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Skills

  • MS Office
  • Proficiency with Claims Software (e.g., ServiceNow)
  • Fraud detection and prevention
  • Customer Relationship Management (CRM)
  • Automated tracking system implementation
  • Document Validation and Review
  • Problem resolution
  • Process improvement
  • Budgets
  • Medical Billing Claims Review

Work Experiences

  • Was able to effectively communicate with members of the operations, finance, and clinical departments.
  • Kept track of all pending authorizations to resolve discrepancies and avoid revenue loss.
  • Oversaw the delivery of standard project by framework team, which resulted in method.
  • Collaborated with IT to implement an automated claims tracking system, enabling real-time monitoring and cutting processing errors by 37% within 6 months.
  • Collaborated with insurance adjusters and legal experts to resolve high-priority claims for Salesforce, achieving customer satisfaction indices above 35% consistently.
  • Answered 18 calls per 6 months to help customers with their questions and concerns.
  • Achieved 50% efficiency gains.
  • Achieved results during the past year.
  • Assisted in the resolution of complex claims.
  • Authored standard operating procedures (SOPs) for high-complexity claims.

Summaries

  • Boosted departmental performance by 19% %.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Achieved repeat business of over 28% from returning clients.
  • Collaborated with legal experts.
  • Strengths in quality assurance and process improvement backed up by Miscellaneous training.
  • Effective at managing phone calls, emails, letters, and in-person requests for assistance while adhering to standard regulations and initiative department guidelines.
  • Achieved 57% improvement in claims processing efficiency.
  • Experienced framework Insurance Specialist with a track record of managing large caseloads in high-pressure situations.
  • Collaborated with insurance adjusters and legal teams.
  • Achieved customer satisfaction scores above 48% for Adobe Creative Suite claims.

Accomplishments

  • Developed client retention strategies that reduced claim disputes by 81% and enhanced customer loyalty within a several months.
  • Achieved a 53% success rate in regulatory audits by ensuring claims adhered to strict local, state, and federal compliance requirements.
  • Worked with IT to introduce claims automation, reducing manual entry errors by 32% and freeing up 9 hours of employee time.
  • Served as the department liaison for cross-functional teams to ensure consistent system updates, successfully transitioning 17 users to new claims processing technology.
  • Created escalation procedures for high-value claims, reducing processing delays on large-scale payouts by 29%.
  • Documented and resolved program which led to procedure.
  • Partnered with risk assessment teams to evaluate potential fraudulent claims, saving the company over $4 in reclaimed losses annually.
  • Actively contributed to policy revisions by monitoring industry trends and regulatory changes, ensuring continued compliance with initiative rules.
  • Reduced processing errors by 64% by implementing new Standard Operating Procedures (SOPs) for handling auto and medical-related claims.
  • Analyzed historical claim data to identify trends, helping the company to adjust its risk management strategies and lower claim payouts by $3.

Affiliations

  • Certified Claims Professional through the National Association of Insurance Commissioners (NAIC) since 2022
  • Toastmasters
  • Active participant in the National Association of Health Underwriters (NAHU) 2016
  • Participant in local Insurance Professionals Association seminars for claims service improvement Raleigh
  • Certified Insurance Services Representative (CISR) credential through the National Alliance for Insurance Education & Research 2015
  • Completed a certificate program in Healthcare Revenue Cycle Management through the Healthcare Financial Management Association (HFMA) 2021
  • Coordinator for partnership initiatives with the National Insurance Crime Bureau (NICB) on reducing fraud-related claims 2015
  • Association for Supply Chain Management (APICS)
  • Freemason
  • Association of Information Technology Professionals

Certifications

  • Certified Digital Claims Expert (CDCE)
  • Workers' Compensation Claims Professional (WCCP)
  • Associate in Claims (AIC)
  • Associate in General Insurance (AINS)
  • Health Claims Associate (HCA)
  • Commercial Claims Adjuster Certification (CCAC) 2023
  • Cyber Claims Professional Accreditation (CCPA)
  • First Aid/CPR Certified
  • Associate in Risk Management (ARM)
  • Senior Claims Law Associate (SCLA)

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