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Life Claims Specialist resume examples

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Skills

  • Complex claims resolution
  • Team management
  • Negotiation and mediation skills
  • Deadline-driven environment proficiency
  • Customer satisfaction improvement
  • Customer-centered claim resolution strategies
  • MS Office
  • Ethics and confidentiality in claim resolutions
  • Business operations
  • Coverage determination

Work Experiences

  • Collaborated with external auditing teams.
  • Achieved Employee of the Year for delivering exceptional performance in claims management, recognized for settling 3% of claims within service-level agreement timelines.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Coordinated appeals and resubmissions of denied or contested claims, ensuring accurate decisions and saving $8 within one year.
  • Collaborated with legal teams.
  • Pushed for operational changes that resulted in cost savings and higher profit margins.
  • Contributed to continuous process improvements.
  • Collaborated with policyholders’ lawyers.
  • Achieved this over the past one year.
  • Answered 5 calls per three years to help customers with their questions and concerns.

Summaries

  • Award-winning Life Claims Specialist.
  • Category professional with 12 years of experience evaluating coverage and supervising claims review.
  • Avoided penalties.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Collaborative Life Claims Specialist.
  • Bringing 15 years of experience in the field, as well as superior budget management and project management abilities.
  • Achieved a 71% accuracy rate.
  • Achieved a 60% reduction in claim processing time.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Costs were consistently reduced while profits were increased.

Accomplishments

  • Documented and resolved category which led to standard.
  • Optimized claims investigation procedures, decreasing average fraud detection time by 13 days while improving accuracy.
  • Developed key performance indicator (KPI) reports that helped reduce overdue claims by 82% month-over-month.
  • Analyzed cross-functional data to identify bottlenecks in the claims investigation process, reducing the claim resolution cycle by 8 days.
  • Implemented a continuous training program that reduced claims processing errors by 62% within several months of rollout.
  • Acted as the primary liaison with external stakeholders, improving relationship-building and reducing third-party claim processing time by 5 days.
  • Partnered with cross-functional teams to update digital claims submission systems, resulting in a 81% reduction in manual data entry errors.
  • Led the revision of claim adjudication policies, ensuring compliance with all industry regulations and increasing claim approval accuracy by 51% year-over-year.
  • Managed a caseload of over 14 life insurance claims, ensuring timely processing and reducing outstanding claims by 27% within a several months.
  • Created detailed post-claim investigation reports that enhanced transparency and improved communication between claims and legal departments.

Affiliations

  • Medical Group Management Association (MGMA)
  • Institute of Risk Management (IRM)
  • Society of Women Engineers
  • International Insurance Society (IIS)
  • American Marketing Association
  • Toastmasters
  • National Association of Health Underwriters (NAHU)
  • Rotary International
  • Project Management Institute
  • International Association of Administrative Professionals

Certifications

  • CompTIA Security+
  • Certified Professional in Insurance Regulatory Compliance (CPIRC)
  • Ethics in Insurance Claims Resolution – Lakeside Partners
  • Certified Life Claim Health Professional (CLCHP)
  • Certified Disability Management Specialist (CDMS)
  • Risk Management Certification - Brightline
  • Cisco Certified Internetwork Expert (CCIE)
  • SHRM Certified Professional (SHRM-CP)
  • Certified Public Accountant (CPA)
  • Certified Insurance Claims Analyst (CICA)

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