power BI Professional for Insurance Claims Processing
  • Educational Member, Claims Data Analytics and Strategy Forum
  • Member, Association of Data Scientists for Health Insurance
  • Active Participant, Society of Actuaries (SOA), Health Section Analysis Team

Certifications

  • Certified Analytical Professional in Insurance Claims - Ironclad Systems
  • Tableau Desktop Specialist Certification
  • R Programming Certification by Adobe Creative Suite
  • Certified Public Accountant (CPA)
  • Cisco Certified Network Associate (CCNA)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Data Management Professional (CDMP)
  • Certified Information Systems Security Professional (CISSP) by (ISC)²
  • SQL Server Database Certification standard
  • AWS Certified Data Analytics – Specialty

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