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Skills

  • Project organization
  • Claims adjudication
  • Customer service
  • Automated Claims Processing Systems
  • Conflict resolution
  • Risk management
  • Root cause analysis
  • Documentation accuracy
  • Experience with initiative
  • Invoice generation

Work Experiences

  • Achieved a 20% faster overall cycle time.
  • Achieved a 31% reduction in manual processing errors.
  • Finished standard of project, which resulted in category.
  • Assisted external providers.
  • Achieved a 34% decrease in claim backlog.
  • Achieved a 76% first-call resolution rate.
  • Advised claimants on alternative dispute resolutions, contributing to a 28% decrease in litigation-related expenses.
  • Collaborated cross-functionally with underwriting teams to better understand risk factors, leading to more accurate claim assessments.
  • Learned vendor management and team leadership to help with office needs.
  • Collaborated cross-functionally with underwriting teams.

Summaries

  • Individual who is accommodating and logical in creating customized requests for each client.
  • Achieved a 69% reduction in claim processing time.
  • Achieved a 35% improvement in efficiency.
  • Achieved favorable settlement outcomes.
  • Inside Claims Representative with risk assessment and client relations abilities.
  • Achieved a 76% improvement in claim precision.
  • With a 3-year career assessing properties, determining liabilities, and negotiating settlements, I am an experienced insurance professional.
  • Expert in framework with a strong aptitude for optimized and automated.
  • Analytical Inside Claims Representative with strong data-gathering, report-writing, and data-compilation abilities.
  • Proven track record of motivating coordinated to achieve team, individual, and management goals.

Accomplishments

  • Optimized customer-facing systems to allow for improved self-service claims, increasing efficiency by 49% and reducing system errors.
  • Led a project to streamline claims intake processes, resulting in a 18% improvement in first-contact resolution rates.
  • Deployed third-party vendor relationships to expedite claims appraisals, reducing cycle time by 61% across regional departments.
  • Spearheaded error reduction initiatives, decreasing claims resubmissions by 65% while ensuring full adherence to state compliance laws.
  • Established a comprehensive regulatory audit checklist, improving compliance rates across the department by 41% during quarterly reviews.
  • Advised claimants and legal teams on state insurance law, effectively resolving disputes before litigation in 28% of cases.
  • Led negotiations for high-value claims, achieving an average savings of $17 per case through targeted legal strategy.
  • Produced compliance reports highlighting areas of improvement that helped the company avoid potential litigation risks and fines of up to $8.
  • Partnered with external auditors to review high-risk claims, facilitating a compliance rate of 74% for the claims department.
  • Collaborated with underwriting on high-value claims, contributing to a 73% increase in initial risk identification accuracy.

Affiliations

  • Active participant in the North Carolina Dispute Resolution Council, focused on developing effective mediation and negotiation strategies in claims disputes.
  • Member of the American Bar Association (ABA) Insurance Coverage Litigation Committee since 2022, contributing thought leadership to insurance dispute resolution.
  • Member of the National Association of Subrogation Professionals (NASP), conducting industry research and sharing best practices on claim recoveries.
  • Participant in Raleigh Insurance Fraud Taskforce, contributing to industry initiatives on fraud reduction and prevention since 2016.
  • Affiliate with the Chartered Property Casualty Underwriters (CPCU) Society, attending yearly seminars focused on trends in insurance policies and claims handling.
  • Certified Claims Professional through the American Educational Institute (AEI), receiving recognition for excellence in claims education and adjudication.
  • Member of the Association of Certified Fraud Examiners (ACFE), dedicated to leveraging fraud examination techniques for insurance claims audits.
  • Certified Trainer within the Global Federation of Insurance Associations (GFIA), focusing on the development of fraud detection training modules.
  • Participant in the Society of Insurance Trainers and Educators (SITE), developing company-wide training modules in claims fraud detection techniques.
  • Affiliated with the Public Risk Management Association (PRIMA), focusing on risk mitigation strategies within claims departments and public insurance.

Certifications

  • Certified Business Analysis Professional (CBAP)
  • Cisco Certified Network Associate (CCNA)
  • Cisco Certified Internetwork Expert (CCIE)
  • All Lines Adjuster License - Illinois Department of Insurance
  • Fraud Claims Law Specialist (FCLS) - Ironclad Systems
  • Certified Claims Professional (CCP) - Summit Group
  • SAP Certified Application Associate
  • Salesforce
  • Cyber Liability Claims Specialist (CLCS) - Summit Group
  • Association for Project Management (APM)

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