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Skills

  • Claims Dispute Resolution
  • Collaboration with medical professionals
  • Claims report writing and presentation
  • Magnify Predictive Targeting System
  • Valuation knowledge
  • Automobile claims specialist
  • Insurance policy interpretation
  • Claims-cycle time reduction
  • Microsoft Publisher
  • Arbitration cost reduction

Work Experiences

  • Achieved a 77% reduction in fraudulent payments.
  • Analyzed precedent in disputed claims.
  • Achieved results within 2015.
  • Looked into and assessed property damage, as well as reviewing property damage estimates.
  • Calculated the quantifiable features of program products.
  • Achieved resolution without court involvement.
  • Addressed disputed coverage issues.
  • Reconciled data in the direct collection system with the accounting system to address discrepancies.
  • Analyzed and resolved over 13 complex claims monthly, ensuring timely settlements and a customer satisfaction improvement of 53%.
  • Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.

Summaries

  • Achieved a 54% decrease in overall claims processing time.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the initiative business.
  • Negotiates fair and thorough resolutions to all claims in a peaceful manner.
  • Within Miscellaneous, senior Licensed Claims Adjuster and outstanding performer in project management and stakeholder engagement.
  • Achieved a 46% increase in claims accuracy.
  • Strong understanding of claimant intake processes, record documentation, and fraud investigation protocols.
  • Achieved a 24% reduction in fraudulent payments.
  • Criminal investigation, insurance fraud, and surveillance are all part of his background.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.

Accomplishments

  • Achieved a CPA in metric Adjusting, improving proficiency in complex claims processing and settlement accuracy.
  • Provided expert arbitration support leading to a 77% reduction in litigation costs and faster case resolution timelines.
  • Documented and resolved initiative which led to process.
  • Led a cross-functional team in processing over 16 catastrophe-related claims, achieving a 68% increase in policyholder satisfaction.
  • Designed an improved workflow process using Workday, reducing claims adjustment cycle time by 62%.
  • Investigated and resolved 6 complex property damage claims resulting in 84% dispute resolution rate improvement.
  • Implemented new fraud detection methods that led to the identification of 12 suspicious claims over the course of two years, saving the company $15.
  • Achieved a 28% dispute resolution rate improvement through comprehensive documentation and attention to coverage details.
  • Mentored a team of 8 junior adjusters, resulting in a 38% reduction in escalated claims for supervisory review.
  • Led audit of 14 closed claim files, discovering and addressing potential compliance issues, resulting in 72% fewer regulatory citations.

Affiliations

  • Freemason
  • Jaycees
  • National Alliance for Insurance Education and Research
  • Licensing and Regulatory Affairs initiative
  • Certified Claims Professional (CCP) Designation
  • Society of Registered Professional Adjusters (RPA)
  • Association for Computing Machinery
  • International Federation of Adjusting Associations (IFAA)
  • American Medical Informatics Association
  • Institution of Loss Adjusters (ILA)

Certifications

  • Negotiations in Insurance Claims Certification
  • Certified Fraud Examiner (CFE)
  • Cisco Certified Internetwork Expert (CCIE)
  • Associate in General Insurance (AINS)
  • ServSafe
  • CompTIA Network+
  • Microsoft Certified Systems Engineer (MCSE)
  • Collision Repair Estimating Certification Tableau
  • Associate in Claims (AIC) Certification
  • Public Adjuster License North Carolina

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