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Skills

  • Fair Isaac Claims Advisor
  • Claims audit preparation
  • Root cause analysis
  • CCC Pathways
  • Claims documentation accuracy
  • Cycle time reduction strategies
  • Automated Work Distributor (AWD)
  • Magnify Predictive Targeting System
  • Vendor relationship management
  • Microsoft Publisher

Work Experiences

  • Adhered to best practices.
  • Maintained a suspicious claims database and prepared supervisory reports on a one year basis.
  • Worked with the claims department and industry anti-fraud organizations to resolve claims.
  • Ensured that all filed hazard and special hazard claims were properly managed.
  • Addressed escalated customer concerns.
  • Actively participated in settlement conferences and mediation, successfully settling 6 claims over one year.
  • Achieved a satisfaction rating of 27%.
  • Followed up with insured people who had not paid their premiums or deductibles.
  • Examined claim forms and other records to determine insurance coverage.
  • Kept track of 2-clients' caseload for each quarter.

Summaries

  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Proven track record of using excellent negotiating skills to speed up settlements.
  • Costs were consistently reduced while profits were increased.
  • Accomplished at managing competing priorities in high-pressure environments.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Solid skills in formulating goals and strategies for resolving process claims.
  • Achieved a 48% uptick in customer satisfaction.
  • Achieved a proven 15% improvement in settlement rates.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Applied analysis-driven strategies to improve settlement outcomes.

Accomplishments

  • Spearheaded quality assurance initiatives, achieving a 74% reduction in claim processing errors and improving first-pass payout accuracy.
  • Negotiated settlement agreements utilizing mediation techniques, resolving 4 of claims disputes with a 72% decrease in litigation costs.
  • Improved customer satisfaction scores by 52% by implementing personalized claim resolution plans based on individual policyholder needs.
  • Collaborated with the IT department to deploy a digital claims reporting platform, decreasing claim submission time by 67% for online customers.
  • Conducted internal audits in collaboration with compliance teams to ensure claim payouts met state and federal regulatory requirements.
  • Resolved product issue through consumer testing.
  • Utilized data analytics tools to monitor claims for trends, identifying and preventing $15 in potential losses.
  • Implemented fraud prevention strategies, resulting in 18 convictions and saving the company $6 in fraudulent claims.
  • Successfully mediated multi-party claims disputes, facilitating settlements that reduced legal intervention by 39%.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.

Affiliations

  • National Association of Mutual Insurance Companies (NAMIC)
  • Society of Actuaries (SOA)
  • Association of Certified Fraud Examiners (ACFE)
  • National Alliance for Insurance Education & Research
  • Casualty Actuarial Society (CAS)
  • National Association of Social Workers
  • National Order of Insurance Experts Trainers (NOIET)
  • Society of Human Resource Management
  • Association for Computing Machinery
  • Association of Litigation Support Professionals (ALSP)

Certifications

  • Certified Insurance Counselor (CIC) - Ironclad Systems
  • Chartered Property Casualty Underwriter (CPCU) - Meridian
  • Certified ScrumMaster (CSM) - Harbor & Co.
  • Associate in Reinsurance (ARe) - Summit Group
  • Certified Fraud Examiner (CFE) - Meridian
  • Project Management Professional (PMP)
  • Certified Business Analysis Professional (CBAP)
  • Certified Analytics Professional (CAP) - 2023
  • CompTIA Security+
  • Accredited Claims Adjuster (ACA) - Meridian

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