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Skills

  • Negotiation skills
  • Claims data accuracy improvement
  • Settlement Negotiation
  • Supervision
  • Invoice generation
  • Insurance billing
  • Data-driven decision making
  • Interdepartmental collaboration
  • Case management systems (Asana)
  • Communications

Work Experiences

  • Provided excellent service and attention when dealing with customers face-to-face or over the phone.
  • Developed a reputation for punctuality and hard work.
  • Analyzed root causes of claim discrepancies.
  • Increased profit margins by streamlining operations and workflow and negotiating competitive vendor contracts.
  • Used Tableau to compile data gathered from various sources.
  • Coordinated with medical professionals.
  • Alerted the team of expiring claims.
  • Assisted in the creation of metric procedures.
  • Avoided potential interest penalties.
  • Conducted regular auditing of pending claims.

Summaries

  • Looking forward to taking on a new challenge with a successful team.
  • With a team-oriented mentality, highly organized, proactive, and punctual.
  • With a 2-year career assessing properties, determining liabilities, and negotiating settlements, I am an experienced insurance professional.
  • Results-oriented Miscellaneous professional with project management, process improvement, and project management strengths.
  • Proven track record of motivating optimized to achieve team, individual, and management goals.
  • Adobe Creative Suite and Power BI experts with exceptional interpersonal skills.
  • Examine documents and property thoroughly to detect damage, estimate costs, and maintain liability limits.
  • Individual who is enthusiastic and capable of working in both a team and independently.
  • Motivating leader who has built and managed framework teams in the past.
  • Miscellaneous student seeking hands-on experience through an internship in stakeholder engagement.

Accomplishments

  • Facilitated training programs on claims fraud detection, educating over 11 employees, significantly lowering fraudulent activity within 2017.
  • Maintained robust relationships with third-party vendors to streamline the claims process and reduce external costs by 32%.
  • Partnered with corporate legal teams and participated in mediation efforts to close out complex claims worth over $15 with minimal financial loss.
  • Negotiated settlements for liability claims valued at over $12 in compliance with company and legal protocols.
  • Reduced company exposure to litigation by improving adherence to compliance requirements for state and federal insurance regulations.
  • Created a streamlined claims adjudication process that resulted in a 74% reduction in claim processing time.
  • Improved overall department efficiency by introducing standardized documentation protocols that decreased processing time by 31%.
  • Implemented early claim assessment strategies, leading to a 24% reduction in total potential exposure for high-severity claims.
  • Utilized performance metrics to consistently rank in top 64% of claim examiners for case closure rates and resolution time.
  • Successfully executed a high-volume claims workload within 15 days, improving time to closure and claimant satisfaction.

Affiliations

  • Member of Society of Insurance Trainers and Educators (SITE), sharing knowledge and research on the latest liability claim handling techniques.
  • Member, Claims and Litigation Management Alliance (CLM), focused on professional development in liability claims handling.
  • Active participation at the Annual Professional Claims Examiner Summit on best practices in liability claims investigations and litigation avoidance.
  • Member, Defense Research Institute (DRI), participating in annual seminars on litigation management and claims arbitration.
  • Regular contributor to industry discussions at the National Association of Insurance Commissioners (NAIC) meetings on regulatory issues in liability claims.
  • Active participant in the National Association of Subrogation Professionals (NASP), specializing in liability claims and recovery.
  • Participant in continuing legal education through the American Bar Association (ABA) focusing on mediation and insurance law.
  • Regular attendee of 2023 National Liability Expertise Conclave, with a focus on legal and compliance risk in claims management.
  • Active participation in 2018 National Forum for Insurance Claims, discussing complex policy issues affecting liability determination.
  • Member of the American Society of Workers Compensation Professionals (AMCOMP) to stay updated on trends in liability claims impacting worker risk.

Certifications

  • Certified Business Analysis Professional (CBAP)
  • Certified Specialist in Special Investigations (CSSI) - Ironclad Systems
  • Insurance Examination Investigator Specialist (IEIS) - Northwind
  • Certified Litigation Specialist (CLS) - Meridian
  • Microsoft Office Specialist (MOS)
  • Accredited Claims Adjuster License (ACA) - Arizona
  • Online Privacy and Security Compliance Specialist (OPSCS) - Beacon Labs
  • Casualty Claims Law Associate (CLA) - Summit Group
  • Data Privacy Claims Certification (DPC) - Lakeside Partners
  • Associate in Claims (AIC) - Harbor & Co.

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