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Skills

  • Data integrity in claims processing
  • Advanced knowledge of QuickBooks
  • Fraud detection and prevention
  • Documentation auditing
  • First Aid/CPR
  • Framework equipment
  • Insurance software proficiency (e.g., program)
  • Budgets
  • Claims analysis and assessment
  • Discrepancy identification in medical records

Work Experiences

  • Assisted policyholders with understanding the scope of their coverage, raising customer satisfaction scores by 6 points year-over-year.
  • Created and presented training materials for new hires, reducing onboarding time by 61% and increasing examination accuracy rates.
  • Coordinated multi-departmental teams.
  • Looked for industry trends on social media and through online sources.
  • Collaborated with external healthcare providers.
  • Oversaw the delivery of program project by category team, which resulted in metric.
  • Completed investigations in three years.
  • Achieved a 71% reduction in policy processing delays.
  • Adjusted claim resolution strategies based on KPIs.
  • Advocated for policyholders.

Summaries

  • Life Insurance Examiner is a multi-talented Life Insurance Examiner who is consistently rewarded for planning and operational improvements.
  • Analyzed life insurance claims.
  • Costs were consistently reduced while profits were increased.
  • Achieved this through effective system automation and process improvements.
  • Bringing 4 years of experience in the field, as well as superior strategic planning and budget management abilities.
  • Adaptable and thorough Life Insurance Examiner with 10 years of hands-on experience in medical record verification, discrepancy identification, and fraud prevention. Proficient in enhancing claim review processes using category.
  • Collaborated with underwriters to ensure compliance.
  • 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%.
  • Analyzed high-volume life insurance claims.
  • Certified Life Insurance Examiner.

Accomplishments

  • Nominated as 2019 Employee of the Year by improving department-wide performance metrics and integrating new risk assessment models.
  • Decreased overall claim processing time by 68% through the integration of AI-based risk assessment tools.
  • Enhanced life insurance claim processing by reducing manual data entry tasks by 17% through effective digital transformation initiatives.
  • Developed and led a training program for 10 junior examiners on advanced underwriting techniques, significantly improving claim review accuracy across the team.
  • Resolved Jira policy disputes by investigating medical and non-medical documentation, improving processing accuracy by 11%.
  • Audited 12 case files to ensure thorough documentation, preventing regulatory non-compliance and saving the organization 52% in potential fines.
  • Executed continuous training on regulatory adherence for team members, leading to a notable 40% decrease in compliance-related errors in 2016.
  • Guided a team of 8 examiners in risk analysis for multifaceted claims, achieving a 55% increase in efficiency and reducing disputes with policyholders.
  • Assisted with the implementation of procedure, resulting in improved processing and tracking of high-volume life insurance claims by 75%.
  • Resolved product issue through consumer testing.

Affiliations

  • Project Management Institute
  • International Claims Association (ICA)
  • Risk and Insurance Management Society (RIMS) – Active Member
  • Rotary International
  • Contributor to Life Insurance Regulatory Bodies – Boston Chapter
  • Chartered Life Underwriter (CLU) Designation
  • American Medical Informatics Association
  • North American Training Academy for Life Insurance and Underwriting
  • American Council of Life Insurers (ACLI)
  • International Council of Nurses

Certifications

  • Cisco Certified Network Associate (CCNA)
  • Certified Compliance and Ethics Professional (CCEP)
  • Certified in Long-Term Care (CLTC)
  • Certified Risk Specialist (CRS) from Risk and Insurance Management Society (RIMS)
  • Fellow, Life Management Institute (FLMI) from LOMA
  • Certified Professional Claims Adjuster (CPCA) from The Institutes
  • SHRM Certified Professional (SHRM-CP)
  • Medicare Claims Training Certification from AHIP
  • Associate, Insurance Regulatory Compliance (AIRC) from LOMA
  • Associate in Risk Management (ARM) from The Institutes

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