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Skills

  • Claims Adjustment Coordination
  • Legal Liaison for Complex Cases
  • Policyholder Support and Communications
  • Data-driven Claim Analysis
  • Claims Management
  • Escalated claims management
  • Customer Relationship Management (CRM)
  • Proficiency with Claims Software (e.g., ServiceNow)
  • Relationship development
  • First Aid/CPR

Work Experiences

  • Processed 9 invoices and mailed documentation to clients each 6 months.
  • Solved metric issues, improved operations, and provided excellent customer service.
  • Achieved compliance within one year.
  • Achieved a 29% success rate in audits.
  • Oversaw the delivery of standard project by framework team, which resulted in method.
  • Presented customers with insurance options in order to close new policy sales.
  • Achieved a 68% decrease in customer escalations.
  • Adopted a collaborative approach by routinely engaging cross-departmental teams, enhancing communication and reducing claims backlog by 12 incidents quarterly.
  • Accurately evaluated policy terms.
  • Kept track of all pending authorizations to resolve discrepancies and avoid revenue loss.

Summaries

  • Accomplished Claims Service Associate known for resolving escalated claims by collaborating with insurance adjusters and legal teams, achieving on-time closures and boosting departmental performance by 75%.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Professional who is resourceful and versatile and has a track record of consistently exceeding aggressive sales targets.
  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate procedure systems is one of my specialties.
  • Achieved customer satisfaction scores above 47% %.
  • Achieved 72% improvements in processing accuracy.
  • Boosted department-wide accuracy rates by 20%.
  • Listening to customers, meeting productivity goals, and staying current on company offerings are all skills she possesses.
  • Achieved on-time closures.
  • Acknowledged with President's Club.

Accomplishments

  • Monitored industry regulations, updating claim procedures regularly to retain a 43% compliance rate on all claims adjudicated over 6 months.
  • Collaborated with team of 3 in the development of method.
  • Coordinated with insurance adjusters and medical providers to expedite the processing of sensitive claims, achieving a 35% improvement in closure times for medical and auto claims.
  • Worked with the internal audit team to develop new audit frameworks, resulting in a 72% improvement in compliance scores during two years.
  • Achieved a 53% success rate in regulatory audits by ensuring claims adhered to strict local, state, and federal compliance requirements.
  • Partnered with risk assessment teams to evaluate potential fraudulent claims, saving the company over $4 in reclaimed losses annually.
  • Provided coaching and mentorship to junior claims associates, contributing to enhanced team productivity and a 82% increase in accuracy.
  • Actively contributed to policy revisions by monitoring industry trends and regulatory changes, ensuring continued compliance with initiative rules.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Resolved product issue through consumer testing.

Affiliations

  • Project Management Institute
  • Society of Women Engineers
  • Society of Human Resource Management
  • American Medical Informatics Association
  • Involved with the Loss Executives Association (LEA) for education and networking around priority case handling 2022
  • Former participant in the Claims and Litigation Management Alliance (CLM), focusing on effective claim dispute resolution 2021
  • Rotary International
  • Toastmasters
  • Enrolled in continuing education offerings from the National Flood Insurance Program (NFIP) related to specialized claim service 2015
  • International Council of Nurses

Certifications

  • Apple Certified Associate (ACA)
  • Certified Claims Professional (CCP)
  • Certified Insurance Counselor (CIC)
  • Certified Insurance Services Representative (CISR)
  • Certified Digital Claims Expert (CDCE)
  • Cisco Certified Network Associate (CCNA)
  • Diploma in Insurance Claims Fraud Investigation
  • Advanced Claims Advisor Program 2021
  • Legal Principles Claims Specialist (LPCS)
  • Fraud Claims Law Specialist (FCLS)

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