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Skills

  • FMLA policy drafting
  • Automobile claims specialist
  • Familiar with fraud statutes
  • AMS360
  • Data analysis and reporting
  • Claims process best practices development
  • Fair Isaac Claims Advisor
  • Personal, casualty and property loss
  • Microsoft Publisher
  • Cross-team FMLA compliance training

Work Experiences

  • Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
  • Analyzed and processed requests for extended leave under FMLA, ensuring accurate documentation and legal compliance for 13 cases annually.
  • Achieved Outstanding Service Award for outstanding customer service.
  • Calculated the quantifiable features of metric products.
  • Investigated potentially fraudulent claims that claims representatives had initiated.
  • Championed internal programs for FMLA understanding.
  • Verified the accuracy of framework records to maintain the accuracy of the records database.
  • Achieved 82% client satisfaction.
  • Was in charge of maintaining claims data in initiative systems.
  • Handled process calls about category processes from customers and other stakeholders.

Summaries

  • Claims Examiner with extensive experience in the system claims industry.
  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Clear understanding of quality assurance and budget management as well as strategic planning training.
  • Adept at ensuring compliance with federal regulations.
  • Collaborative professional with experience as the primary point of contact for FMLA-related queries. Improved employee-manager relations and increased process transparency by 71% over the past year.
  • Strong conflict resolution and negotiation skills, as well as excellent reporting and research abilities.
  • Achieved efficiency through effective communication and process management.
  • For the past year, I've been a member of the National Society of Professional Insurance Investigators.
  • Strong understanding of claimant intake processes, record documentation, and fraud investigation protocols.
  • Achieved reduced employee absenteeism by 43%.

Accomplishments

  • Provided comprehensive FMLA consultations to 12 employees, increasing FMLA knowledge base and reducing claim disputes by 81%.
  • Collaborated with insurance providers and legal teams to manage FMLA and workers’ compensation cases, reducing overlap issues by 62%.
  • Investigated complex overlapping FMLA and ADA cases, achieving a 83% success rate in legal compliance and employee satisfaction.
  • Performed compliance audits of 8 FMLA claims, identifying gaps and ensuring a 85% improvement in regulatory adherence.
  • Resolved product issue through consumer testing.
  • Reviewed and fine-tuned FMLA cases involving sensitive medical details in compliance with HIPAA, improving confidentiality measures by 45%.
  • Analyzed and audited 14 FMLA claims, identifying trends in errors that improved claim resolution by 27%.
  • Developed and implemented case management protocols for intermittent FMLA leaves, increasing compliance by 25% and improving employee satisfaction.
  • Advised on revisions to FMLA leave policies, resulting in a 74% improvement in employee satisfaction and reduced complaint cases.
  • Reviewed and processed over 9 medical certifications and recertifications, reducing claim processing times by 20%.

Affiliations

  • The Health Advocate Group
  • Society for Industrial and Organizational Psychology (SIOP)
  • American Payroll Association (APA)
  • American Medical Informatics Association
  • American Marketing Association
  • Human Resources Certification Institute (HRCI)
  • Association of Information Technology Professionals
  • Case Management Society of America (CMSA)
  • Employer Healthcare & Benefits Congress (EHBC)
  • National Association of Claims Professionals (NACP)

Certifications

  • Advanced Certification in Employee Relations Law by The Institute for Applied Management & Law (IAML)
  • Certified Employee Benefits Specialist (CEBS) by International Foundation of Employee Benefit Plans
  • Human Resources Management Certification by program
  • CompTIA A+ Technician
  • Certified Human Resources Specialist - Compliance by Northwind
  • Microsoft Certified Systems Engineer (MCSE)
  • Professional in Human Resources (PHR) by HR Certification Institute (HRCI)
  • ServSafe
  • CompTIA Security+
  • Certified HR Professional (CHRP) by the National Human Resources Association (NHRA)

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