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Skills

  • Account management
  • Case management software proficiency (Tableau)
  • Business operations
  • Relationship development
  • Comprehensive report generation
  • Communications
  • Insurance policy interpretation
  • Team building
  • First Aid/CPR
  • Documentation abilities

Work Experiences

  • Conducted proactive outreach to policyholders about pending claims, improving engagement and reducing unresolved case load by 58%.
  • Achieved results in 6 months.
  • Saved $10 by putting in place cost-cutting measures that addressed long-standing issues.
  • Conducted on-site investigations at Boston.
  • Achieved policyholder satisfaction.
  • Aligned on decisions with key stakeholders.
  • Conducted on-site investigations at Atlanta to assess damage and gather evidence, expediting claim resolutions.
  • Collaborated with the legal team.
  • Oversaw the delivery of standard project by category team, which resulted in metric.
  • Achieved a 75% decrease in payouts.

Summaries

  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Achieved 43% improvement in claims handling efficiency.
  • With excellent planning and problem-solving abilities, I am organized, driven, and adaptable.
  • Insurance Claims Representative with 17 years of successful stakeholder engagement and risk assessment experience.
  • Adhered to compliance across multiple jurisdictions.
  • Effective at managing phone calls, emails, letters, and in-person requests for assistance while adhering to program regulations and system department guidelines.
  • Collaborated with underwriters to implement $15+ claim reassessments, providing fair and balanced resolutions for both the company and policyholders.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Expert at providing insurance coverage advice to current and potential clients, as well as processing applications, payments, and corrections.
  • Coached junior claims representatives.

Accomplishments

  • Resolved product issue through consumer testing.
  • Facilitated successful resolution of escalated claims by collaborating with external legal counsel and adjusters, reducing litigation costs by 58%.
  • Developed fraud detection models that reduced fraudulent claims by 25% over a 2019 period.
  • Spearheaded the adoption of paperless claims processing, reducing administrative overhead by 71%.
  • Worked with external adjusters to ensure prompt and accurate property damage assessments for over 11 claims.
  • Trained a team of 15 new claims assistants on regulatory compliance and internal claim procedures.
  • Assessed and processed over 10 claims per week with a 69% adherence to department deadlines and accuracy targets.
  • Utilized data analytics software to track and forecast claim trends, contributing to a 30% reduction in delayed payouts.
  • Monitored a high volume of claims for quality and compliance, achieving a President's Club for team efficiency.
  • Collaborated with team of 6 in the development of method.

Affiliations

  • Certified Specialist in Insurance Claims Law (SICL) certification endorsed by standard
  • Active participant in continuing education forums by the National Association of Public Insurance Adjusters (NAPIA)
  • Active contributor to the Consortium of Insurance Claims Fraud Researchers (CICFR)
  • Volunteer participant in local Professional Underwriting Society (PLUS) events
  • Member of Toastmasters, focusing on professional communication skills development
  • Society of Women Engineers
  • Regular attendance at regional workshops hosted by the Insurance Services Office (ISO)
  • Project Management Institute
  • National Association of Social Workers
  • Membership in the Council on Litigation Management (CLM), training on best claims practices

Certifications

  • Apple Certified Associate (ACA)
  • Catastrophe Adjuster Certification from Summit Group for management of disaster claims
  • Cisco Certified Network Associate (CCNA)
  • Managing and Resolving Insurance Coverage Disputes, Certification from procedure, 2019
  • Chartered Property Casualty Underwriter (CPCU) from The Institutes
  • CompTIA Security+
  • Certified Professional Insurance Agent (CPIA) from the American Insurance Marketing and Sales Society
  • Cisco Certified Internetwork Expert (CCIE)
  • Licensed Claims Adjuster from the National Insurance Adjusters Association
  • Associate in Risk Management (ARM) from The Institutes

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