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Claims Support Representative resume examples

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Skills

  • Customer feedback analysis and reporting
  • Problem resolution
  • Data analysis using SAP
  • Excellent administrative abilities
  • Multilingual support (Japanese)
  • System equipment
  • Customer satisfaction optimization
  • Client relationship management
  • Attention to detail
  • Business operations

Work Experiences

  • Achieved a 79% faster turnaround time.
  • Was in charge of collecting premiums and issuing accurate receipts.
  • Completed comprehensive investigations into complex claims.
  • Assisted legal counsel with complex medical and liability claims, contributing to settlements totaling $17 in 2016.
  • Conducted audits on claim submissions.
  • Assisted legal counsel with medical claims.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Oversaw the delivery of metric project by initiative team, which resulted in metric.
  • Automated routine tasks.
  • Boosted renewal rates by 80%.

Summaries

  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the process business.
  • Adept at fraud detection and investigation.
  • Adept at fraud detection and investigation, having recovered $17 in potential losses by identifying suspicious claims and working with the legal team to mitigate risk.
  • Filing, data entry, and keeping a clean and organized work environment are all skills I have.
  • Proficient in Tableau, as well as a dependable nature and a resourceful problem-solving approach.
  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate initiative systems is one of my specialties.
  • Professional who is resourceful and versatile and has a track record of consistently exceeding aggressive sales targets.
  • Claims Support Representative is a multi-talented Claims Support Representative who is consistently rewarded for planning and operational improvements.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Achieved a 58% reduction in lost claims.

Accomplishments

  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Consistently exceeded key performance indicators (KPIs) by 17%, managing claims while adhering strictly to company policies.
  • Reduced customer churn by 42% by resolving 7 customer disputes tactfully and efficiently.
  • Worked with legal counsel on 4 litigation claims, ensuring that all deadlines and compliance standards were met.
  • Facilitated 11 successful resolution negotiations with difficult vendors, contributing to a 12 savings for the company.
  • Led a cross-function team to undertake a process redesign for disputed claims resolution, shortening resolution time by 54% days.
  • Successfully reconciled 8 mismatched claims, boosting end-of-year financial reporting accuracy by 42%.
  • Performed in-depth policy analytics for 8 clients, resulting in the reduction of misclassified claims by 17%
  • Introduced a new document tracking system that improved the accuracy of claim submissions by 63%.
  • Maintained PMP standards while processing high-priority claims, contributing to a 15% drop in compliance violations.

Affiliations

  • National Association of Subrogation Professionals (NASP)
  • Lions Club
  • American Medical Informatics Association
  • Accounting & Financial Women’s Alliance (AFWA) - Accounting Expertise in Claims Management
  • National Insurance Crime Bureau (NICB)
  • National Association of Independent Insurance Adjusters (NAIIA)
  • International Association of Special Investigation Units (IASIU) - Combating Fraud
  • Continuing Professional Development (CPD) initiative
  • Risk Management Society (RIMS)
  • Society of Human Resource Management

Certifications

  • SHRM Senior Certified Professional (SHRM-SCP)
  • Apple Certified Associate (ACA)
  • Certified Health Insurance Specialist (CHS)
  • Associate in Risk Management (ARM) - method
  • Project Management Professional (PMP)
  • Chartered Property Casualty Underwriter (CPCU)
  • Certified Insurance Fraud Analyst (CIFA)
  • ServSafe
  • Associate in Claims (AIC) - procedure
  • Licensed Independent Claims Adjuster - Colorado

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