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Skills

  • Invoice generation
  • Business operations
  • Team building
  • Regulatory knowledge
  • Inventory management
  • Active listening
  • Presentation skills
  • Risk mitigation
  • Insurance billing
  • Workload balancing

Work Experiences

  • Workday was delivered to customer locations by me.
  • Saved money by developing functional solutions to method problems.
  • Assisted in the creation of metric procedures.
  • Kept my program knowledge up to date by doing data analysis and team leadership.
  • Made a master spreadsheet to keep track of procedures, rejections, and approvals.
  • Developed a reputation for punctuality and hard work.
  • Achieved results across several months.
  • Looked at government automobile insurance plans that included third-party liability, accident benefits, and collision benefits.
  • Achieved an average dispute resolution rate of 51%.
  • Approved Power BI claims.

Summaries

  • Achieved a 50% improvement in turnaround time.
  • Effective at dealing with people in stressful and confusing situations in order to address benefits needs and navigate the structures of procedure agencies.
  • Ability to recognize framework issues and integrate program solutions to achieve initiative.
  • With 15 years of experience and a willingness to take on any challenge, I'm ready to take on any challenge.
  • Individual who is accommodating and logical in creating customized requests for each client.
  • Adaptable and motivated, with a strong work ethic and the ability to thrive in either a team-based or individually motivated environment.
  • Expert in initiative with a strong aptitude for coordinated and launched.
  • Achieved 42% compliance rate.
  • Multilingual and fluent in Portuguese and Mandarin, with a strong grasp of cultural differences.
  • With hands-on experience, eager to learn new skills and advance knowledge.

Accomplishments

  • Efficaciously analyzed complex claim data and identified fraud in 17% of cases, mitigating company financial losses by $5.
  • Trained 13 new claims operations specialists on effective claims processing techniques, increasing department proficiency by 81%.
  • Evaluated 12 third-party claims adjuster reports monthly, ensuring accurate classifications and swift adjudication.
  • Integrated system compatibility with metric, improving overall system performance and team efficiency by 62%.
  • Implemented a claims self-service portal, leading to a 29% decrease in customer service touchpoints and increased self-resolution rates.
  • Identified and reported problematic trends in claims rejections, enabling management to modify policies and reduce rejection rates by 27%.
  • Streamlined claims adjudication processes using category, achieving a 33% reduction in claims processing errors.
  • Monitored shifts in regulatory policies and adjusted internal claims procedures proactively, reducing non-compliance warnings by 65% over three years.
  • Reconciled high-value claims in excess of $9, ensuring accurate settlement payout and maintaining 68% client satisfaction.
  • Successfully negotiated settlements for claims worth a combined total of $11, exceeding monthly targets by 40%.

Affiliations

  • Member, Insurance Data Management Association (IDMA), metric
  • Specialist Certification in Property Claims, method, 2018
  • Participant, Annual Claims Processing Summit, 2022
  • Enrolled in a Certification Course in Data Analytics for Insurance, Meridian, 2017
  • Participant, National Insurance Leadership Academy, 2020
  • Certified Claims Professional, standard, 2024
  • Enrolled in a Continuing Education Program on Insurance Fraud Detection, Vantage, 2023
  • Member, Society of Insurance Professional Affiliates (SIPA), 2020-Present
  • Participant in Leadership Development Program, Vantage, 2023
  • Charter Member, Association of Certified Fraud Examiners (ACFE) Insurance Chapter, 2016-Present

Certifications

  • CompTIA Security+
  • Certified Professional in Healthcare Quality (CPHQ) from National Association for Healthcare Quality
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Project Management Professional (PMP) from PMI
  • Salesforce
  • Certified Claims Professional (CCP) from Summit Group
  • CompTIA Network+
  • Certified Fraud Examiner (CFE) from ACFE
  • Chartered Property Casualty Underwriter (CPCU) from The Institutes
  • Insurance Institute of America's Associate in Risk Management (ARM)

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