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Skills

  • Attention to detail
  • Problem resolution
  • Time management and prioritization
  • Cross-departmental teamwork
  • Process improvement
  • Legal Team Collaboration
  • Operational improvement
  • Project management skills
  • Customer service
  • System equipment

Work Experiences

  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Oversaw the delivery of metric project by initiative team, which resulted in metric.
  • Assisted legal counsel with complex medical and liability claims, contributing to settlements totaling $17 in 2016.
  • Collaborated with the engineering on a project.
  • Conducted audits on claim submissions.
  • Was in charge of collecting premiums and issuing accurate receipts.
  • Transported ServiceNow to 18 months customer locations.
  • Answered phone calls from clients, vendors, and a variety of other callers looking for information.
  • Existing policies were modified, updated, and processed by me.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.

Summaries

  • Achieved a 20% success rate.
  • Adept at fraud detection and investigation.
  • Achieved a 58% reduction in lost claims.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Selling over 2 policies weekly and maintaining excellent relationships with customers and coworkers are two of my strongest skills.
  • Hardworking Claims Support Representative with 18 years of telecommuting experience meeting customer needs.
  • Achieved quicker dispute resolution times.
  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate initiative systems is one of my specialties.
  • Insurance Clerk with a track record of organization, customer service, and professionalism.
  • Expert in all aspects of the insurance sales cycle, including prospecting and follow-up.

Accomplishments

  • Improved efficiency of claims submissions by 40% by collaborating with IT department to automate manual data entry.
  • Partnered with external auditors to secure necessary evidence for 7 cases, reducing claim processing delays by 48%.
  • Enhanced interdepartmental communication, resulting in a 27% faster approval rate for high-value claims.
  • Achieved 8 years of error-free claims management despite high-volume workload through expert multitasking and organizational skills.
  • Achieved a 80% customer satisfaction increase by responding to inquiries within 18 months and addressing concerns with urgency.
  • Proficient in the use of Asana for processing claims, delivering a 76% faster submission rate for critical accounts.
  • Consistently exceeded key performance indicators (KPIs) by 17%, managing claims while adhering strictly to company policies.
  • Developed and presented training materials focused on claims accuracy, contributing to a 47% improvement in overall team performance.
  • Led a cross-function team to undertake a process redesign for disputed claims resolution, shortening resolution time by 54% days.
  • Collaborated with team of 13 in the development of method.

Affiliations

  • Association for Computing Machinery
  • American Risk and Insurance Association (ARIA)
  • National Association of Subrogation Professionals (NASP)
  • National Medical Management Certifications (NMMC)
  • American Society of Safety Professionals
  • Society of Human Resource Management
  • International Council of Nurses
  • Workers' Compensation Claim Professionals Association (WCCPA)
  • National Association of Social Workers
  • Claims and Liability Management Resources (CLM)

Certifications

  • Salesforce
  • CompTIA Network+
  • Certified Medical Reimbursement Specialist (CMRS)
  • Digital Claims Transformation Certificate - Beacon Labs
  • Google Certified Professional Cloud Architect
  • Health Care Compliance Association - Certified in Healthcare Compliance (CHC)
  • Payment Card Industry Data Security Standard (PCI DSS) Certification
  • SHRM Certified Professional (SHRM-CP)
  • Certificate in General Insurance (Cert CII) – program
  • Chartered Property Casualty Underwriter (CPCU)

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