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Skills

  • Workflow Optimization
  • Root cause analysis
  • Project organization
  • Customer service
  • Business acumen in insurance industry
  • Business operations
  • Client relationship management
  • Process improvement
  • Fraud detection and prevention
  • Standard equipment

Work Experiences

  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Conducted in-depth analysis of overturned claims.
  • Completed claims resolution within several months.
  • Conducted thorough reviews of claims involving new standard legislation, ensuring compliance while minimizing the organization's legal exposure.
  • Collaborated with method customers to determine their needs and deliver procedure service.
  • Achieved a 49% reduction in resolution time.
  • Conducted in-depth analysis of overturned claims, implementing policy changes that reduced future overturns by 18%.
  • Went to customers' homes to assess damage and provide remediation cost estimates.
  • Conducted detailed investigation and analysis.
  • Conducted 5 training sessions for new hires, emphasizing attention to detail in claims documentation, improving accuracy by 20%.

Summaries

  • Within Miscellaneous, senior Claims Resolution Specialist and outstanding performer in workflow optimization and budget management.
  • Accomplished specialist in fraud detection.
  • Completed within several months.
  • Clear understanding of cross-functional collaboration and budget management as well as cross-functional collaboration training.
  • Accomplished specialist in fraud detection, saving $4 through collaboration with the fraud department to prevent and resolve fraudulent claims.
  • Achieved backlog reduction within several months.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Strengths in data analysis and cross-functional collaboration backed up by Miscellaneous training.
  • Closed 2 claims per week.
  • Working with initiative claims for the past 7 years.

Accomplishments

  • Trained and mentored new team members on claims processing best practices, increasing departmental productivity by 60%.
  • Optimized the claims intake process, shortening the time-to-decision by 14 days and enhancing customer satisfaction ratings by 63%.
  • Achieved a 45% increase in claims processing efficiency by integrating automated documentation systems via Salesforce.
  • Reviewed insurance policies to ensure consistent compliance for every case, reducing claim rejections by 36%.
  • Developed a comprehensive training manual on budget management that reduced onboarding time for new hires by 81%.
  • Created and maintained reporting dashboards in Adobe Creative Suite, providing real-time claims status insights to upper management.
  • Utilized deep knowledge of policy guidelines to resolve escalated claims disputes, recovering $10 in client premiums.
  • Implemented a claims auditing system that identified and corrected claims errors, reducing erroneous payouts by 66%.
  • Saved Vantage an estimated $12 in potential losses by identifying and rejecting fraudulent fraudulent claims before approval.
  • Documented and resolved category which led to process.

Affiliations

  • Conference of Insurance Regulators (CIR)
  • American Medical Informatics Association
  • Society of Insurance Research (SIR)
  • Freemason
  • Toastmasters
  • Association of Information Technology Professionals
  • American Educational Institute (AEI) for Claims Law Certifications
  • Workers' Compensation Institute (WCI)
  • Insurance Data Management Association (IDMA)
  • National Association of Subrogation Professionals (NASP)

Certifications

  • Cisco Certified Internetwork Expert (CCIE)
  • Project Management Professional (PMP)
  • Techniques of Risk Analysis (TRA) Certification by Cedar Works
  • SHRM Certified Professional (SHRM-CP)
  • Workers’ Compensation Claims Professional (WCCP) Certification
  • Certified Enterprise Risk Analyst (CERA) by procedure
  • Certified Public Accountant
  • Google Certified Professional Cloud Architect
  • Fellow, Academy of Healthcare Management (FAHM) by AHIP
  • Certified Fraud Examiner (CFE) by the Association of Certified Fraud Examiners (ACFE)

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