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Skills

  • Error reduction through procedural improvements
  • Benefits review
  • Adaptability to regulatory changes
  • Multitasking in fast-paced environments
  • Collaboration with underwriters and adjusters
  • Damage itemization
  • Business operations
  • Coverage determination
  • Project organization
  • Organization

Work Experiences

  • Achieved Top Performer for excellence in claims accuracy.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Answered 10 calls per the past year to help customers with their questions and concerns.
  • Achieved a 72% increase in customer satisfaction.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Achieved a 44% reduction in errors.
  • Achieved a $11 reversal in payments.
  • Achieved a 64% improvement in customer satisfaction scores.
  • Assisted in the creation of anti-fraud programs.
  • Collaborated with legal and investigations teams.

Summaries

  • Analytical Insurance Examiner with expertise in high-value claim assessments.
  • Clear understanding of cross-functional collaboration and data analysis as well as project management training.
  • Adept at accurate policy assessments.
  • Achieved a $14 reduction in payout losses.
  • Accomplished Insurance Examiner with a strong track record in auditing claims processes, resulting in a 28% reduction in overpayments and recovery of $6. Adept at managing large datasets to ensure accuracy.
  • Achieved a 35% improvement in departmental productivity.
  • Insurance Examiner with 5 years of successful project management and data analysis experience.
  • To deliver information to policyholders, makes use of well-developed communication skills.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the procedure business.

Accomplishments

  • Facilitated the reduction of overall departmental claim dispute rates by 24% through more proactive collaboration with underwriting and risk assessment teams.
  • Partnered with IT and data analytics teams to adopt new tracking and fraud detection software, enhancing fraud detection rates by 49% in 2017.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Leveraged an in-depth knowledge of insurance regulations to create claim resolution protocols that resulted in a 35% improvement in regulatory compliance.
  • Designed and led workshops on advanced claims processing techniques, which helped team members efficiently process 6 claims weekly.
  • Successfully reduced claim processing times by 52% through consistent alignment of cross-functional teams and improved communication processes.
  • Played a pivotal role in successfully closing claims valued at over 10 through accurate assessments and timely communication with key stakeholders.
  • Reduced fraudulent claims by 70% through robust data analysis, ensuring claims met underwriting criteria while improving cost containment.
  • Led troubleshooting efforts on high-value claims, achieving successful resolution in 17 cases and avoiding litigation costs exceeding 9.
  • Collaborated with team of 6 in the development of initiative.

Affiliations

  • American College of Healthcare Executives (ACHE)
  • Association of Information Technology Professionals
  • Certified Specialist in Insurance Fraud (CSIF)
  • Society of Women Engineers
  • American Society of Chartered Life Underwriters
  • Toastmasters
  • Insurance Regulatory Examiners Society (IRES)
  • Medical Review Officer Certification Council (MROCC)
  • National Underwriter Co.
  • International Association of Administrative Professionals

Certifications

  • Associate in Fidelity and Surety Bonding (AFSB)
  • Cisco Certified Network Associate (CCNA)
  • Certified Health Insurance Specialist (CHS)
  • Associate in General Insurance (AINS) by The Institutes
  • Salesforce
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Life Underwriter Training Council Fellow (LUTCF)
  • Health Insurance Associate (HIA) by AHIP
  • National Society of Insurance Premium Auditors (NSIPA)
  • Certified Professional Insurance Woman (CPIW) by NAIW

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