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Skills

  • Achieving and surpassing productivity goals
  • Ability to archive files
  • Analytical decision-making
  • Bilingual proficiency in French
  • Multitasking in fast-paced environments
  • MS Office
  • Ability to compile data
  • Natural disaster claim management
  • Client relationship management
  • Fast learning and adaptability to new policies and procedures

Work Experiences

  • Was in charge of processing and recording new policies and claims.
  • Conducted routine audits of active claims, preventing $2 in potential overpayments due to errors and misreporting.
  • Automated team leadership.
  • Achieved rapid claim resolutions.
  • Answered phone calls from clients, vendors, and a variety of other callers looking for information.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Coordinated investigations with external third-party firms.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Acted as a lead coordinator for special project claims, reducing outstanding cases by 31% within several months.
  • Had an excellent attendance record and was always on time for work.

Summaries

  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate initiative systems is one of my specialties.
  • Empathy, dependability, and enthusiasm for customer satisfaction.
  • Adept in collaborating with legal and underwriting teams to resolve high-value, complex case claims, minimizing risks and increasing accuracy.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Claims Representative Associate is a multi-talented Claims Representative Associate who is consistently rewarded for planning and operational improvements.
  • 10 wpm typing speed with 2% accuracy and Tableau knowledge.
  • Selling over 14 policies weekly and maintaining excellent relationships with customers and coworkers are two of my strongest skills.
  • Costs were consistently reduced while profits were increased.
  • Achieved recognition for navigating complex claims.
  • Accomplished Claims Representative Associate.

Accomplishments

  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Developed streamlined claims procedures that cut processing time from 6 months to the past year, benefiting both clients and internal departments.
  • Processed an average of 11 claims per day using Workday with a 79% accuracy rate, resulting in timely disbursement of funds.
  • Managed claims documentation processes for standard claims, minimizing legal reviews by 59% and improving overall claim completion rates.
  • Implemented a skills tracking matrix to align team expertise with claim complexity, improving productivity by 40%.
  • Supported team during a surge in claims due to seasonal standard, maintaining processing efficiency at 44% above the department average.
  • Resolved product issue through consumer testing.
  • End-to-end oversight of claims involving sensitive information, ensuring regulatory compliance and maintaining 82% data integrity.
  • Ensured compliance and proper documentation for claims above $13, reducing legal exposure and penalties.
  • Effectively settled claims totaling over $7 with minimal corporate expenditure by leveraging negotiation techniques and clear knowledge of claim policy.

Affiliations

  • Affiliated with the American Institute of Professional Claims
  • Certified through the Medical Billing and Coding Association
  • Certification through America’s Health Insurance Plans (AHIP)
  • Completed courses through the Insurance Institute of America (IIA)
  • Chartered Institute of Loss Adjusters (CILA) Accreditation
  • Affiliation with the National Healthcare Anti-fraud Association (NHCAA)
  • International Association of Administrative Professionals
  • Active role in the Customer Experience Professionals Association (CXPA)
  • Associate Member of the Society of Claims Law Associates
  • Member of the International Claim Association (ICA)

Certifications

  • Google Certified Professional Cloud Architect
  • Microsoft Certified Systems Engineer (MCSE)
  • SHRM Certified Professional (SHRM-CP)
  • Senior Claims Law Associate (SCLA) - initiative
  • Certified Subrogation Recovery Professional (CSRP) - category
  • Commercial Claims Specialist (CCS) - 2023, procedure
  • Fundamentals of Insurance Risk Management - Beacon Labs, Seattle
  • Certified Regulatory and Compliance Professional (CRCP) - standard
  • CompTIA Security+
  • Certified Business Analysis Professional (CBAP)

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