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Skills

  • Building construction knowledge
  • Invoice generation
  • Automated claims software refinement
  • Insurance billing
  • Client relations and satisfaction improvement
  • Operational improvement
  • Inventory management
  • Communications
  • Onsite evaluation
  • Cross-functional collaboration

Work Experiences

  • Developed a reputation for punctuality and hard work.
  • Answered 7 phone calls per three years to assist customers.
  • Based outcomes on evidence and policy interpretation.
  • Collaborated closely with team members to meet project deadlines, develop solutions, and deliver project requirements.
  • Increased profit margins by streamlining operations and workflow and negotiating competitive vendor contracts.
  • Applied advanced data analytics to identify trends in claims rejections, leading to revised protocols that reduced rejection rates by 77%.
  • Achieved a 52% improvement in claims accuracy.
  • Best Claims Processing Team in Chicago.
  • Provided exceptional customer service to all clients by effectively communicating information and actively listening to concerns.
  • Audited process insurance products.

Summaries

  • Lead Claims Review Analyst with more than 2 years of experience working for insurance companies with a strategic mindset.
  • Results-oriented Miscellaneous professional with workflow optimization, client relations, and cross-functional collaboration strengths.
  • With over 12 years of experience reviewing claims and determining coverage, I am highly trained and successful.
  • Achieved 66% increase in claims accuracy.
  • Looking forward to taking on a new challenge with a successful team.
  • Strategic thinker with expertise in data analysis.
  • Lead Claims Review Analyst with strategic planning and vendor management abilities.
  • Adept at overseeing fraud detection processes.
  • Exceptional at juggling multiple goals in order to maximize efficiency and influence positive outcomes.
  • Achieved effective claims resolutions.

Accomplishments

  • Slashed claim handling times by developing and implementing a triage model that streamlined the initial assessment process, improving time-to-resolution by 73%.
  • Formulated and executed a training initiative for claims analysts to raise proficiency in ServiceNow, resulting in 26% reduction in claim handling variations.
  • Reduced claim costs by $14 annually after implementing improved negotiation methodologies and loss prevention initiatives.
  • Led the integration of a new claims adjudication software, accelerating claims processing efficiency and increasing department throughput by 23% within the past year.
  • Helped standardize the department's claim audit approach, increasing overall audit compliance within ISO 9001 standards by 35%.
  • Championed new policy interpretation guidelines that optimized compliance with complex regulatory changes, speeding up claims resolution by 43%.
  • Formulated strategies to streamline policy interpretation for the team, reducing manual review times by 68%.
  • Managed a portfolio of 16 high-value insurance claims, surpassing departmental targets by achieving a claim closure rate 25% higher than the established benchmark.
  • Performed root cause analysis on recurring claims issues, leading to process changes that cut rework rates by 70%.
  • Increased client satisfaction by reducing claim review cycle times by 36%, resulting in a projected annual revenue increase of $14.

Affiliations

  • Certified Claims Professional through program, completed training in regulatory compliance and claims auditing 2022.
  • Attended conferences hosted by the American Society of Workers Comp Professionals (AmCOMP), gaining insights specific to workers' compensation disputes.
  • Participated in risk management audits and reviews with the Association of Certified Insurance Adjusters (ACIA) 2021-framework.
  • Affiliation with the American College of Healthcare Executives (ACHE) to stay current on healthcare claims and administrative innovations.
  • Frequent presenter at the Society of Risk Management Professionals (SRMP) on topics such as claim negotiations and client satisfaction improvement.
  • Earned membership with the Society of Professional Benefit Administrators (SPBA) for ongoing education in employee benefits claims processing.
  • Participated in a corporate-sponsored Claims Risk Management initiative, collaborating with industry experts to diagnose and improve operational inefficiencies in claims.
  • Collaborated with the Professional Liability Underwriting Society (PLUS) to host webinars on managing high-risk claims in professional liability scenarios.
  • Certified in Lean Six Sigma by Cedar Works to improve process efficiency in claims handling, reducing turn-around times 85% 2016.
  • Served as Treasurer for the Risk and Insurance Management Society (RIMS) local chapter Austin, overseeing the accurate reporting of chapter finances.

Certifications

  • Certified ITIL Practitioner - AXELOS
  • Salesforce
  • Association for Project Management (APM)
  • Certified Insurance Data Analyst (CIDA) - system
  • Six Sigma Black Belt - Meridian
  • Certified Healthcare Auditor (CHA) - IAOA
  • ISO 9001 Internal Auditor Certification - Summit Group
  • Healthcare Compliance Certificate Program - framework
  • CompTIA Network+
  • Certified ScrumMaster (CSM) – Scrum Alliance

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