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Skills

  • Account management
  • Reporting skills
  • Time management
  • Attention to Detail in High-Stakes Claims
  • Process improvement
  • Vendor relationship management
  • Regulatory compliance
  • Industry regulation knowledge
  • Data Analysis in Claims Trends
  • Stakeholder management

Work Experiences

  • Had an excellent attendance record and was always on time for work.
  • Looked for industry trends on social media and through online sources.
  • Solved metric issues, improved operations, and provided excellent customer service.
  • Authored internal best practices guides for claims processing, reducing onboarding time for new employees by one year months.
  • Created and delivered educational webinars for policyholders.
  • Actively researched complex coverage issues, delivering recommendations that resulted in a 58% reduction in disputed claims.
  • Achieved Innovation Award/week recognition for service excellence.
  • Accurately processed and resolved over 7 claims.
  • Achieved $16 in savings for Cedar Works.
  • Kept patient finances, records, and health statuses confidential.

Summaries

  • Achieved cost savings exceeding $11.
  • Accomplished Claims Liaison with a proven ability to streamline claims processes, resulting in a 38% reduction in resolution time through effective cross-functional collaboration.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the standard business.
  • Within Miscellaneous, senior Claims Liaison and outstanding performer in budget management and team leadership.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Collaborative Claims Liaison.
  • Achieved a 34% satisfaction rate in dispute outcomes.
  • Empathy, dependability, and enthusiasm for customer satisfaction.
  • Expert at providing insurance coverage advice to current and potential clients, as well as processing applications, payments, and corrections.

Accomplishments

  • Analyzed standard data trends, identifying areas of improvement in claims handling, resulting in a 35% reduction in errors.
  • Improved stakeholder expectations management by creating a weekly claims dashboard, providing real-time insight into the status of 14 open claims.
  • Partnered with IT to integrate standard into the company’s system, cutting average resolution times by 10 days.
  • Successfully negotiated settlements with external partners, reducing liability expenses by 68%.
  • Facilitated training workshops for 9 employees on advanced claims auditing techniques, increasing team efficiency by 38%.
  • Resolved 18 escalated high-value claims annually while maintaining adherence with system and industry standards.
  • Led team to conduct post-resolution reviews of high-value claims, identifying crucial negotiation strategies, saving Cedar Works 70% on settlement costs.
  • Achieved a 29% settlement success rate on high-value claims, minimizing financial exposure for the company.
  • Collaborated with team of 18 in the development of metric.
  • Successfully resolved 12 longstanding claims in collaboration with the legal department, mitigating risk and avoiding potential litigation costs.

Affiliations

  • Freemason
  • Compliance and Claims Management Association (CCMA) - Participated in certification programs focused on compliance risks in claims.
  • Institute of Risk Management (IRM) - Networking and certification on risk mitigation approaches relevant to claims.
  • Claims Management Educational Institute (CMEI) - Completed specialized coursework on resolving complex high-value claims.
  • Society of Insurance Research (SIR) - Contributed to insurance claims research and development of data-driven strategies.
  • Society of Chartered Property & Casualty Underwriters (CPCU) - Professional designation for advanced claims handling expertise.
  • National Association of Subrogation Professionals (NASP) - Membership enhancing collaboration in subrogation claims handling.
  • America’s Health Insurance Plans (AHIP) - Contributed to policy discussions affecting health claims.
  • International Claim Association (ICA) - Affiliated member with a focus on education around claims processing regulations.
  • Jaycees

Certifications

  • Cisco Certified Internetwork Expert (CCIE)
  • Cisco Certified Network Associate (CCNA)
  • Accredited Advisor in Insurance (AAI)
  • Certified Public Accountant (CPA)
  • CompTIA Security+
  • Legal Principles Claims Specialist (LPCS)
  • Certified Insurance Data Scientist (CIDS)
  • Insurance Carrier Dispute Specialist Certification
  • SHRM Certified Professional (SHRM-CP)
  • Casualty Claim Law Associate (CCLA)

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