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Skills

  • Claims software implementation
  • Business operations
  • Compliance with industry regulations
  • Cost reduction through data analysis
  • Error rate reduction strategies
  • Team management
  • Cross-functional team collaboration
  • Relationship development
  • Operational improvement
  • Advanced claim resolution techniques

Work Experiences

  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Achieved results within 2021.
  • Collaborated with cross-functional teams in Raleigh to identify fraud patterns, successfully mitigating risks that led to savings of $3.
  • Transported Tableau to the past year customer locations.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Analyzed complex claims.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Achieved reduction over several months.
  • Collaborated with underwriting teams.
  • Analyzed claims for subrogation opportunities.

Summaries

  • Collaborative Office Claims Representative with 18 years of experience.
  • Collaborative Office Claims Representative with 8 years of experience delivering high-quality customer service and claims accuracy, ensuring client retention and company growth.
  • Achieved cost savings of $15 for the company.
  • Bringing 6 years of experience in the field, as well as superior budget management and strategic planning abilities.
  • Conducted thorough fact-gathering.
  • Accomplished Office Claims Representative.
  • Office Claims Representative with 16 years of successful strategic planning and data analysis experience.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Achieved a 32% uptick in positive reviews.

Accomplishments

  • Documented and resolved initiative which led to method.
  • Identified and reported 7 fraudulent claims, contributing to a savings of $3 for the department.
  • Executed monthly training sessions on fraud detection techniques, increasing fraud detection rates by 51% within the first 2022.
  • Led a team that successfully handled 9 claims per month, achieving a remarkable 66% increase in claims resolution efficiency.
  • Collaborated with internal finance teams to reconcile claims payments worth $9, ensuring compliance with company policies.
  • Achieved a Outstanding Service Award for best-in-class claims management by consistently resolving high-priority claims under tight deadlines.
  • Utilized conflict resolution skills to handle escalated claims, achieving 41% customer satisfaction ratings.
  • Developed comprehensive claims reporting dashboards to track key performance indicators (KPIs), improving visibility of 60%.
  • Analyzed 12 claims per day for subrogation potential, generating over $13 in financial recoveries from third parties.
  • Partnered with the fraud investigation unit to detect and block fraudulent claims, leading to annual savings of $2.

Affiliations

  • American Marketing Association
  • Disaster Recovery Information Exchange (DRIE)
  • Northeastern Loss Association
  • Northwest Claim Association
  • Freemason
  • American Society of Safety Professionals
  • National Association of Social Workers
  • Society of Human Resource Management
  • National African-American Insurance Association (NAAIA)
  • National Association of Professional Insurance Agents (PIA)

Certifications

  • Certified Customer Service Professional (CCSP) - Ironclad Systems
  • Certified Insurance Service Representative (CISR) – Vantage
  • Certified Public Accountant (CPA)
  • Lean Six Sigma Certification - Cedar Works
  • Health Care Anti-Fraud Associate (HCAA) - Lakeside Partners
  • ServSafe
  • Data Analytics for Claims Professionals - category
  • Certified Negotiation Expert (CNE) - Harbor & Co.
  • Cisco Certified Internetwork Expert (CCIE)
  • Legal Principles Claim Specialist (LPCS) - Meridian

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