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Skills

  • Ability to archive files
  • Database Management (QuickBooks)
  • Claims process automation
  • Settlement Negotiation
  • Process improvement strategies
  • First Aid/CPR
  • Claims adjudication
  • MS Office
  • Attention to detail in claim documents
  • Claims fraud detection tools

Work Experiences

  • Achieved large claim settlements by 7%.
  • Awarded Outstanding Service Award by recognizing and remediating incorrect billing information in Tableau claims.
  • Analyzed appeals in denied claims, resulting in a 42% overturn rate, boosting customer retention by 17%.
  • Had an excellent attendance record and was always on time for work.
  • Achieved consistent top-performance.
  • Achieved results across 6 months.
  • Assisted 7 customers per month.
  • Championed internal audit initiatives.
  • Addressed recurring issues.
  • Looked for industry trends on social media and through online sources.

Summaries

  • Over 11 years of experience obtaining information from policyholders and assisting with claim forms as an honest Insurance Clerk.
  • Achieved results within two years.
  • Achieved an 4% faster resolution time on complex cases.
  • Excellent interpersonal skills with a track record of successfully interpreting and explaining process insurance policy details to customers.
  • Excellent clerical, mathematical, and interpersonal skills.
  • Adapted claims processes to meet new regulatory changes.
  • Achieved a 30% increase in customer satisfaction.
  • Achieved a 49% accuracy rate.
  • Excellent communication and computer skills, as well as a thorough understanding of metric insurance policies.
  • Adaptable Claims Reviewer adept at implementing process automation, reducing review times by 16% and optimizing claim handling procedures.

Accomplishments

  • Analyzed claims trends and recommended policy changes, leading to a 46% reduction in recurring claim submission issues.
  • Managed escalated claims, reducing resolution cycles by 33% through detailed case management strategies.
  • Assessed and processed health and property claims, resulting in the identification and prevention of fraudulent claims worth $9.
  • Led initiatives to automate claims review workflow, enhancing processing speed by 35%.
  • Processed high-volume claims with minimal errors, improving department approval quality control by 55%.
  • Collaborated with external vendors and adjusters to resolve high-value property claims within 6 months, achieving a 34% faster resolution of disputable cases.
  • Resolved complex disputes in claims processing with a 65% success rate in favor of the company, reducing legal risks and costs.
  • Collaborated with team of 5 in the development of method.
  • Implemented an improved claims categorization system, increasing daily claim processing capacity by 58%.
  • Utilized Power BI for accurate claims database management, ensuring 53% data accuracy across one year.

Affiliations

  • American Medical Informatics Association
  • Healthcare Financial Management Association (HFMA)
  • National Association of Insurance Commissioners (NAIC)
  • Risk Management Society (RIMS)
  • Toastmasters
  • Association of Information Technology Professionals
  • Association for Supply Chain Management (APICS)
  • Professional Liability Underwriting Society (PLUS)
  • Certified Claims Professional Accreditation Council (CCPAC)
  • Council on Litigation Management (CLM)

Certifications

  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certificate in Commercial Claims by Vantage
  • ISO Claims Adjuster Certification
  • Certified Fraud Examiner (CFE)
  • CompTIA A+ Technician
  • Licensed Adjuster – Washington Licensing Board
  • Chartered Property and Casualty Underwriter (CPCU)
  • Accredited Claims Adjuster (ACA) – Workday
  • Professional in Insurance Regulation (PIR) by National Association of Insurance Commissioners (NAIC)
  • Certified Litigation Management Professional (CLMP)

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