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Skills

  • Automated Claims Processing Systems
  • CCTV
  • Relationship development
  • Inventory management
  • Analytical thinking for claim resolution
  • Operational improvement
  • Claims investigation using digital tools
  • Team building
  • Cross-functional team collaboration
  • Customer service

Work Experiences

  • Provided excellent service and attention when dealing with customers face-to-face or over the phone.
  • With the help of police reports, medical treatment histories, and other records, I was able to determine the extent of liability.
  • Achieved a 20% faster overall cycle time.
  • Achieved a 35% reduction in outstanding claim reserves.
  • Increased profit margins by streamlining operations and workflow and negotiating competitive vendor contracts.
  • Collaborated with human resources to overhaul claims processes.
  • Built strong relationships with policyholders.
  • Collaborated cross-functionally with underwriting teams.
  • Developed a reputation for punctuality and hard work.
  • Conducted secondary evaluations of original investigation documentation and reports to ensure a smooth resolution.

Summaries

  • Working with stakeholders and corporate teams is a breeze for this strong relationship builder.
  • With hands-on experience, eager to learn new skills and advance knowledge.
  • Achieved 24% reductions in claims handling time.
  • Analytical Inside Claims Representative with strong data-gathering, report-writing, and data-compilation abilities.
  • Can offer extensive Inside Claims Representative experience with a progressive insurance industry background.
  • Student pursuing a Miscellaneous degree who is eager to contribute developed knowledge in the role of Inside Claims Representative.
  • Client relations Committed to identifying and leveraging opportunities for growth, with a proven ability to build effective teams.
  • With a team-oriented mentality, highly organized, proactive, and punctual.
  • Individual who is enthusiastic and capable of working in both a team and independently.
  • Achieved accurate claim adjudications.

Accomplishments

  • Gathered, analyzed, and presented field data to identify risk factors, facilitating quicker claims determination and closure.
  • Conducted detailed investigations into catastrophic claims, ensuring adherence to policies and minimizing dispute escalations by 24%.
  • Advised stakeholders on the proper course of action for claims disputes, reducing pending backlogs by 9 cases.
  • Directed resolution of multi-jurisdictional claims in compliance with state-specific regulations, avoiding $17 in fines.
  • Led a project to streamline claims intake processes, resulting in a 18% improvement in first-contact resolution rates.
  • Implemented a streamlined claims process integration with the underwriting team, reducing claim resolution time by 65%.
  • Produced and presented claims analytics to executive team, providing actionable insights that improved process efficiency by 35%.
  • Developed training programs on leveraging legal and regulatory knowledge in claims processing, improving team accuracy by 56%.
  • Collaborated with underwriting on high-value claims, contributing to a 73% increase in initial risk identification accuracy.
  • Integrated sophisticated data analysis tools to track claims trends and root causes, reducing reoccurrence of specific issues by 29%.

Affiliations

  • Leader of Columbus Chapter of the Society for Human Resource Management (SHRM), organizing workshops that include topics on workplace benefit claims adjudication.
  • Member of the American Bar Association (ABA) Insurance Coverage Litigation Committee since 2022, contributing thought leadership to insurance dispute resolution.
  • Certified Customer Experience Professional (CCXP) through the Customer Experience Professionals Association (CXPA), implementing practices to enhance policyholder satisfaction.
  • Certified Trainer within the Global Federation of Insurance Associations (GFIA), focusing on the development of fraud detection training modules.
  • Completes annual certifications with the Certified Insurance Service Representatives (CISR) program, remaining aligned with evolving standards in claims customer service.
  • Recipient of Distinguished Claims Handling professional certification from the National Underwriting Association (NUA) for work in claims adjudication and risk management.
  • Affiliated with the Public Risk Management Association (PRIMA), focusing on risk mitigation strategies within claims departments and public insurance.
  • Certified Claims Professional through the American Educational Institute (AEI), receiving recognition for excellence in claims education and adjudication.
  • Active member of the International Association of Claims Professionals (IACP), networking with professionals globally and enhancing skills in claims resolution.
  • Certified Legal Principles Claims Specialist (LPCS), awarded by the American Educational Institute (AEI) after passing examinations on legal aspects of insurance coverage.

Certifications

  • Microsoft Certified Systems Engineer (MCSE)
  • Associate in Claims (AIC) - Beacon Labs
  • Association for Project Management (APM)
  • Insurance Operations Certificate - Harbor & Co.
  • Cisco Certified Internetwork Expert (CCIE)
  • General Insurance (INS) Certification - Northwind
  • Apple Certified Associate (ACA)
  • Certificate in Insurance Fraud - Vantage
  • SCLA Silver Award (Senior Claims Law Associate) - Harbor & Co.
  • CompTIA Security+

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