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Skills

  • Regulatory compliance
  • Policy analysis and interpretation
  • Regulatory compliance enforcement
  • Budgets
  • Confidential information management
  • Case adjudication
  • High-profile or sensitive case handling
  • Team building
  • Business operations
  • Problem resolution

Work Experiences

  • Achieved higher consistency across initiative cases.
  • Adjudicated initiative cases.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Weighed support and opposition to proposals by evaluating physical and digital records, testimony, and reports.
  • Achieved a 44% success rate.
  • Applied program in evaluations.
  • Achieved 77% faster case processing times.
  • Completed detailed evaluations based on information provided by procedure and method people.
  • Addressed issues over 6 months.
  • Contributed issue knowledge and key expertise in three years meetings focused on budget management concerns.

Summaries

  • Dedicated and proactive Senior Adjudicator with over 17 years of experience synthesizing complex case data and successfully implementing an appeals process that reduced decision time by the past year.
  • Accomplished Senior Adjudicator skilled at driving compliance with process, leading teams of junior adjudicators, and achieving a 69% reduction in appeals through enhanced case analysis techniques.
  • Clear understanding of team leadership and vendor management as well as strategic planning training.
  • Contributed to the recovery of $9 in inaccurate claims.
  • Senior Adjudicator with 14 years of successful risk assessment and stakeholder engagement experience.
  • Adept at handling politically sensitive cases.
  • Achieved 22% faster case closures.
  • Achieved a 46% reduction in errors.
  • Analytical Senior Adjudicator.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.

Accomplishments

  • Conducted internal audits on claim decisions, leading to the discovery of 14 oversights and implementing fixes that reduced future errors by 48%.
  • Detect inconsistencies in system submissions, resulting in recovery of over $6 in erroneous claims.
  • Exceeded departmental performance targets by increasing the adjudication close rate by 23% through more effective triage and resource allocation strategies.
  • Instituted a metrics-based performance review system for the department, leading to clarified expectations and an increase in team productivity by 23%.
  • Collaborated with team of 7 in the development of system.
  • Performed detailed case reviews leading to the identification and correction of 10 misjudgments, reducing litigation exposure by 15%.
  • Reduced the appeals backlog by 19% by implementing improved case prioritization procedures and decision accuracy standards.
  • Monitored regulatory updates and adjusted team workflows, leading to full compliance on category standards during audits across a 18 months period.
  • Recommended updates to adjudication software, improving document processing time by 36% while enhancing record keeping accuracy.
  • Crafted case hearing documentation templates that expedited report preparation times by 39% across the team.

Affiliations

  • American Society of Safety Professionals
  • State Portland Adjudicators Association
  • American Marketing Association
  • Professional Certification in Fraud Detection and Prevention
  • Judicial Institute for Adjudicative Professionals
  • American Bar Association – Judicial Division
  • American Society for Public Administration – Judicial Branch Section
  • Association for Administrative Law Judges
  • International Association of Administrative Professionals
  • Society for Adjudicative Professionals

Certifications

  • Google Certified Professional Cloud Architect
  • Appeals and Adjudication Professional Certification Summit Group
  • Certified Legal Data Analyst Ironclad Systems
  • CompTIA Network+
  • Certified in Governance, Risk & Compliance (CGRC)
  • SHRM Certified Professional (SHRM-CP)
  • Salesforce
  • Apple Certified Associate (ACA)
  • Certified Public Accountant
  • Certified Administrative Judge Lakeside Partners

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