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Skills

  • Financial analysis and planning
  • Relationship development
  • MS Office
  • Organization
  • Planning and coordination
  • Employee performance evaluation
  • Administrative support
  • Project organization
  • Security systems
  • Fraud detection and prevention

Work Experiences

  • Collaborated with underwriting teams on claims assessments.
  • Increased employee productivity by managing inter-team conflict resolution, yearly performance reviews, hiring and terminating processes, training initiatives, scheduling, time and attendance, and payroll.
  • Achieved accuracy throughout 2021.
  • Activated contingency planning during peak periods.
  • Raised funds by forming partnerships with investors and maintaining positive relationships with stockholders.
  • Increased customer base by acquiring new customers and identifying needs so that relevant products could be delivered.
  • Developed an annual branch business plan for maximum profitability and effectiveness.
  • Champion of lean methodologies, saving $6 in year-over-year operational expenses and reducing claims processing bottlenecks by 17%.
  • Automated tracking tools.
  • Achieved a 52% reduction in multitasking errors.

Summaries

  • Director of Claims Operations is a hardworking and dependable Director of Claims Operations who excels at strategic planning and data analysis.
  • Initiative and process have a proven track record.
  • Branch Manager with experience overseeing operations in the standard field.
  • With hands-on experience, eager to learn new skills and advance knowledge.
  • Multilingual and fluent in Mandarin and Portuguese, with a strong grasp of cultural differences.
  • Workday and Microsoft Excel experts with exceptional interpersonal skills.
  • Motivating leader who has built and managed standard teams in the past.
  • Individual who is enthusiastic and capable of working in both a team and independently.
  • Director of Claims Operations has prior management experience in the Miscellaneous.
  • Expert in program with a strong aptitude for streamlined and spearheaded.

Accomplishments

  • Researched and implemented AI-driven claims evaluation strategies, decreasing under/overpayment discrepancies by 84%.
  • Optimized end-to-end claims workflows by integrating Salesforce, resulting in a 42% improvement in processing speed across human resources.
  • Collaborated with cross-functional teams to build a risk assessment framework, minimizing claim approval errors by 50% annually.
  • Led multi-departmental efforts to create a staffing forecast model, ensuring optimal resource allocation during peak claim periods and reducing bottlenecks by 79%.
  • Directed negotiations and successfully secured standard reimbursement approval for initiative claims, resulting in cost savings of $3.
  • Completed a claims leakage audit that revealed and addressed multiple inefficiencies, saving the company $4 in the first 9 months post-implementation.
  • Authored internal best-practice guidelines for the high-severity claims team, driving a 42% improvement in resolution times for complex cases.
  • Introduced workflow automation tools that lowered operational expenses by $14 annually.
  • Built a claims risk evaluation program in partnership with key stakeholders, saving the organization $7 in high-risk exposure.
  • Developed and rolled out enhanced claims training material that reduced common error rates by 83% within the first 11 months of deployment.

Affiliations

  • Participant, Claims Handling Excellence Workshops – Facilitated multi-stakeholder workshops to assess operational efficiency
  • Member, North American Claim Executives Association (NACEA)
  • President, Local Chapter of Insurance Professionals Association Portland
  • Member, International Association of Insurance Professionals (IAIP)
  • Certified Claims Professional, Claims and Litigation Management Alliance (CLM) – Certification obtained for expertise in claims management
  • Certificate Holder, Financial Risk Manager (FRM) – Specialized in risk assessment
  • Affiliate Member, Risk and Insurance Management Society (RIMS)
  • Keynote Speaker, Annual Conference on Risk & Claims Management held in 2021
  • Member, Claims Management Council – Participated in developing industry-specific KPIs and tracking tools
  • Member, National Association of Insurance Commissioners (NAIC)

Certifications

  • Human Resources Organizational Development Certification - Vantage
  • Certified Analytics Professional (CAP) - INFORMS
  • Advanced Claims Management Training - Brightline
  • Certified Change Management Professional (CCMP) - Association of Change Management Professionals
  • Certified Healthcare Financial Professional (CHFP) – procedure
  • CompTIA Network+
  • Lean Six Sigma Black Belt Certification - Northwind
  • Certified Public Accountant (CPA)
  • Healthcare Claims Management Certification - Ironclad Systems
  • Microsoft Certified Systems Engineer (MCSE)

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