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Skills

  • HIPAA compliance
  • Insurance claims software proficiency
  • Compliance with state, federal, and local disability regulations
  • Conflict resolution and de-escalation skills
  • Appeals case resolution track record
  • Fraud detection and prevention strategies
  • Automobile claims specialist
  • Valuation knowledge
  • Expert testimony in disability hearings
  • Claims data analysis

Work Experiences

  • Conducted in-depth interviews with witnesses and claimants to gather facts and information.
  • Assessed applicant’s conditions.
  • Organized category data in order to finish metric files.
  • Investigated and analyzed insurance claims that appeared to be suspicious or potentially fraudulent.
  • Adjudicated claims.
  • Analyzed the data gathered during the investigation and wrote a report with my findings and recommendations.
  • Achieved improvements in 2023.
  • Analyzed disability claims.
  • Was in charge of maintaining information files and processing paperwork on a daily basis.
  • Achieved 70% compliance.

Summaries

  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the procedure business.
  • Adaptive professional with expertise in both initial disability claim determination and appeals processing, successfully resolving 11% of denied claims without escalation.
  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Expert at creating profitable and high-quality processes.
  • Achieved a 68% reduction in claims processing times.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Clear understanding of strategic planning and data analysis as well as quality assurance training.
  • Achieved timeliness in claims processing.
  • Disability Claims Examiner is a multi-talented Disability Claims Examiner who is consistently rewarded for planning and operational improvements.
  • Adept at reviewing complex medical certifying statements.

Accomplishments

  • Led a district-wide implementation of new claim processing software, reducing manual processing by 23% hours per week.
  • Ensured strict compliance with HIPAA and other regulatory guidelines while handling sensitive claimant information.
  • Conducted deep-dive case reviews to assess compliance with Social Security Disability Insurance (SSDI) guidelines, decreasing administrative errors by 83%.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Provided expert testimony in 9 appeals hearings, achieving a 20% decision upheld rate.
  • Successfully identified and resolved discrepancies in 15 claims, resulting in recovery of 16 in overpaid funds.
  • Improved stakeholder relations by establishing open lines of communication, achieving a 74% increase in claimant satisfaction scores.
  • Increased team output by 82% through effective time management and assignment prioritization strategies.
  • Worked directly with claimants, stakeholders, and third-party providers to ensure clear, timely communication and resolve disputes efficiently.
  • Collaborated with external legal teams and medical experts to provide comprehensive case summaries for appeals, contributing to a 80% upheld decision rate.

Affiliations

  • Association for Supply Chain Management (APICS)
  • International Association of Administrative Professionals
  • Federal Employment Lawyers Group (FELG)
  • Disability Determination Services (DDS) - Examiner Certification
  • International Council of Nurses
  • Disability Management Employer Coalition (DMEC)
  • National Conference on Social Security Disability Representation (NOSSCR)
  • American Marketing Association
  • Institute of Medicine & Law (IML) - Worker's Compensation Chapter
  • American Risk and Insurance Association (ARIA)

Certifications

  • National Insurance Producer Registry (NIPR) Certification
  • Certified Life Care Planner (CLCP)
  • Associate in Risk Management (ARM) – Workers' Compensation
  • Certified Public Accountant (CPA)
  • Fundamentals of Insurance Regulation (FOR) Certificate
  • Certified Insurance Counselor (CIC)
  • CompTIA Security+
  • Cisco Certified Network Associate (CCNA)
  • Certified Case Manager (CCM)
  • ServSafe

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