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Licensed Claims Adjuster resume examples

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Skills

  • Policy investigations
  • Advanced data analytics for claims
  • CCC Pathways Appraisal Quality Solution
  • Familiar with fraud statutes
  • Underwriting knowledge
  • Accurate liability evaluations
  • Expertise in bodily injury claims
  • Cost savings through claim optimization
  • ClaimsPro
  • Claims-cycle time reduction

Work Experiences

  • Achieved a 67% success rate.
  • Reviewed new files to determine the current status of an injury claim and devise a strategy.
  • Followed up with insured people who had not paid their premiums or deductibles.
  • Calculated the quantifiable features of program products.
  • Achieved resolution without court involvement.
  • Closed 81% of claims within 6 days.
  • Examined claim forms and other records to determine insurance coverage.
  • Testified on behalf of the agency in criminal and civil proceedings.
  • Reconciled data in the direct collection system with the accounting system to address discrepancies.
  • Achieved settlements exceeding $8.

Summaries

  • Expert at creating profitable and high-quality processes.
  • Advanced skills in fraud investigation.
  • Detailed Adjuster with 18 years of corporate insurance claims experience.
  • Accomplished at managing end-to-end claims in category insurance, improving claims closure rates by 54% within 2018, and delivering timely settlements.
  • Claims Examiner with extensive experience in the procedure claims industry.
  • Achieved a 57% reduction in claims processing times.
  • Licensed Claims Adjuster is a multi-talented Licensed Claims Adjuster who is consistently rewarded for planning and operational improvements.
  • Analyzed and closed 13 claims each month.
  • Achieved reductions in litigation costs.
  • Proven track record of using excellent negotiating skills to speed up settlements.

Accomplishments

  • Resolved product issue through consumer testing.
  • Created training programs for adjusters covering fraud detection and reporting, achieving a reduction of fraudulent claims by 50%.
  • Developed standardized reporting procedures for the claims adjustment department, reducing processing times by 20%.
  • Proactively communicated in Portuguese to multilingual claimants, resulting in a 37% improved customer service experience for non-English-speaking clients.
  • Led team to resolve claims related to method within three years, achieving a 49% reduction in customer complaints due to expediting the process.
  • Analyzed high-volume claims data to identify trends, resulting in a 43% reduction in overpayments year-over-year.
  • Assisted in training new claims adjusters on Jira, leading to a team-wide 21% increase in productivity.
  • Designed an improved workflow process using Workday, reducing claims adjustment cycle time by 62%.
  • Utilized Workday to streamline claims handling process, leading to a 79% reduction in handling time and a 29% increase in customer satisfaction.
  • Implemented new fraud detection methods that led to the identification of 12 suspicious claims over the course of two years, saving the company $15.

Affiliations

  • Society of Women Engineers
  • Association of Certified Fraud Specialists (ACFS)
  • American Medical Informatics Association
  • Insurance Fraud Prevention Authority (IFPA)
  • National Alliance for Insurance Education and Research
  • International Council of Nurses
  • American Educational Institute (AEI) in Claims Law
  • Freemason
  • Association of Information Technology Professionals
  • Property Claims Association of the Pacific

Certifications

  • Project Management Professional (PMP)
  • Certified Fraud Examiner (CFE)
  • Certified Claims Professional (CCP)
  • Certified Insurance Counselor (CIC)
  • Certified Public Accountant (CPA)
  • Associate in General Insurance (AINS)
  • Certified Property and Casualty Underwriter (CPCU)
  • HAAG Certified Inspector (Residential Roof Damage)
  • Associate in Reinsurance (ARe)
  • Intermediate Claims Investigation Techniques standard

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