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Skills

  • Conflict resolution
  • Hardware evaluation
  • MS Office
  • Report writing
  • Customer service excellence
  • User interface understanding
  • Clerical support
  • System equipment
  • Risk management processes and analysis
  • Public speaking

Work Experiences

  • Addressed high-priority program claims.
  • Answered an average of 10 calls, emails, and faxes per day, responding to customer inquiries, resolving problems, and informing customers about new products.
  • Initiative helped me achieve $186,000.
  • Accelerated onboarding success within 7 weeks.
  • Started two key partnerships that resulted in a 54% increase in revenue.
  • Adhered to program standards.
  • Local, state, and federal agencies provided me with documents, clearances, certificates, and approvals.
  • Accurately processed claims in adherence to initiative standards, contributing to an error-free audit for 2023.
  • Solved metric issues, improved operations, and provided excellent customer service.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.

Summaries

  • Claims Service Specialist with 4 years of successful vendor management and quality assurance experience.
  • Costs were consistently reduced while profits were increased.
  • Achieved a 27% improvement in key claim metrics.
  • Top-producing salesperson and industry expert in Miscellaneous.
  • Working with Agile and Scrum methodologies to meet project milestones within specified timeframes is a strong suit.
  • Process professional with 14 years of experience evaluating coverage and supervising claims review.
  • Achieved this through comprehensive documentation.
  • Consistently maintained compliance.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Collaborated with litigation teams.

Accomplishments

  • Mentored junior claims agents and provided ongoing training, leading to an overall team performance increase by 32%.
  • Authored and revised policy documents to ensure compliance with system, reducing audit flags by 37% across multiple departments.
  • Spearheaded a cost-saving initiative that resulted in 34% reduction in litigation costs by improving early settlement procedures.
  • Enhanced the customer claims journey by developing a more efficient service model, leading to a net promoter score (NPS) increase of 23%.
  • Championed a process improvement project that reduced claim approval time from 13 days to 7 days, increasing overall productivity by 38%.
  • Utilized initiative to efficiently manage high-volume claims, reducing average claim handling time by 40% minutes.
  • Documented and resolved standard which led to framework.
  • Monitored and improved claims submission procedures, decreasing rejection rates by 43% over several months.
  • Created and distributed monthly performance reports for senior management, tracking improvements in claims processing efficiency by 53%.
  • Achieved consistent 81% improvement in claims resolution time by identifying and fixing bottlenecks within the claims process.

Affiliations

  • National African-American Insurance Association (NAAIA)
  • American Association of Insurance Services (AAIS)
  • American Marketing Association
  • American Institute For Chartered Property Casualty Underwriters (AICPCU)
  • Claims and Litigation Management Alliance (CLM)
  • American College of Financial Services – Insurance Members Group
  • Institute of Risk Management (IRM)
  • National Association of Insurance Commissioners (NAIC)
  • Association for Computing Machinery
  • Healthcare Financial Management Association (HFMA)

Certifications

  • Provider Credentialing Specialist Certification – system
  • Insurance Litigation and Risk Management Certification – Ironclad Systems
  • Certificate in General Insurance (Cert CII) – process
  • Microsoft Certified Systems Engineer (MCSE)
  • Lean Six Sigma Green Belt Certification – metric
  • Chartered Property Casualty Underwriter (CPCU) – 2016, standard
  • Project Management Professional (PMP)
  • CompTIA Security+
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Business Analysis Professional (CBAP)

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