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Skills

  • Medical provider liaison
  • Cross-functional team collaboration
  • Claims Processing Automation
  • Operational improvement
  • Negotiation and mediation skills
  • Insurance product knowledge (Power BI)
  • Process improvement
  • Supervision
  • Multilingual communication skills
  • Regulatory compliance

Work Experiences

  • Collaborated with medical professionals.
  • Completed processing within three years.
  • Analyzed over 9% of insurance claims annually, detecting fraudulent submissions and saving the company $14 in potential payouts.
  • Advocated for policyholders.
  • Coordinated multi-departmental teams to swiftly handle 8 emergency life insurance claims after Atlanta disaster, cutting response time by 4 hours.
  • Coordinated multi-departmental teams.
  • Created and presented training materials for new hires, reducing onboarding time by 61% and increasing examination accuracy rates.
  • Assisted policyholders with understanding the scope of their coverage, raising customer satisfaction scores by 6 points year-over-year.
  • Balanced a caseload of 17 life insurance examinations.
  • Assisted policyholders with understanding their coverage.

Summaries

  • Costs were consistently reduced while profits were increased.
  • Boosted customer satisfaction scores by 18 points year-over-year.
  • Adept at maintaining precise records.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • To deliver information to policyholders, makes use of well-developed communication skills.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Analyzed life insurance claims.
  • Bringing 4 years of experience in the field, as well as superior strategic planning and budget management abilities.
  • Collaborated with medical providers.
  • Certified Life Insurance Examiner with a specialization in risk mitigation and claims processing automation. Excelled at improving operational efficiencies and accelerating high-risk claim examinations by 38%.

Accomplishments

  • Audited 12 case files to ensure thorough documentation, preventing regulatory non-compliance and saving the organization 52% in potential fines.
  • Promoted to senior examiner following successful management of 3 complex life insurance cases with zero discrepancies over a the past year period.
  • Decreased overall claim processing time by 68% through the integration of AI-based risk assessment tools.
  • Elevated team productivity by 75% after introducing data automation tools for processing Workday claims in initiative.
  • Facilitated communication between adjusters, medical providers, and policyholders to resolve disputed claims in under 2 days on average, improving client retention by 44%.
  • Implemented new risk mitigation strategies for high-value Salesforce policies, reducing insurer liabilities by 14 over one year.
  • Reduced regulatory reporting errors by 79%, ensuring consistent compliance with Raleigh insurance regulations through system.
  • Identified and rectified discrepancies in 17 high-value taxable life insurance claims, saving the firm 3 in potential losses.
  • Contributed to the successful retention of 18 key clients by collaborating with sales teams on custom life insurance product offerings aligning with client profiles.
  • Nominated as 2019 Employee of the Year by improving department-wide performance metrics and integrating new risk assessment models.

Affiliations

  • American Council of Life Insurers (ACLI)
  • Insurance Institute of America (IIA) – Ongoing Participation
  • National Healthcare Anti-Fraud Association (NHCAA)
  • Chartered Life Underwriter (CLU) Designation
  • Freemason
  • Jaycees
  • International Claims Association (ICA)
  • American Academy of Financial Management (AAFM)
  • Association for Supply Chain Management (APICS)
  • Insurance Fraud Management Society – Member since 2017

Certifications

  • Salesforce
  • Certified Customer Experience Professional (CCXP)
  • Certified Medical Claims Examiner (CMCE)
  • Finance, Risk and Insurance Specialist Certification (FRIS)
  • Leadership Through Effective Communication from Brightline
  • SHRM Senior Certified Professional (SHRM-SCP)
  • First Aid/CPR Certified
  • Associate in Risk Management (ARM) from The Institutes
  • Project Management Professional (PMP)
  • CompTIA Security+

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