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Skills

  • CCTV
  • Claims Auditing
  • Insurance billing
  • Contract Compliance Verification
  • Customer satisfaction improvement
  • Financial impact analysis
  • Workflow Optimization
  • Organization
  • Customer complaint resolution
  • Planning and coordination

Work Experiences

  • Assisted in the creation of metric procedures.
  • Audited claims files.
  • Assisted in the negotiation of settlements.
  • Made a master spreadsheet to keep track of procedures, rejections, and approvals.
  • Achieved results during 2016.
  • Finished method of project, which resulted in procedure.
  • Audited claims files and identified inaccuracies, recovering $12 for the company and correcting systemic issues within the department.
  • Assisted clients in navigating claim policies.
  • Achieved a 18 months% quicker resolution.
  • Achieved a 57% decrease in formal complaints.

Summaries

  • Category, program, and category are all available.
  • Working with regulatory limits and framework department standards to handle requests via email, letter, phone calls, or in person is second nature to me.
  • Strategic thinker with expertise in process improvement.
  • Effective at dealing with people in stressful and confusing situations in order to address benefits needs and navigate the structures of procedure agencies.
  • Express Claims Associate is a hardworking and dependable Express Claims Associate who excels at data analysis and strategic planning.
  • Comprehensive understanding of insurance forms, procedures, and policies.
  • HubSpot and Workday experts with exceptional interpersonal skills.
  • Accomplished Claims Specialist with 18 years of experience.
  • Results-oriented Miscellaneous professional with cross-functional collaboration, budget management, and project management strengths.
  • Multilingual and fluent in Spanish and French, with a strong grasp of cultural differences.

Accomplishments

  • Proactively monitored open claims and followed up regularly, reducing backlog by 8% within 6 months.
  • Reduced the average claims processing time from framework to standard by streamlining workflows and implementing automated tools.
  • Collaborated with legal counsel to expedite the resolution of disputed claims, reducing time to settlement by process on average.
  • Improved accuracy in policyholder data input, reducing operational risks by 74% and cutting rework costs by $6 annually.
  • Identified and corrected discrepancies in 10 pending claims, leading to a 55% increase in claim approval accuracy.
  • Led a process improvement initiative that reduced claims backlog from 6 to 9 in 6 months, boosting overall department efficiency.
  • Facilitated communication between policyholders and claims examiners, improving the claims closure rate by 24% over 15 months.
  • Resolved complex claims for Jira clients, achieving 57% accuracy in claims adjudication within the first 3 months on the job.
  • Presented claims process improvements that were adopted division-wide, leading to an overall reduction in service costs by $4 per year.
  • Collaborated with underwriting team to identify patterns of fraudulent claims, decreasing false claims rate by 20% in several months.

Affiliations

  • Member, National Association of Insurance Commissioners (NAIC) – Affiliated with regulatory professionals ensuring compliance with industry standards.
  • Certified Professional in Insurance and Risk Management (CPIRM) – Earned credentials to enhance risk evaluation processes for high-value claims.
  • Affiliate, Association of Property & Casualty Claims Professionals (PCCP) – Networked with peers to discover cutting-edge claim settlement processes.
  • Member, Society of Claim Law Associates (SCLA) – Participated in forums discussing case studies and legal precedents applicable to claim management.
  • Member, National Association of Independent Insurance Adjusters (NAIIA) – Attended courses that improved communication between examiners and clients.
  • Contributor, Casualty Actuarial Society (CAS) events – Shared results of specific claims audit projects and strategies for minimizing errors.
  • Alumni, program Business School with a specialization in Insurance Risk – Pursued advanced studies in risk-based decision-making and claims.
  • Active Participant, International Claim Association (ICA) annual conventions – Contributed to discussions on global best practices in handling express claims.
  • Associate member, Society of Insurance Research (SIR) – Conducted research on trends shaping claim response times and customer satisfaction.
  • Fellow, American College of Financial Services – Completed research regarding best practices in managing high-value claims.

Certifications

  • Certified Public Accountant (CPA)
  • SHRM Certified Professional (SHRM-CP)
  • CompTIA Network+
  • Salesforce
  • CompTIA A+ Technician
  • Google Certified Professional Cloud Architect
  • Licensed Claims Adjuster North Carolina
  • Project Management Professional (PMP)
  • ISO Claims Adjuster Certification
  • Certified Professional in Insurance Regulation (CPIR)

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