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Skills

  • Fraud case investigation
  • Organization
  • Contract and policy interpretation
  • CCC EZNet
  • ClaimsPro
  • Cross-functional collaboration
  • Experience with program
  • Supervision
  • MS Office
  • Operational improvement

Work Experiences

  • Collaborated with the fraud detection unit, resulting in the successful prevention of fraudulent claims worth $7.
  • Customer issues, field conditions, safety concerns, and policy issues were all reported to management.
  • Avoided litigation through effective negotiation strategies.
  • Consistently exceeded the process service level agreements by processing 26% more claims weekly than the target benchmark.
  • Collaborated with cross-functional teams.
  • Built strong client relationships by providing clear documentation and communication, resulting in repeat policy renewals for 28% of the portfolio.
  • Reviewed new files to determine the current status of an injury claim and devise a strategy.
  • Assessed total loss auto claims.
  • Maintained a suspicious claims database and prepared supervisory reports on a several months basis.
  • Assessed total loss auto claims, negotiating recoveries exceeding $8 in a single quarter.

Summaries

  • Clear understanding of quality assurance and data analysis as well as quality assurance training.
  • Effective at managing phone calls, emails, letters, and in-person requests for assistance while adhering to system regulations and metric department guidelines.
  • Claims Handler with a passion for personal, property, and casualty losses and damages.
  • Achieved this within 16 weeks.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Claims Handler with 10 years of successful strategic planning and performance reporting experience.
  • Achieved results through workflow optimizations.
  • Achieved a 41% reduction in administrative errors.
  • Accomplished in interdepartmental collaboration, having worked with legal experts to reduce litigation cases by 81% % through early mediation options.
  • Bringing 14 years of insurance experience to the table.

Accomplishments

  • Analyzed closed claims to generate actionable insights on process improvements, boosting the claims settlement speed by 62%.
  • Reduced litigation risk by 21% through proactive investigation and early settlement negotiations.
  • Collaborated with actuaries to provide more accurate reserve estimations, improving overall company risk management by 41%.
  • Developed a quality assurance process for high-value claims, increasing accuracy and consistency in evaluations by 73%.
  • Trained in-house employees on the use of Workday, increasing team efficiency in claim processing by 62%.
  • Partnered with claims adjusters and investigators leading to a 79% improvement in the accuracy of claim assessments.
  • Supported legal counsel with pre-litigation case summaries for method, speeding up the resolution process by 14 business days.
  • Established a cooperative partnership with 8 external vendors, expediting settlement times while maintaining a 28% satisfaction rate.
  • Provided exceptional customer service by maintaining a 24% satisfaction rate in claim resolution communications.
  • Reviewed and processed liability claims in HubSpot, avoiding litigation through effective negotiation strategies, saving $18 in legal fees.

Affiliations

  • Certified Insurance Fraud Examiner (CIFE) Certification Holder
  • Project Management Institute
  • International Association of Claims Professionals (IACP) Member
  • Association of Information Technology Professionals
  • National Association of Social Workers
  • International Association of Administrative Professionals
  • National Association of Public Insurance Adjusters (NAPIA)
  • Rotary International
  • Workers' Compensation Claim Professionals (WCCP) Designation Holder
  • Associate in Risk Management (ARM) Completion

Certifications

  • Cisco Certified Network Associate (CCNA)
  • First Aid/CPR Certified
  • ServSafe
  • Certified Claims Professional (CCP) – Harbor & Co.
  • Advanced Fraud Analytics Certification – Meridian
  • Salesforce
  • Certified Subrogation Recovery Professional (CSRP) – Cedar Works
  • CompTIA A+ Technician
  • Certified Public Accountant
  • Associate in Reinsurance (ARe) – method

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