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Skills

  • Communications
  • Claims Process Optimization
  • Loss analysis reporting
  • Insurance industry standards
  • Reporting skills
  • Accurate document preparation
  • Claims tracking system implementation
  • Process improvement
  • Fraudulent claim investigation
  • Risk Assessment

Work Experiences

  • Had an excellent attendance record and was always on time for work.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Achieved $11 in claims savings.
  • Claims exceeded $7.
  • Authored 7 training modules on injury claim handling.
  • Achieved results in 18 months.
  • Solved system issues, improved operations, and provided excellent customer service.
  • Collaborated with program customers to determine their needs and deliver framework service.
  • Was able to effectively communicate with members of the operations, finance, and clinical departments.
  • Adjusted reserves to ensure accuracy.

Summaries

  • Awarded Employee of the Year in 2021.
  • Within Miscellaneous, senior Injury Claims Associate and outstanding performer in risk assessment and vendor management.
  • Aligned with industry best practices.
  • Accomplished Injury Claims Associate recognized for preventing fraud and managing complex injury claims, securing favorable outcomes in 15 arbitration hearings.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the framework business.
  • Injury Claims Associate with 8 years of successful workflow optimization and process improvement experience.
  • Analytical Injury Claims Associate.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Collaborated with attorneys and medical providers.
  • Empathy, dependability, and enthusiasm for customer satisfaction.

Accomplishments

  • Achieved a 32% reduction in disputed claims by proactively communicating with claimants and medical professionals.
  • Mentored 17 new associates on injury claim protocols, decreasing team training time by 56% and boosting efficiency.
  • Managed injury claims portfolio of over $16, ensuring timely settlements and adherence to financial reserves.
  • Introduced a new claims intake protocol, improving intake accuracy by 72% and reducing follow-up calls by 71%.
  • Conducted monthly audits on pending cases, resulting in a 47% decrease in processing backlogs.
  • Successfully resolved 2 injury claims per month, reducing average claimant wait time by 77% year-over-year.
  • Proactively identified and corrected misclassified injury claims, preventing overpayments totaling 5 within several months.
  • Reduced claims overpayments by 38% by closely auditing high-risk injury claims and rectifying reserve discrepancies.
  • Collaborated with team of 6 in the development of initiative.
  • Led the implementation of a new claims monitoring system, resulting in a 15% improvement in claims processing speed and customer satisfaction.

Affiliations

  • Risk and Insurance Management Society (RIMS)
  • Claims and Litigation Management (CLM) Alliance
  • National Association of Social Workers
  • Society of Human Resource Management
  • Professional Liability Underwriting Society (PLUS)
  • American Association of Claims Professionals (AACP)
  • American Society of Safety Professionals
  • Association for Healthcare Risk Management (ASHRM)
  • American Marketing Association
  • American Legal and Financial Network (ALFN)

Certifications

  • Professional in Claims Law (PCL) Certificate
  • SHRM Certified Professional (SHRM-CP)
  • Project Management Professional (PMP)
  • Salesforce
  • Certified Subrogation Recovery Professional (CSRP)
  • Liability Claims Law Specialist (CLCS)
  • Certification in Bodily Injury Claims (CBIC)
  • Certified Professional Insurance Women (CPIW)
  • ServSafe
  • Certified Claims Management Professional (CCMP) - Harbor & Co.

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