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Skills

  • Verbal and written communication
  • Insurance claim investigation
  • Collaboration with underwriting teams
  • File management and documentation organization
  • Time management for deadlines
  • Investigation of fraudulent insurance claims
  • Claims backlog reduction
  • Fraud case resolutions
  • Regulatory compliance management
  • Workflow Optimization

Work Experiences

  • Contributed to resolving 16 cases.
  • Coordinated with cross-functional teams.
  • Conducted initial reviews for liability, personal injury, and property damage claims valued up to $11, ensuring accuracy and compliance.
  • Analyzed trends and irregularities for 2024.
  • Achieved 30% accuracy in assessments.
  • Conducted fraud risk assessments on claims.
  • Applied conflict-resolution skills to protect client satisfaction.
  • Compiled data-driven reports for senior management.
  • Assisted in the final approval of no-fault claims.
  • Assisted in drafting evolving best practices for handling claims related to ServiceNow, decreasing error rates and increasing turnaround time.

Summaries

  • Achieved 59% faster claim documentation review times.
  • Assisted in implementing digital claims processing systems.
  • Contributed to reduced case resolution times.
  • Ambitious Claims Intern with expertise in fraud detection and prevention, contributing to recovered funds exceeding $18. Experienced in investigating and resolving disputed claims, improving accuracy and resolution time.
  • Aided in reducing claims review times.
  • Assisted in the resolution of high-complexity cases.
  • Claims Intern skilled in improving workflow processes.
  • Contributed to resolving fraud cases valued at over $5.
  • Contributed to underwriting and compliance.
  • Contributed to reducing claim delays by 62%.

Accomplishments

  • Maintained open communication with claimants and provided proactive updates on their cases, resulting in an 82% increase in customer satisfaction scores.
  • Created actionable reports summarizing reserve adequacy and potential liabilities, which led to adjustments that saved the company $9.
  • Collaborated with cross-functional teams to streamline the claims review process, improving efficiency by 80% and enhancing internal communication standards.
  • Delivered data-driven insights that optimized resource allocation for high-priority claims, reducing handling costs by 52%.
  • Provided root cause analysis of bottlenecked claims, leading to a 29% reduction in delays for cases exceeding procedure days.
  • Contributed to the successful implementation of a digital claims platform, resulting in a 84% decrease in manual errors and lost documentation.
  • Achieved a 83% improvement in data accuracy by refining the claims documentation processes and implementing regular review protocols.
  • Successfully managed a workload of over 10 claims per week, maintaining error-free documentation and ensuring compliance with corporate policies.
  • Performed detailed expense analyses for claim payouts, maintaining a variance within 61% of projected costs and ensuring financial objectives were met.
  • Worked directly in the investigation and assessment of high-value claims above $16, delivering consistently accurate projections within 46% variance.

Affiliations

  • Certified Claims Adjuster through framework, validating skills in claims assessment, documentation, and settlement negotiation.
  • Enrolled in RIMS-CRMP certification program, expanding knowledge on risk management and liability processing for efficient claims handling.
  • Member of the National Association of Public Insurance Adjusters (NAPIA), exchanging knowledge on policyholder representation during claims processing.
  • Affiliate of the American College of Financial Services, enrolled in courses focusing on insurance ethics and legalities for claim handlers.
  • Completed Digital Claim Processing Practitioner Training through initiative, specializing in Workday.
  • Member of the International Association of Claims Professionals, fostering best practices and international claims process efficiency.
  • Attendee of annual Insurance Fraud Conference organized by method, staying current on fraud detection techniques in the claims process.
  • Participant in the Claims Management Training Program at Meridian, gaining advanced claim audit and documentation skills.
  • Enrolled in Chartered Property Casualty Underwriter (CPCU) Program, focusing on underwriting, risk management, and liability protection.
  • Attended workshops with the American Academy of Professional Coders (AAPC), honing skills related to injury coding for personal injury claims.

Certifications

  • Intermediate Insurance Claims Management - category
  • Risk Management for Insurance Professionals - Harbor & Co.
  • Chartered Property Casualty Underwriter (CPCU) - Ironclad Systems
  • Subrogation and Recovery Specialist Certification - Vantage
  • Data Analysis for Claims Professionals - Cedar Works
  • Certified Claims Professional (CCP) - Lakeside Partners
  • Insurance Policy Interpretation and Coverage Analysis - Cedar Works
  • Fundamentals of Insurance - Summit Group
  • Loss Adjusting Certification - Ironclad Systems
  • Associate in Insurance Services (AIS) - Vantage

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