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Skills

  • Budget reporting on claims settlements
  • Communications
  • Business operations
  • Data entry accuracy and speed
  • Excellent administrative abilities
  • Data visualization and reporting tools (e.g., QuickBooks)
  • Medical billing and records review
  • Loss adjustment methodologies
  • Cross-department collaboration
  • Vendor relationship management

Work Experiences

  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Analyzed 16 years of historical data.
  • Analyzed and validated data from policyholders, contributing to a 25% increase in overall operational efficiency.
  • Oversaw the delivery of method project by category team, which resulted in process.
  • Answered 15 calls per the past year to help customers with their questions and concerns.
  • Achieved results in several months.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Collaborated closely with underwriters and adjusters to resolve complex claims valued at over $3, reducing processing delays by 30% in 2020.
  • Achieved 100% regulatory compliance.
  • Collaborated with procedure customers to determine their needs and deliver program service.

Summaries

  • Clear understanding of budget management and strategic planning as well as performance reporting training.
  • Within Miscellaneous, senior Claims Technician and outstanding performer in budget management and project management.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the program business.
  • Accomplished Claims Technician with 9 years of experience.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Achieved accurate coverage determinations.
  • Excellent interpersonal skills with a track record of successfully interpreting and explaining method insurance policy details to customers.
  • Proficient in Salesforce, as well as a dependable nature and a resourceful problem-solving approach.
  • Hardworking Claims Technician with 3 years of telecommuting experience meeting customer needs.

Accomplishments

  • Led process improvement initiative resulting in a 48% reduction in claim processing times, directly contributing to higher customer satisfaction scores.
  • Provided mentorship and training to a newly hired team of 8 claims technicians, boosting department efficiency by 69%.
  • Created standardized response templates for customer communications, which improved team productivity and reduced average claims resolution time by 36%.
  • Facilitated collaboration between claims and legal teams regarding high-profile cases, ensuring compliance with legal mandates and resolving disputes faster.
  • Rolled out a new customer relationship management platform, improving claim interaction documentation and increasing customer retention by 30%.
  • Actively led a project to migrate legacy claims data to a new system, safeguarding data integrity and improving retrieval times by 27%.
  • Enhanced customer satisfaction by implementing a new CRM system that improved response times and allowed for tracking of client queries in real-time.
  • Spearheaded the integration of a new claims management software, resulting in a 15% reduction in manual data entry time and increased processing efficiency.
  • Utilized bilingual fluency in Mandarin to manage and resolve a high volume of claims for initiative customers, improving customer satisfaction metrics.
  • Collaborated with team of 9 in the development of method.

Affiliations

  • Project Management Institute
  • Association for Computing Machinery
  • Certified Professional in Insurance Claims (CPIC), category
  • International Association of Claims Professionals (IACP)
  • Certified Bilingual Insurance Professional, process
  • Society of Human Resource Management
  • American College of Healthcare Executives (ACHE)
  • Jaycees
  • Underwriting and Claims Management Advisory Group Austin
  • Insurance Accounting & Systems Association (IASA)

Certifications

  • Certified Professional Coder (CPC)
  • Certified Compliance & Ethics Professional (CCEP)
  • Associate in Marine Insurance Management (AMIM)
  • Apple Certified Associate (ACA)
  • Certified Claims Professional (CCP)
  • Senior Professional in Insurance Regulation (SPIR)
  • Professional Risk Manager (PRM)
  • Certified Case Manager (CCM)
  • Senior Claim Law Associate (SCLA)
  • Certified Public Accountant

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