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Skills

  • Regulatory compliance
  • Cross-departmental collaboration
  • Customer satisfaction management
  • Compliance with local and federal insurance laws
  • Relationship development
  • Customer service
  • Risk mitigation strategies
  • Insurance coverage verification
  • Team management
  • Regulation enforcement

Work Experiences

  • Collaborated with customer success to evaluate underwriting risk, reducing potential liability by 56% in 2020.
  • Assessed the appropriateness of payers in order to protect the organization and reduce risk.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Completed the process in under two years.
  • Assisted in resolving complex insurance disputes between clients and carriers, achieving 57% resolution within several months.
  • Authored standard operating procedures for processing HubSpot claims.
  • Built strong relationships with clients.
  • Had an excellent attendance record and was always on time for work.
  • Built strong relationships with external vendors.
  • Achieved 32% resolution.

Summaries

  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Exceptional organizational skills and meticulous attention to detail.
  • Insurance Verification Specialist with 8 years of experience explaining benefits and tracking coverage.
  • Insurance Administrator with 3 years of successful project management and performance reporting experience.
  • Costs were consistently reduced while profits were increased.
  • Achieved a 71% reduction in financial risk.
  • Achieved 64% client satisfaction.
  • Effective at managing phone calls, emails, letters, and in-person requests for assistance while adhering to framework regulations and process department guidelines.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the framework business.
  • Adhered to state regulations.

Accomplishments

  • Implemented data validation protocols resulting in zero discrepancies during external audits over a 8-year period.
  • Resolved product issue through consumer testing.
  • Established a centralized customer support system, enhancing claims status inquiries and decreasing resolution time by 6 months.
  • Coordinated 18 annual audits, ensuring compliance with state and federal regulations with zero discrepancies.
  • Created and maintained comprehensive claims data archives that streamlined internal audit processes.
  • Implemented a new training program for onboarding staff, decreasing errors and rework by 60%.
  • Directed a cross-departmental task force that reduced claims processing times by the past year, which earned Top Performer from upper management.
  • Designed and implemented a claims approval matrix that decreased the average review time by 19%, earning senior leadership recognition.
  • Resolved disputes and appeals effectively, improving client satisfaction scores by 77% in the 2015 survey.
  • Developed quarterly metric dashboards for the executive team that highlighted key areas to optimize beneath regulatory caps.

Affiliations

  • Lions Club
  • Global Association of Risk Professionals (GARP)
  • Chartered Insurance Institute (CII)
  • Project Management Institute
  • Freemason
  • National Association of Insurance Commissioners (NAIC)
  • American Medical Informatics Association
  • National Alliance for Insurance Education & Research (NA)
  • Insurance Data Management Association (IDMA)
  • Society of Human Resource Management

Certifications

  • Fundamentals of Risk Management (FoRM)
  • Certified Regulatory Compliance Manager (CRCM)
  • Certified Claims Professional (CCP)
  • Accredited Adviser in Insurance (AAI)
  • Certified Insurance Fraud Investigator (CIFI)
  • Chartered Property Casualty Underwriter (CPCU)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Workers' Compensation Professional (CWCP)
  • Associate in Marine Insurance Management (AMIM)
  • SHRM Certified Professional (SHRM-CP)

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