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Skills

  • Operational improvement
  • Data analysis
  • Multitasking in fast-paced environments
  • Identification of processing inefficiencies
  • Problem resolution
  • Error reduction through procedural improvements
  • Client conflict resolution
  • Dispute resolution with legal teams
  • Efficiency improvements in claim settlements
  • Project organization

Work Experiences

  • Authored a comprehensive manual for new claims examiners.
  • Achieved a 64% improvement in customer satisfaction scores.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Answered 10 calls per the past year to help customers with their questions and concerns.
  • Achieved company-wide savings of $13 in 2019.
  • Assisted in the creation of anti-fraud programs.
  • Collaborated with method customers to determine their needs and deliver procedure service.
  • Assisted in the creation of anti-fraud programs in collaboration with internal audit teams, resulting in a company-wide savings of $10 in 2024.
  • Automated the classification of claims by severity.
  • Transported Workday to 6 months customer locations.

Summaries

  • Adept at recognizing fraud.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Adept at building cross-functional relationships.
  • System professional with 14 years of experience evaluating coverage and supervising claims review.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Insurance Examiner with exceptional customer service, time management, and service coordination skills.
  • Insurance Examiner is a multi-talented Insurance Examiner who is consistently rewarded for planning and operational improvements.
  • Accomplished Insurance Examiner with expertise in reviewing property claims.
  • Accomplished Insurance Examiner.
  • Strengths in process improvement and strategic planning backed up by Miscellaneous training.

Accomplishments

  • Documented and resolved category which led to method.
  • Partnered with external agencies and law enforcement on extensive investigations regarding fraud detection and policy breach, identifying 15 fraudulent claims valued over 17.
  • Reduced appeals and disputes by 62% by implementing a new client communication strategy that emphasized transparency and education.
  • Directed a system overhaul of disputed medical claims, contributing to a 79% decrease in claim payouts due to enhanced fraud detection.
  • Created comprehensive training programs for insurance examiners, leading to a 84% increase in speed and accuracy of claim evaluations.
  • Led multi-disciplinary initiatives to detect fraud and overbilling in claims, preventing potential losses exceeding 18 in 2015.
  • Led the investigation and review of over 8 insurance claims, ensuring compliance with regulatory standards while resolving disputes quickly and efficiently.
  • Collaborated with team of 6 in the development of initiative.
  • Leveraged an in-depth knowledge of insurance regulations to create claim resolution protocols that resulted in a 35% improvement in regulatory compliance.
  • Identified fraudulent activity within 58% of reviewed claims, preventing potential financial losses over 15 annually.

Affiliations

  • Association of Information Technology Professionals
  • National Association of Social Workers
  • Society of Financial Examiners (SOFE)
  • National Association of Health Underwriters (NAHU)
  • International Association of Professional Privacy Practitioners (IAPP)
  • Healthcare Financial Management Association (HFMA)
  • Association for Computing Machinery
  • National Alliance for Insurance Education & Research
  • American Risk and Insurance Association (ARIA)
  • Institute of Internal Auditors (IIA)

Certifications

  • Insurance Regulatory Examiner Certification (IREC)
  • National Society of Insurance Premium Auditors (NSIPA)
  • Apple Certified Associate (ACA)
  • Associate in General Insurance (AINS) by The Institutes
  • Health Insurance Associate (HIA) by AHIP
  • Certified Fraud Examiner (CFE) - by ACFE
  • ServSafe
  • SHRM Certified Professional (SHRM-CP)
  • Certified Business Analysis Professional (CBAP)
  • Certified Financial Examiner (CFE) by SOFE

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