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Skills

  • Team building
  • Process improvement
  • Data analysis and trend identification
  • Project organization
  • Claims backlog reduction
  • Problem resolution
  • Program equipment
  • System troubleshooting
  • Stakeholder management
  • New system implementation

Work Experiences

  • Awarded Top Performer for excellence in claims handling.
  • Had an excellent attendance record and was always on time for work.
  • Awarded Outstanding Service Award for consistent excellence in handling an average of 7 claims weekly, maintaining a 52% accuracy rate.
  • Built strong relationships with external claim handlers.
  • Was able to effectively communicate with members of the operations, finance, and clinical departments.
  • Oversaw the delivery of category project by program team, which resulted in system.
  • Awarded Top Performer for top performance.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Collaborated with cross-functional teams.
  • Reviewed open requests and redirected workloads to ensure that projects were completed on time.

Summaries

  • Experienced method Insurance Specialist with a track record of managing large caseloads in high-pressure situations.
  • Offering 17 years of experience as well as the willingness to take on any challenge.
  • Clear understanding of risk assessment and stakeholder engagement as well as risk assessment training.
  • Awarded for managing claims with a 60% error-free rate.
  • Accomplished External Claims Assistant recognized for implementing systems that shortened claim handling times by 14 days. Adept at working cross-functionally to ensure timely claim dispute resolutions.
  • Bringing 4 years of insurance experience to the table.
  • Adept at working cross-functionally.
  • Collaborative Claims Task Assistant with deep experience in regulatory compliance and process optimization. Known for reducing error rates by 22% and working well across multiple departments to improve outcomes.
  • Analytical External Claims Assistant capable of reviewing and auditing claims for discrepancies, leading to a 46% reduction in errors. Demonstrates clear understanding of regulatory compliance and third-party management.
  • Achieved a 60% decrease in processing times.

Accomplishments

  • Assisted in the design and rollout of a claims performance dashboard, improving insight into daily claims volumes and reducing response bottlenecks by 61%.
  • Reduced backlog of open claims by 18% by prioritizing high-risk claims and streamlining the review process.
  • Acted as the primary point of contact for escalated claims cases, reducing response times and improving the resolution of disputes by 67%.
  • Guided a process improvement initiative that reduced unnecessary interdepartmental hand-offs, cutting claims review times by 65% hours.
  • Enhanced claims status reporting by introducing a streamlined tracking system that reduced report generation time by 61% hours/days.
  • Provided accurate resolution recommendations following thorough analysis of 10 high-profile claims cases, increasing resolution efficiency.
  • Maintained high levels of customer service by resolving 60% of claim-related inquiries within three years, increasing customer satisfaction.
  • Created training materials for 3 new staff members, ensuring quicker onboarding and reducing claims audit errors by 81%.
  • Analyzed key performance metrics and provided actionable insights that helped reduce overall processing errors by 50%, improving company KPIs.
  • Enabled the procedure to successfully transition to a new claim management system, reducing administrative time by 48%.

Affiliations

  • Lions Club
  • Society of Insurance Trainers and Educators (SITE)
  • National Healthcare Anti-Fraud Association (NHCAA)
  • Public Risk Management Association (PRIMA)
  • Rotary International
  • Healthcare Financial Management Association (HFMA)
  • Association for Computing Machinery
  • American Society of Professional Claims Managers
  • Society of Financial Examiners (SOFE)
  • National Association of Health Underwriters (NAHU)

Certifications

  • Salesforce
  • Fundamentals in Claims Settlement and Investigation - HubSpot
  • Certified Professional in Healthcare Risk Management (CPHRM) - Summit Group
  • Certified Public Accountant (CPA)
  • Certified Advanced Claims Examiner (CACE) - Cedar Works
  • Associate in Risk Management (ARM) - Beacon Labs
  • CompTIA Security+
  • Analytics and Claims Investigation - Adobe Creative Suite
  • Certified Regulatory Compliance Manager (CRCM) - Summit Group
  • Apple Certified Associate (ACA)

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