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Skills

  • Billing management
  • Fraud detection and prevention
  • Attention to detail
  • Operational improvement
  • Relationship development
  • Liability determinations
  • Standard equipment
  • Claims management software proficiency (e.g., QuickBooks)
  • Cross-functional collaboration
  • Workflow Optimization

Work Experiences

  • Achieved a 71% success rate.
  • Built strong relationships with third-party vendors to expedite claim solutions, reducing vendor cycle time by 18%.
  • Collaborated with the fraud investigation department, identifying fraudulent claims, saving the company $14 in losses.
  • Advocated for expedient claim closure.
  • Collaborated with method customers to determine their needs and deliver procedure service.
  • Adjustments were processed, and refunds were posted.
  • Achieved results over 18 months.
  • Achieved results within 6 months.
  • Benefited overall efficiency.
  • Carried out root cause analysis on denied claims.

Summaries

  • Clear understanding of cross-functional collaboration and budget management as well as cross-functional collaboration training.
  • Addressed legal discrepancies.
  • Collaborated with various internal departments to streamline claims processes, which resulted in a backlog reduction of 73% within several months.
  • Advanced problem-solver with strong negotiation skills, resolving escalated claims and legal discrepancies with a 73% decrease in ongoing disputes.
  • Achieved successful resolution of large-loss claims.
  • Costs were consistently reduced while profits were increased.
  • Achieved a 46% improvement in feedback post-issue resolution.
  • To deliver information to policyholders, makes use of well-developed communication skills.
  • Achieved 47% customer retention.
  • Claims Resolution Specialist with 14 years of successful strategic planning and process improvement experience.

Accomplishments

  • Optimized the claims intake process, shortening the time-to-decision by 14 days and enhancing customer satisfaction ratings by 63%.
  • Collaborated with cross-functional teams to resolve complex claims disputes, resulting in cost savings of $18 for the company.
  • Enhanced customer satisfaction by 83% through personalized communication strategies during the claims resolution process.
  • Proactively addressed discrepancies in claims data using Salesforce, which resulted in a 76% accuracy increase across all processed claims.
  • Achieved a 45% increase in claims processing efficiency by integrating automated documentation systems via Salesforce.
  • Successfully negotiated claims settlements that resulted in a 36% approval rating from policyholders.
  • Negotiated settlements that limited payout adjustments for complex claims, keeping reserve amounts within $18 under expectations.
  • Reviewed insurance policies to ensure consistent compliance for every case, reducing claim rejections by 36%.
  • Managed ServiceNow claims, achieving a 41% closure rate while minimizing dispute escalations by consistently ensuring policy adherence.
  • Saved Vantage an estimated $12 in potential losses by identifying and rejecting fraudulent fraudulent claims before approval.

Affiliations

  • Association of Legal Administrators (ALA)
  • Society of Human Resource Management
  • Jaycees
  • Institute of Risk Management (IRM)
  • The American Institute For Chartered Property Casualty Underwriters (CPCU Society)
  • Association of Information Technology Professionals
  • National Association of Insurance Commissioners (NAIC)
  • American Society of Safety Professionals
  • Association for Claims Professionals (ACP)
  • National Health Care Anti-Fraud Association (NHCAA)

Certifications

  • Advanced Claims Certificate (ACC) by Chartered Insurance Institute (CII)
  • Certified Business Analysis Professional (CBAP)
  • FLMI (Fellow, Life Management Institute) by LOMA
  • CompTIA Security+
  • Cisco Certified Internetwork Expert (CCIE)
  • First Aid/CPR Certified
  • ISO 9001 Lead Auditor Certification for Quality Management Systems
  • Cisco Certified Network Associate (CCNA)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certificate in General Insurance by Chartered Insurance Institute (CII)

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