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Skills

  • Customer satisfaction improvement
  • Documentation and Evidence Review
  • Coverage determination
  • Continuous improvement strategies
  • Customer complaint resolution
  • Communications
  • Relationship development
  • Training and mentoring
  • Operational improvement
  • Cost-reduction initiatives

Work Experiences

  • Looked for industry trends on social media and through online sources.
  • Analyzed conflicting evidence.
  • Collaborated on President's Club-winning continuous improvement initiatives.
  • Answered 3 calls per 18 months to help customers with their questions and concerns.
  • Balanced a caseload of over 9 claims.
  • Boosted departmental reporting accuracy by 24%.
  • Collaborated with cross-functional teams.
  • Transported SAP to 18 months customer locations.
  • Championed an initiative to improve coordination between claims and legal departments, leading to a 44% reduction in litigation cases.
  • Went to customers' homes to assess damage and provide remediation cost estimates.

Summaries

  • Within Miscellaneous, senior Claims Resolution Analyst and outstanding performer in vendor management and quality assurance.
  • Trying to get a similar job with a growing insurance company.
  • Advised clients to increase claim success rates by 65%.
  • Advised clients on regulatory matters.
  • Achieved 64% efficiency gain.
  • Achieved 31% improvement in claim visibility.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • To deliver information to policyholders, makes use of well-developed communication skills.
  • Costs were consistently reduced while profits were increased.
  • Achieved a 50% increase in claim acceptance rates.

Accomplishments

  • Standardized reporting templates for claims audits, increasing efficiency for data collection by 29%.
  • Supported the development of analytical tools to review complex claims, improving overall speed of resolution for high-priority cases.
  • Consistently processed insurance claims with 39% accuracy, contributing to a 9 reduction in operational costs.
  • Led the introduction of a data auditing system that reduced inaccuracies in claims processing by 70%.
  • Utilized Adobe Creative Suite to process and manage incoming claims, reducing error rates by 21%.
  • Built and maintained strong vendor relationships, ensuring claims processing times were reduced by 68%.
  • Resolved product issue through consumer testing.
  • Streamlined cross-border claim documentation processes, improving compliance with international regulations by 77%.
  • Collaborated with attorneys to monitor compliance with updated insurance legislation in 2016, ensuring the company's adherence to new regulations.
  • Collaborated with legal and compliance departments to ensure all claims met state and federal insurance regulations.

Affiliations

  • Lions Club
  • Member, International Association of Insurance Supervisors (IAIS)
  • Rotary International
  • Regular Contributor, Claims and Litigation Management (CLM) Alliance
  • Association of Information Technology Professionals
  • Association for Computing Machinery
  • Peer Reviewer, Journal of Insurance Issues
  • Contributor, National Healthcare Anti-Fraud Association (NHCAA)
  • Volunteer, Pro Bono Work with Claim Advocacy Organizations Atlanta
  • Member, Association for Financial Professionals (AFP)

Certifications

  • Six Sigma Green Belt Certification (CSSGB)
  • CompTIA A+ Technician
  • Apple Certified Associate (ACA)
  • Advanced Professional Certificate in Claims Fraud Investigation by Beacon Labs
  • Change Management Certification from Summit Group
  • Certified Claims Professional (CCP) by Lakeside Partners
  • Certified Financial Services Auditor (CFSA) by Beacon Labs
  • Certified Insurance Data Analyst (CIDA)
  • ISO 9001:2015 Lead Auditor Certification
  • Certified Healthcare Insurance Professional (CHIP)

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