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Skills

  • MS Office
  • Project organization
  • Negotiation skills for large-loss settlements
  • Multilingual communication skills (e.g., Spanish)
  • Supervision
  • Cross-functional team leadership
  • Reporting skills
  • Team building
  • Process improvement methodologies
  • Insurance policy analysis

Work Experiences

  • Achieved compliance improvement over 2018.
  • Assisted in the implementation of a claims management system.
  • Kept patient finances, records, and health statuses confidential.
  • Coordinated with legal, medical, and technical experts.
  • Achieved a 31% improvement in client satisfaction scores.
  • Collaborated with the IT department to introduce new claims tracking technologies, which decreased evaluation times by 75%.
  • Achieved recovery in metric.
  • Communicated coverage decisions effectively.
  • Coordinated multiple claim-handling teams to process high-volumes during major catastrophe events, managing a surge of 2 claims.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.

Summaries

  • Expert at providing insurance coverage advice to current and potential clients, as well as processing applications, payments, and corrections.
  • Bringing 8 years of insurance experience to the table.
  • Collaborative Claims Professional with extensive experience working with external attorneys to mitigate legal risks and defend against fraudulent claims.
  • Committed Claims Professional with expertise in vendor management, ensuring seamless operations and improved service delivery for internal and external stakeholders.
  • Claims Professional with expertise in subrogation and recovery.
  • Within Miscellaneous, senior Claims Professional and outstanding performer in process improvement and project management.
  • Costs were consistently reduced while profits were increased.
  • Claims Professional with 15 years of successful budget management and quality assurance experience.
  • Achieved 77% accuracy in claim determinations.
  • Achieved efficiency through workflow automation.

Accomplishments

  • Handled 17 claims per month in compliance with company service level agreements, contributing to a 84% reduction in backlog.
  • Achieved a customer satisfaction rate of 34% by introducing new claim status communication tools.
  • Engineered claims tracking reports that improved insights into claims performance metrics, boosting team accountability.
  • Delivered claims-handling training sessions on system compliance, ensuring the department maintained a 64% compliance record.
  • Managed a portfolio of high-complexity claims, successfully negotiating settlements valued at $5 during 2015.
  • Collaborated with underwriting team to identify and resolve coverage deviations, ensuring regulatory compliance across 8 policies.
  • Collaborated with team of 6 in the development of process.
  • Led quality control checks for 7-claim audit, improving overall processing accuracy by 84%.
  • Contributed to a procedure policy overhaul that resolved historical claims issues, reducing repeat claims cases by 68%.
  • Executed targeted training for policyholders, leading to a 57% reduction in claim submission errors in 2021.

Affiliations

  • Association of Information Technology Professionals
  • Jaycees
  • Workers' Injury Law & Advocacy Group (WILG)
  • American Association of Insurance Services (AAIS)
  • Rotary International
  • Institute of Risk Management (IRM)
  • Property Casualty Insurers Association of America (PCIAA)
  • Public Risk Management Association (PRIMA)
  • Casualty Actuarial Society (CAS)
  • American College of Coverage Counsel (ACCC)

Certifications

  • Foundation Certificate in Insurance from the Chartered Insurance Institute (CII)
  • Google Certified Professional Cloud Architect
  • Chartered Insurance Professional (CIP)
  • Certified Professional in Enterprise Risk Management (CPERM)
  • ServSafe
  • Claims and Insurance Fraud Specialist (CIFS)
  • Certified Professional in Health Insurance (CPHI)
  • Multiline Claims Adjuster Certification
  • Life and Health Insurance License from Texas
  • Cisco Certified Internetwork Expert (CCIE)

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