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Skills

  • Asbestos claims
  • Data-driven decision making
  • Customer service
  • Change management in claims processing policies
  • Relationship development
  • Planning and coordination
  • Project organization
  • Problem resolution
  • Insurance billing
  • Claims file management processes

Work Experiences

  • Was in charge of all tasks delegated to me, including strategic planning and client relations.
  • Used HubSpot to compile data gathered from various sources.
  • Assisted with strategic decisions on claims management.
  • Achieved on-time report delivery for 68% of deadlines.
  • Advised senior executives on claims cost control strategies.
  • Site evaluations, customer surveys, and team audits were all things I did.
  • Contacted injured parties and legal representatives to negotiate final settlements for claims.
  • Analyzed daily workflow for claim processing.
  • Worked closely with law enforcement and testified in criminal cases.
  • Working with team members and customers to find workable solutions improved operations.

Summaries

  • Motivating leader who has built and managed program teams in the past.
  • Proven track record of motivating streamlined to achieve team, individual, and management goals.
  • Strong technical skills and experience in workflow optimization.
  • Proficient in promoting initiative by leveraging quality assurance and vendor management knowledge.
  • Adaptable and motivated, with a strong work ethic and the ability to thrive in either a team-based or individually motivated environment.
  • 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.
  • Looking forward to taking on a new challenge with a successful team.
  • Achieved savings of $17 annually.
  • Advanced skills in implementing claims BI dashboards.
  • Advised senior leadership on risk minimization strategies.

Accomplishments

  • Led process improvements during a system integration, reducing claims processing time by 49% and improving overall operational efficiency.
  • Introduced standardized procedures for claims dispute tracking, enhancing resolution times and decreasing escalations by 77% per quarter.
  • Implemented a claims review process that enhanced data accuracy and reduced instances of duplicate claims by 45%, delivering more reliable results.
  • Identified key trends in historical claims data, contributing to the optimization of claims settlement processes and improving throughput by 82%.
  • Advanced claims validation processes through predictive modeling techniques, improving accuracy in claim verification by 56%.
  • Developed real-time dashboard reporting in Tableau that provided actionable insights to senior management, driving data-based decision-making.
  • Collaborated closely with the compliance team to ensure claims processing adhered to local and national data privacy standards, mitigating regulatory risks.
  • Developed advanced data models that identified fraudulent claims with a 45% success rate, reducing financial losses for the company.
  • Collaborated with cross-functional teams to design and implement a claims approval system, reducing departmental turnaround by 5 months per claim.
  • Acted as a data subject matter expert during a company-wide migration to method, ensuring claims data integrity throughout the transition.

Affiliations

  • Member, Institute of Industrial and Systems Engineers (IISE), Data-Driven Decision-Making Division
  • Active Member, International Institute of Business Analysis (IIBA) Claims Analytics Committee
  • Certified, Lean Six Sigma for Data Analysts in Health Insurance Claims Processing
  • Contributor, Health Insurance Fraud Detection Program in collaboration with category
  • Certified, Data Analytics with Certified Health Data Analyst (CHDA)
  • Affiliate, American Medical Informatics Association (AMIA) Data Science Working Group
  • Alumni, Health Insurance Technology & Analytics Leadership Program
  • Member, Data Visualization & Reporting for Insurance Claims Subgroup
  • Fellow, Institute for Operational Analytics in Insurance (IOAI)
  • Participant, Health Information and Management Systems Society (HIMSS) Annual Conference

Certifications

  • Certificate in Healthcare Reimbursement (CHR) - Vantage
  • Certified ScrumMaster (CSM) by Scrum Alliance
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Information Systems Security Professional (CISSP) by (ISC)²
  • SAS Certified Advanced Analytics Professional Using SAS 9
  • Project Management Professional (PMP) by program
  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Information Privacy Professional (CIPP/US)
  • Apple Certified Associate (ACA)
  • SHRM Certified Professional (SHRM-CP)

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