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Skills

  • Process equipment
  • Customer service excellence
  • Attention to detail
  • Root cause analysis
  • Change management and adaptability
  • Operational improvement
  • Organization
  • Client relationship management
  • Benefits review
  • Claims investigation coordination

Work Experiences

  • Analyzed customer feedback trends.
  • Achieved Top Performer for outstanding service.
  • Developed a revised escalation protocol for complex claims which reduced managerial intervention by 16%.
  • Collaborated with underwriters to clarify policy terms.
  • Achieved 6 favorable outcomes.
  • Collaborated with the claims investigation unit to assess high-risk claims, leading to an Top Performer for 18 months.
  • Achieved results over 16 months.
  • Assisted in processing 9 claims.
  • Acquired ITIL.
  • Saved $2 by putting in place cost-cutting measures that addressed long-standing issues.

Summaries

  • Claims specialist adept in reducing escalations.
  • Achieved first-call resolution rates above 84%.
  • Trying to get a similar job with a growing insurance company.
  • Averaged 7 minutes for claim processing.
  • Coordinated with cross-functional teams.
  • Collaborative professional adept at coordinating with external vendors.
  • Within Miscellaneous, senior Claims Support Specialist and outstanding performer in quality assurance and vendor management.
  • Committed to creating positive claimant experiences.
  • Achieved 23% fewer errors over 5 months.
  • Boosted claimant satisfaction by 40%.

Accomplishments

  • Provided detailed data analyses using Tableau to streamline reporting processes, reducing report preparation time by 72%.
  • Built strong relationships with external stakeholders to expedite the resolution of outstanding claims and complaints.
  • Managed a portfolio of over 7 client cases, achieving a 85% claims accuracy rate and minimal client disputes.
  • Facilitated resolution of disputes for high-stakes claim cases valued at over $16, ensuring fair outcomes and customer satisfaction.
  • Co-authored new policies for claim escalations, standardizing responses and enhancing resolution rates by 68% in complex scenarios.
  • Developed and monitored performance dashboards using SAP, providing real-time updates on critical claim metrics.
  • Played a critical role in resolving claims backlog by prioritizing and utilizing task management tools such as Adobe Creative Suite.
  • Led a cross-departmental initiative to improve claims communication protocols, resulting in a 75% increase in customer satisfaction.
  • Earned Lean in 2022, empowering a deeper understanding and handling of employer liability claims.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.

Affiliations

  • Association of Information Technology Professionals
  • Institute of Risk Management (IRM)
  • National Association of Independent Insurance Adjusters (NAIIA)
  • Association of Certified Fraud Examiners (ACFE)
  • International Association of Administrative Professionals
  • National Alliance for Insurance Education & Research
  • Chartered Property Casualty Underwriters (CPCU) Society
  • Society of Women Engineers
  • International Association of Insurance Professionals (IAIP)
  • American Institute For Chartered Property Casualty Underwriters (AICPCU)

Certifications

  • Property & Casualty Insurance License - initiative
  • Project Management Professional (PMP)
  • Claims and Risk Assessment Certificate - Brightline
  • Business Process Improvement Specialist Certification - Brightline
  • Professional Risk Manager (PRM) - Professional Risk Managers International Association (PRMIA)
  • Associate in Insurance Data Analytics (AIDA) - The Institutes
  • Certified Medical Reimbursement Specialist (CMRS) - American Medical Billing Association (AMBA)
  • Associate in Claims (AIC) - offered by The Institutes
  • Accredited Insurance Management Professional Certification - method
  • Apple Certified Associate (ACA)

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