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Skills

  • Problem resolution
  • First Aid/CPR
  • On-time resolution tracking
  • Compliance with system
  • Relationship development
  • Audit preparation and execution
  • Training program development
  • Root cause analysis
  • Corporate client negotiation
  • Documentation abilities

Work Experiences

  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Had an excellent attendance record and was always on time for work.
  • Collaborated with the legal team.
  • Answered 8 calls per the past year to help customers with their questions and concerns.
  • Collaborated with the legal team in the successful defense of 16 claim disputes, saving $2 in potential litigation costs.
  • Conducted root cause analysis on rejected claims, leading to a 78% correction rate.
  • Collaborated with external vendors and evaluation teams to speed up assessment procedures, reducing average payout time by 50% days.
  • Achieved zero penalties or sanctions during multiple audits.
  • Achieved industry-leading timeframes of 16 months.
  • Achieved swift claim resolutions.

Summaries

  • Achieved zero assessment failures.
  • With excellent planning and problem-solving abilities, I am organized, driven, and adaptable.
  • Experienced program Insurance Specialist with a track record of managing large caseloads in high-pressure situations.
  • Achieved over 95% on-time claim resolution rates.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Clear understanding of quality assurance and budget management as well as strategic planning training.
  • Achieved full adherence to national regulations.
  • Achieved industry-leading 12 months-day turnaround time.
  • Collaborated with legal teams.
  • Accomplished in securing payouts exceeding $9 for complex claims, leveraging exceptional litigation avoidance strategies to reduce legal costs by 25% %.

Accomplishments

  • Utilized data analytics to create a system for tracking claim resolution efficiency, leading to 80% improvement in on-time completions.
  • Trained a team of 5 claims adjusters, resulting in a 37% decrease in errors across operational workflows.
  • Developed and maintained comprehensive claim resolution reports, which improved transparency and helped achieve Brightline's financial recovery goals.
  • Achieved a 40% reduction in errors for high-complexity claim review processes by coordinating targeted team trainings.
  • Orchestrated multidepartment collaboration to expedite claims resolution for high-value clients, resulting in a 51% turnaround improvement.
  • Collaborated with team of 12 in the development of framework.
  • Conducted internal audits of claims protocols, achieving 35% accuracy improvement and showcasing compliance with industry standards.
  • Collaborated with IT to integrate claims software with other business systems, creating a seamless filing process that reduced delays by 61% hours.
  • Monitored and reported on key claim KPIs, enabling timely adjustments to strategies that resulted in 21% faster resolutions.
  • Supported leadership in adjusting claims protocols during metric, reducing long-term disruption and ensuring business continuity.

Affiliations

  • Society of Human Resource Management - Insurance Claims division
  • Certified Claims Professional Accreditation Council (CCPAC)
  • Jaycees
  • International Council of Nurses
  • Project Management Institute
  • International Arbitration Association
  • Society of Claim Law Associates (SCLA)
  • National Association of Social Workers
  • National Association of Insurance Commissioners (NAIC)
  • American Institute for Chartered Property Casualty Underwriters (CPCU Society)

Certifications

  • CompTIA A+ Technician
  • Associate in Insurance Services (AIS) - standard
  • CompTIA Security+
  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Insurance Counselor (CIC) - Harbor & Co.
  • Certified Fraud Examiner (CFE) - Portland
  • Associate Risk Management (ARM) Designation
  • Associate in Claims (AIC) - standard
  • Certified Public Accountant
  • Microsoft Certified Systems Engineer (MCSE)

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