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Skills

  • Insurance policy review and compliance
  • Budgets
  • Advanced Excel for data tracking
  • Fraud detection and prevention
  • Stakeholder relationship management
  • Machine learning application for risk prediction
  • Operational improvement
  • Team building
  • Supervision
  • Attention to detail in claims processing

Work Experiences

  • Collaborated with legal and investigations teams.
  • Collaborated with adjusters and underwriters to assess high-value claims and increase process efficiency by 81%.
  • Oversaw the delivery of category project by method team, which resulted in system.
  • Applied a customer-first approach.
  • Collaborated with the finance team to track high-tier claims, ensuring sufficient reserves were in place and reducing operational risks.
  • Achieved Excellence Award for excellence in claims accuracy, maintaining a 45% or higher success rate in claim adjudications.
  • Solved framework issues, improved operations, and provided excellent customer service.
  • Achieved a 64% improvement in customer satisfaction scores.
  • Authored a comprehensive manual for new claims examiners.
  • Communicated delicately with customers.

Summaries

  • Achieved swift resolutions and accurate assessments.
  • Adhered to regional regulations.
  • Analytical Insurance Examiner with expertise in high-value claim assessments.
  • Achieved a 38% productivity boost.
  • Adept at fraud identification.
  • Accomplished Insurance Examiner with hands-on expertise in reviewing property claims after major events. Ensured fair compensation to policyholders and successfully reduced disputes by 44% post-resolution.
  • Accomplished Insurance Examiner with expertise in reviewing property claims.
  • Achieved timely resolution of claims.
  • Accomplished Insurance Examiner with strong skills in adjudicating complex Adobe Creative Suite claims and regulatory compliance. Demonstrated success in saving $10 annually through operational reviews and fraud prevention techniques.
  • Achieved a 16% reduction in payout errors.

Accomplishments

  • Led multi-disciplinary initiatives to detect fraud and overbilling in claims, preventing potential losses exceeding 18 in 2015.
  • Enhanced claim investigation accuracy by updating digital tracking systems, leading to a 41% reduction in administrative errors.
  • Resolved product issue through consumer testing.
  • Identified and corrected operational inefficiencies within the claims review process, slashing average review time by 27% and improving employee productivity.
  • Documented and resolved category which led to method.
  • Identified fraudulent activity within 58% of reviewed claims, preventing potential financial losses over 15 annually.
  • Collaborated with team of 6 in the development of initiative.
  • Utilized strong analytical skills to assess high-value claims exceeding 2, driving early resolutions and limiting prolonged settlements.
  • Played a pivotal role in successfully closing claims valued at over 10 through accurate assessments and timely communication with key stakeholders.
  • Led troubleshooting efforts on high-value claims, achieving successful resolution in 17 cases and avoiding litigation costs exceeding 9.

Affiliations

  • Association for Cooperative Operations Research and Development (ACORD)
  • American Medical Informatics Association
  • National Association of Public Insurance Adjusters (NAPIA)
  • Jaycees
  • Institute of Internal Auditors (IIA)
  • Association for Supply Chain Management (APICS)
  • Insurance Regulatory Examiners Society (IRES)
  • Lions Club
  • Freemason
  • International Association of Special Investigation Units (IASIU)

Certifications

  • Certified Fraud Examiner (CFE) - by ACFE
  • Life and Health Insurance Analyst Certification
  • Certified Business Analysis Professional (CBAP)
  • Compliance & Ethics Professional (CCEP)
  • Associate in Risk Management (ARM) by The Institutes
  • CompTIA Network+
  • General Lines Agent License (State Specific)
  • Project Management Professional (PMP)
  • Associate in Insurance Data Analytics (AIDA) by The Institutes
  • Accredited Claims Adjuster (ACA)

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