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Skills

  • Claims Auditing
  • Compliance with industry regulations
  • Customer Satisfaction Enhancement
  • Time management and prioritization
  • Fraud detection and prevention
  • Team management
  • Cross-functional team collaboration
  • Industry trend analysis
  • First Aid/CPR
  • Leadership in team settings

Work Experiences

  • Collaborated across departments to reduce customer claims processing cycle time by 66%, improving overall satisfaction.
  • Collaborated with cross-functional teams to redesign the claims reporting system, reducing reporting times by 44% hours.
  • Looked for industry trends on social media and through online sources.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Boosted claims accuracy.
  • Had an excellent attendance record and was always on time for work.
  • Achieved cost savings of $8 over 2016 period.
  • Collaborated across departments.
  • Achieved a 48% reduction in customer complaints.
  • Collaborated with cross-functional teams.

Summaries

  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Achieved results in the past the past year.
  • Achieved cost efficiencies.
  • Accomplished leader with a history of restructuring workflows.
  • Boosted claims accuracy by 75%.
  • Bi-lingual Claims Manager with over 15 years of leadership experience, recognized for improving claims outcomes through streamlined communication and teamwork.
  • Establishes top-performing claims departments by combining strategic planning and leadership skills.
  • Achieved 19% win rates in disputed cases.
  • Achieved a 34% faster claims resolution rate.
  • Achieved a 78% increase in staff productivity.

Accomplishments

  • Achieved a 47% reduction in manual entry errors by introducing an automated claims tracking system.
  • Coached and mentored new hires, which led to a 30% decrease in employee churn and improved retention of experienced staff members.
  • Developed and launched employee training programs focused on claims handling and fraud detection, improving overall team performance by 31%.
  • Streamlined claim adjudication processes by reducing turnaround time by 46% through optimization of workflows.
  • Led a team of 17 to implement AI-based tools for fraud detection, which improved the identification of fraudulent claims by 78%.
  • Collaborated with legal and compliance teams to review 2 contested claims, mitigating company litigation risk by 79%.
  • Implemented performance metrics that reduced claim processing delays by 58% across customer success.
  • Designed and implemented a customer loyalty program that improved repeat claim filing ease, boosting overall client retention by 74%.
  • Successfully managed the introduction of new claims management software, resulting in a 44% reduction in manual claim rework.
  • Identified and resolved bottlenecks in the authorization process, reducing approval wait times by 41% days.

Affiliations

  • Women in Insurance and Financial Services (WIFS)
  • National Association of Mutual Insurance Companies (NAMIC)
  • Certified Fraud Examiner (CFE) Membership - Association of Certified Fraud Examiners
  • Workers' Compensation Institute (WCI)
  • Council for Insurance Agents & Brokers (CIAB)
  • Institute of Risk Management (IRM)
  • National Association of Social Workers
  • American Bar Association - Tort Trial and Insurance Practice Section (ABA-TIPS)
  • Society for Human Resource Management (SHRM), specialized in insurance claims departments
  • National Insurance Crime Bureau (NICB)

Certifications

  • Associate in Personal Insurance (API)
  • Cisco Certified Internetwork Expert (CCIE)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • CompTIA Network+
  • Certified Business Analysis Professional (CBAP)
  • Certified Fraud Examiner (CFE)
  • Google Certified Professional Cloud Architect
  • Certificate in Insurance Claims Management Beacon Labs
  • ISO 9001 Certified (Quality Management Systems for Insurance Claims)
  • Senior Claims Law Associate (SCLA)

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