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Skills

  • Internal reporting and record-keeping
  • Category equipment
  • Claim eligibility review
  • Project organization
  • First Aid/CPR
  • Relationship development
  • Fraud detection and prevention
  • Time management
  • Process improvement
  • Disputed claims resolution

Work Experiences

  • Had an excellent attendance record and was always on time for work.
  • Achieved 52% reduction in manual input errors.
  • Corrected discrepancies to prevent non-compliance.
  • Collaborated with cross-functional teams to expedite high-priority cases, resulting in a 63% increase in customer satisfaction scores.
  • Achieved results over a the past year-month period.
  • Achieved results within 18 months.
  • Looked for industry trends on social media and through online sources.
  • Collaborated with vendors and external partners.
  • Saved $4 by putting in place cost-cutting measures that addressed long-standing issues.
  • Boosted resolution rates by 7 claims per day.

Summaries

  • Accomplished at developing time-saving procedures.
  • Adept at handling all aspects of claims processing.
  • Accomplished Claims Processer experienced with advanced software tools.
  • Claims Processer with 8 years of successful budget management and team leadership experience.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the process business.
  • Achieved a 50% reduction in overall claims denial rate.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Achieved a 74% boost in customer satisfaction.
  • Accomplished at developing and implementing time-saving procedures that reduced claims processing delays by 65% and increased departmental savings by $11.
  • Adept at process automation.

Accomplishments

  • Conducted in-depth claims investigations, reducing claim discrepancies by 82%.
  • Exceeded monthly claims processing benchmarks by 48% through the optimization of workflow strategies.
  • Actively processed claims across multiple states, ensuring compliance with 16 state-specific regulations.
  • Resolved complex claims disputes by analyzing coverage discrepancies, especially under multi-state insurance policies.
  • Reviewed high-value claims to ensure compliance with underwriters' guidelines, reducing fraudulent claims by 61%.
  • Managed relationships with third-party vendors, ensuring timely and accurate processing of claims while maintaining 52% service level compliance.
  • Increased departmental output by 22% through real-time monitoring of key metrics and cross-training initiatives.
  • Developed and implemented a workflow efficiency strategy that reduced claim processing time by 2 hours while maintaining accuracy.
  • Contributed to a multi-phase transition of claims handling from manual to automated processes, improving department-wide efficiency by 67%.
  • Led analysis of post-claim settlement procedures, implementing feedback that improved workflow efficiency by 38%.

Affiliations

  • International Council of Nurses
  • Risk and Insurance Management Society (RIMS) - Involved in strategic projects related to claims protocol evaluation and restructuring
  • National Association of Social Workers
  • Association for Computing Machinery
  • Claims and Litigation Management Alliance (CLM) - Certification coursework in claims litigation best practices by 2019
  • Rotary International
  • American Marketing Association
  • Managed Care Executive Group (MCEG) - Active in discussions on healthcare claims handling innovations
  • Association of Home Office Underwriters (AHOU) - Active member, focusing on life and health claims management
  • American Medical Informatics Association

Certifications

  • Google Certified Professional Cloud Architect
  • Cyber Insurance Specialist Certificate - Summit Group, 2022
  • Auto Damage Adjuster Professional Certification - Northwind, 2016
  • ISO Claims Adjuster Training Certification - Harbor & Co., 2018
  • ServSafe
  • Project Management for Insurance Professionals Certification - Vantage, 2019
  • Lean Claims Processing Certification - Cedar Works, 2015
  • Certified Professional Coder (CPC) – Summit Group, 2016
  • First Aid/CPR Certified
  • CompTIA A+ Technician

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