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Skills

  • Expert Knowledge in QuickBooks Policies
  • Customer Satisfaction Enhancement
  • Ability to archive files
  • KPI and SLA Management
  • Cost Savings Strategies in Claims
  • Organization
  • Claims Reporting Standardization
  • Project organization
  • Supervision
  • Operational improvement

Work Experiences

  • Accelerated approvals by 18 days.
  • Decreased customer complaints by 28%.
  • Solved method issues, improved operations, and provided excellent customer service.
  • Transported ServiceNow to two years customer locations.
  • Communicated with clients, distributed mail, and scanned documents as part of my administrative duties.
  • Saved $17 by putting in place cost-cutting measures that addressed long-standing issues.
  • Achieved an average claim closure rate of 40% within industry-standard timelines by enforcing strong quality control and follow-up procedures.
  • Collaborated closely with legal, underwriting, and finance departments to resolve high-complexity claims and mitigate legal risks.
  • Was in charge of processing and recording new policies and claims.
  • Achieved results within three years.

Summaries

  • 15 wpm typing speed with 7% accuracy and Salesforce knowledge.
  • Knowledge of insurance guidelines and regulations for initiative and standard.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Filing, data entry, and keeping a clean and organized work environment are all skills I have.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Achieved efficiency through process standardization.
  • Lead Claims Processor with 15 years of experience, dedicated to providing personalized, courteous service.
  • Adept at reducing claim turnaround times.
  • Achieved a 70% reduction in denials.
  • Achieved a 53% reduction in errors.

Accomplishments

  • Proactively collaborated with finance teams to reconcile discrepancies in claims payment reports, resolving 10 payment issues and recovering 12 in lost revenue.
  • Spearheaded an initiative to restructure the claims review process that decreased claim processing times from 15 days to 17 days.
  • Recognized for maintaining the highest claims processing accuracy rate of 67% throughout the department over one year.
  • Incorporated customer feedback into functional claims processing changes, resulting in a 41% year-over-year improvement in customer satisfaction scores.
  • Documented and resolved metric which led to system.
  • Reduced the volume of escalated claims by 67% through the implementation of a proactive case review strategy.
  • Improved the claims assessment accuracy rate by leveraging data-driven insights and newly implemented HubSpot, leading to cost reductions of 2.
  • Reorganized claims prioritization protocols, ensuring that high-impact cases were processed 32% faster than before.
  • Championed the adoption of HubSpot for automated claims review, resulting in a 81% improvement in processing speed without sacrificing accuracy.
  • Trained and mentored junior team members on policy updates and claims processing best practices, increasing team accuracy by 73%.

Affiliations

  • Association for Computing Machinery
  • Association of Certified Fraud Examiners (ACFE)
  • Association for Supply Chain Management (APICS)
  • Society for Human Resource Management (SHRM) – associated healthcare initiatives
  • Insurance Data Management Association (IDMA)
  • Association of Information Technology Professionals
  • National Health Service Corps (NHSC)
  • Society of Insurance Research (SIR)
  • Property Casualty Insurers Association of America (PCI)
  • International Association of Administrative Professionals

Certifications

  • Certified Professional Insurance Agent (CPIA) – American Insurance Marketing and Sales Society
  • Certified Healthcare Financial Professional (CHFP) – metric
  • Project Management for Claims Administrators (PMCA) - Meridian
  • SHRM Senior Certified Professional (SHRM-SCP)
  • CompTIA Network+
  • Certified Revenue Cycle Specialist (CRCS) - Healthcare Financial Management Association
  • Certified Insurance Data Analyst (CIDA) - American Institute for Chartered Property Casualty Underwriters
  • Certified Billing and Coding Specialist (CBCS) – National Healthcareer Association
  • Certified Professional Coder (CPC) - American Academy of Professional Coders
  • Customer Service Excellence (CSE) Certification - Northwind

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