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Skills

  • Relationship development
  • Continuous process improvement
  • Stakeholder management
  • Process streamlining
  • Business operations
  • Communications
  • Client escalation handling
  • Vendor relationship management
  • Regulatory compliance
  • Initiative equipment

Work Experiences

  • Analyzed program data to identify and correct patterns of incorrect coding, misbilling, and payment disputes saving Vantage $2.
  • Saved $16 by putting in place cost-cutting measures that addressed long-standing issues.
  • Oversaw the delivery of process project by initiative team, which resulted in method.
  • Achieved a 48% increase in customer retention.
  • Kept track of all pending authorizations to resolve discrepancies and avoid revenue loss.
  • Accurately processed and resolved over 9 claims within three years, ensuring a 79% increase in satisfaction among stakeholders.
  • Collaborated with underwriting to clarify policy wording.
  • Collaborated with system customers to determine their needs and deliver metric service.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Accurately processed and resolved over 7 claims.

Summaries

  • Bringing 12 years of insurance experience to the table.
  • Empathy, dependability, and enthusiasm for customer satisfaction.
  • Listening to customers, meeting productivity goals, and staying current on company offerings are all skills she possesses.
  • Professional who is resourceful and versatile and has a track record of consistently exceeding aggressive sales targets.
  • Analytical Claims Liaison.
  • Analyzed trends.
  • Analytical Claims Liaison who conducted regular audits of processed claims, identifying discrepancies and saving Summit Group $8 in annual costs.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the standard business.
  • Achieved cost savings exceeding $11.
  • Costs were consistently reduced while profits were increased.

Accomplishments

  • Worked directly with insurance adjusters and underwriters to renegotiate terms of disputed claims, resulting in a 19% cost saving for Lakeside Partners.
  • Designed a predictive model using QuickBooks that forecasted claim outcomes, improving claim accuracy by 28%.
  • Implemented a new procedure for pre-filing audits on claims, leading to 54% fewer errors and disputes post-submission.
  • Reviewed claims exceeding $17 and ensured compliance with both internal policies and state regulations, reducing legal exposure by 22%.
  • Achieved a 29% settlement success rate on high-value claims, minimizing financial exposure for the company.
  • Improved claims processing time by 39% through direct collaboration with IT to implement a claims automation tool.
  • Served as the primary point of contact for 10 internal stakeholders, addressing and resolving claim disputes to preserve Northwind's relationships with key clients.
  • Successfully resolved 12 longstanding claims in collaboration with the legal department, mitigating risk and avoiding potential litigation costs.
  • Successfully negotiated settlements with external partners, reducing liability expenses by 68%.
  • Reduced operational costs by 76% through the introduction of optimized claims documentation processes.

Affiliations

  • Association for Computing Machinery
  • International Association of Administrative Professionals
  • Customer Care Institute (CCI) - Engaged in enhancing customer relations and claims resolution satisfaction.
  • Society of Insurance Ethics and Policy (SIEP) - Advocated for ethical practices in managing and resolving claims.
  • Institute of Risk Management (IRM) - Networking and certification on risk mitigation approaches relevant to claims.
  • America’s Health Insurance Plans (AHIP) - Contributed to policy discussions affecting health claims.
  • Society of Human Resource Management
  • International Foundation of Employee Benefit Plans (IFEBP) - Membership focusing on benefit claims and disputes resolutions.
  • National Association of Social Workers
  • Northeastern Group of Insurance Claims Professionals - Participated in monthly webinars on claims adjustments in 2017.

Certifications

  • First Aid/CPR Certified
  • Certified Investigator Fraud Specialist (CIFS)
  • Professional Risk Manager (PRM)
  • Project Management Professional (PMP)
  • Health Care Anti-Fraud Associate (HCAFA)
  • Associate in Claims (AIC)
  • Certified Business Analysis Professional (CBAP)
  • Certified Healthcare Reform Specialist (CHRS)
  • Customer Service Representative (CSR) Insurance License
  • Certified Public Accountant (CPA)

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