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Skills

  • Fraud prevention and detection
  • Advanced auditing techniques
  • Claims-cycle time reduction
  • Cross-functional collaboration
  • Claims backlog reduction
  • Employee Productivity Improvement
  • Supervision
  • Data-driven decision making
  • Continuous Improvement Initiatives
  • Team leadership and development

Work Experiences

  • Analyzed over 18 claims a week for compliance with regulations and internal policies, achieving 70% adherence to SLAs.
  • Achieved results over a period of one year.
  • Increased profit margins by streamlining operations and workflow and negotiating competitive vendor contracts.
  • Achieved reduction over the past year.
  • Site evaluations, customer surveys, and team audits were all things I did.
  • Jira was delivered to customer locations by me.
  • Best Claims Processing Team in Chicago.
  • Visited customers' homes to assess damage, such as fallen trees, leaking roofs, and other issues, in order to generate accurate cost estimates.
  • Achieved results in 18 months.
  • Explained loss coverage to policyholders, assisted them in itemizing damages, and arranged alternative living arrangements.

Summaries

  • Knowledge of Power BI in depth, as well as vendor management and project management abilities.
  • Lead Claims Review Analyst is a hardworking and dependable Lead Claims Review Analyst who excels at performance reporting and project management.
  • Expert in initiative with a strong aptitude for improved and implemented.
  • Accomplished in implementing SLA governance metrics, I ensured a 62% compliance in service delivery, analyzing 6 claims monthly for efficient, error-free processing.
  • Advanced auditing techniques.
  • Lead Claims Review Analyst and team leader with 8 years of experience in category settings.
  • Accomplished results within 18 months.
  • Strategic thinker with expertise in data analysis.
  • Proven track record of motivating spearheaded to achieve team, individual, and management goals.
  • Achieved a 82% reduction in errors in 2020.

Accomplishments

  • Contributed to the transition of claims data to a centralized Salesforce, improving data accessibility and processing speed by 51%.
  • Collaborated on complex claims audits, implementing an enhanced triage system that reduced claim fraud detection times by 69%.
  • Collaborated with cross-functional teams to design a claim evaluation process that reduced review-related backlogs by 47% in 2020.
  • Assisted in the implementation of real-time monitoring of claims via Adobe Creative Suite, reducing resolution gaps by 55% and increasing reporting accuracy.
  • Proposed and initiated a claims workflow revision project that achieved a 23% improvement in reviewer productivity.
  • Led the integration of a new claims adjudication software, accelerating claims processing efficiency and increasing department throughput by 23% within the past year.
  • Reduced financial exposure by 82% through precise policy adjudication and claims validation techniques.
  • Formulated and executed a training initiative for claims analysts to raise proficiency in ServiceNow, resulting in 26% reduction in claim handling variations.
  • Successfully updated claims adjudication procedures to comply with ISO 9001 guidelines, resulting in a full departmental audit pass with zero non-conformances.
  • Formulated strategies to streamline policy interpretation for the team, reducing manual review times by 68%.

Affiliations

  • Affiliation with the International Association of Special Investigation Units (IASIU), engaging in workshops devoted to fraud mitigation and high-risk claims.
  • Certified in Advanced Negotiation Techniques for Insurance Claims via Harbor & Co., improving claim settlements and client satisfaction outcomes.
  • Achieved membership in the Global Claims Review Association (GCRA), focused on high-level industry insights and trends in claims adjudication.
  • Organized and participated in workshops through the American Arbitration Association (AAA) to improve skills in claims dispute resolution.
  • Affiliation with the International Association of Insurance Supervisors (IAIS), contributing to discussions on international insurance supervision related to compliance.
  • Member of the National Association of Insurance Commissioners (NAIC) 2021–Present, contributing to the review of state-level insurance regulations.
  • Participated in risk management audits and reviews with the Association of Certified Insurance Adjusters (ACIA) 2021-framework.
  • Earned membership with the Society of Professional Benefit Administrators (SPBA) for ongoing education in employee benefits claims processing.
  • Member of the International Underwriting Association (IUA), collaborating on best practices in claims underwriting and policy interpretation.
  • Active participant in the Claim and Litigation Management Alliance (CLM), focusing on professional development in claims handling and litigation management.

Certifications

  • Certified Professional in Healthcare Quality (CPHQ) - process
  • Associate in Claims (AIC) - The Institutes
  • Cisco Certified Internetwork Expert (CCIE)
  • CompTIA Network+
  • Agile Certified Practitioner (PMI-ACP) - PMI
  • Healthcare Compliance Certificate Program - framework
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Public Accountant (CPA)
  • Certified ScrumMaster (CSM) – Scrum Alliance
  • Google Certified Professional Cloud Architect

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