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Skills

  • Claims system tool implementation
  • KPI-driven performance improvements
  • Damage itemization
  • Emergency Response
  • Cost containment and reduction
  • Project organization
  • Cross-functional team collaboration
  • Budgets
  • Benefits review
  • Problem resolution

Work Experiences

  • Achieved a 19% reduction in external legal fees.
  • Collaborated with actuaries and underwriters.
  • Collaborated with framework customers to determine their needs and deliver metric service.
  • Accomplished this within 7 months.
  • Authored training manuals and guidelines for external claims evaluators, resulting in a uniform claims process with a 85% reduction in variance.
  • Achieved a 30% reduction in claim processing errors.
  • Allowed accurate workload predictions.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Achieved goals for 2018.
  • Looked for industry trends on social media and through online sources.

Summaries

  • External Claims Representative is a multi-talented External Claims Representative who is consistently rewarded for planning and operational improvements.
  • Trying to get a similar job with a growing insurance company.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Conducted complex accident investigations.
  • Achieved 38% savings in case handling.
  • Within Miscellaneous, senior External Claims Representative and outstanding performer in performance reporting and risk assessment.
  • External Claims Representative with 6 years of successful vendor management and strategic planning experience.
  • Process professional with 14 years of experience evaluating coverage and supervising claims review.
  • Closed claims within a three years.
  • Achieved 46% cost savings for the company.

Accomplishments

  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Built and maintained strong relationships with external stakeholders such as vendors, adjusters, and third-party administrators to achieve faster claims resolutions.
  • Delivered complex monthly claims reports to senior leadership, providing actionable insights that led to a 59% reduction in cost overruns.
  • Collaborated with cross-functional teams, including underwriters and legal, to successfully resolve 4+ high-complexity claims within SLA timeframes.
  • Reviewed high-volume claims while maintaining a 9 claim-per-day average, ensuring all claims were processed within the Service Level Agreement.
  • Provided timely and targeted risk evaluations, mitigating potential financial exposure on SAP claims.
  • Leveraged automated claims systems to identify potential fraud risks, saving the company $18 in false claims prevention annually.
  • Played a key role in migrating claims data to a new cloud-based platform, reducing downtime by 23% and improving process scalability.
  • Spearheaded a high-volume claims operation, achieving a 85% decrease in outstanding claims through quick settlements and proactive negotiations.
  • Led an effort to streamline third-party vendor billing processes, resulting in $9 in annual cost savings.

Affiliations

  • Professional Liability Underwriting Society (PLUS)
  • Claim Academy Alumni Association
  • Society of Human Resource Management
  • American Marketing Association
  • Workers’ Compensation Insurance Organizations and Associations
  • Healthcare Financial Management Association (HFMA)
  • National Association of Subrogation Professionals (NASP)
  • International Risk Management Institute (IRMI)
  • Society of Risk Management Consultants (SRMC)
  • American Medical Informatics Association

Certifications

  • Associate Risk Management (ARM) Certification
  • Project Management Professional (PMP)
  • Certified Public Accountant (CPA)
  • Accredited Adviser in Insurance (AAI)
  • CompTIA Network+
  • Chartered Property Casualty Underwriter (CPCU)
  • Workers' Compensation Specialist (WCS)
  • Liability Risk Management Certification Cedar Works
  • Cisco Certified Internetwork Expert (CCIE)
  • Diversity and Inclusion in Insurance Training Certification

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