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Skills

  • Process optimization
  • Emergency Response
  • Customer satisfaction management (achieved 95% satisfaction rating)
  • Negotiation and mediation skills
  • Data entry accuracy (maintained 98% accuracy rate)
  • Operational improvement
  • Root cause analysis
  • Fraud investigation & prevention
  • Budgets
  • Data analysis

Work Experiences

  • Achieved closure within 17 months.
  • Achieved reduction over a 9-week period.
  • Consistently exceeded department goals.
  • Transported Salesforce to the past year customer locations.
  • Collaborated with legal teams to resolve claims disputes.
  • Created claims risk reports.
  • Consistently exceeded department goals by processing an average of 11 claims per day, 20% higher than department standards.
  • Collaborated with legal teams to resolve claims disputes, resulting in a $15 reduction in claims settlements costs annually.
  • Achieved a 95% customer satisfaction rating through proactive, empathetic communication and conflict resolution in claims handling.
  • Decreased claim resolution time by 5 days.

Summaries

  • Adaptable and reliable Claims Processor, successfully handling the review and approval of 13 claims during category, ensuring quick payouts for policyholders in critical cases.
  • Achieved a 55% reduction in overpayment risks.
  • Trying to get a similar job with a growing insurance company.
  • Customer-focused Claims Processor with a demonstrated ability to effectively communicate claims status, reducing inbound customer inquiries by 63% within a 5-week period.
  • Achieved audit compliance.
  • Consistently exceeded departmental standards.
  • Collaborated with IT and operations teams to introduce a new claims software tool, resulting in streamlined processing and a reduction in claim cycle time by 9 days.
  • Costs were consistently reduced while profits were increased.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Consistently praised for quick claims settlements.

Accomplishments

  • Utilized escalation protocols for sensitive cases, leading to expedited resolutions and customer satisfaction improvements by 65%.
  • Handled claims escalations and resolved disputes, leading to a 46% increase in customer satisfaction scores.
  • Equipped with expertise in Microsoft Excel, resulting in a 74% increase in claims management efficiency.
  • Streamlined data entry processes for claims processing, cutting average claim resolution times by 55% and increasing staff productivity.
  • Optimized claims review workflow, shortening processing times by 68% while increasing overall claims approval rate by 40%.
  • Utilized root cause analysis to effectively improve claims approval efficiency by 40% in 2017.
  • Consistently identified and corrected discrepancies in billing processes, resulting in total savings of $5 over 16 months.
  • Generated comprehensive reports about claims trends, leading to a 29% decrease in erroneous claims over a 6-month period.
  • Reduced escalated disputes by 75% by efficiently resolving high-priority claims in collaboration with the legal team.
  • Collaborated with third-party vendors to negotiate reimbursement for non-covered expenses, saving an average of $13 per claim.

Affiliations

  • American Marketing Association
  • Volunteer with Insurance Accounting & Systems Association (IASA) claims track programs
  • Freemason
  • Active participation in the Society of Insurance Research (SIR)
  • Participant, Association of Professional Claims Adjusters (APCA) training seminars
  • Association of Claims Professionals (ACP) networking and business development participant
  • Rotary International
  • Member, National Risk Management Society (RIMS)
  • Lions Club
  • International Association of Administrative Professionals

Certifications

  • SHRM Senior Certified Professional (SHRM-SCP)
  • Apple Certified Associate (ACA)
  • Certified Professional in Healthcare Risk Management (CPHRM) - initiative
  • First Aid/CPR Certified
  • Certified Medical Reimbursement Specialist (CMRS) - Vantage
  • Certified Healthcare Insurance Claims Specialist (CHICS) - Summit Group
  • Certified Customer Service Professional (CCSP) - Meridian
  • Accredited Healthcare Fraud Investigator (AHFI) - Brightline
  • Insurance Data Analytics Certification - Meridian
  • Certified Business Analysis Professional (CBAP)

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