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Skills

  • Regulatory compliance
  • Operational improvement
  • Training and development
  • Documentation abilities
  • Project management
  • Continuous professional development
  • Time management
  • Negotiation and mediation
  • Deadline management
  • Strategic decision making

Work Experiences

  • Acted as the claims department liaison in cross-company compliance projects, ensuring claims operations were fully aligned with broader organizational directives.
  • Affected claims handling protocols.
  • Automated manual processes.
  • Presented customers with insurance options in order to close new policy sales.
  • Achieved team alignment to business goals.
  • Conducted trainings for claims teams.
  • Had an excellent attendance record and was always on time for work.
  • Achieved Employee of the Year in Columbus for outstanding performance in resolving customer claims while maintaining a perfect regulatory compliance score.
  • Achieved results over 18 months.
  • Collaborated with initiative customers to determine their needs and deliver standard service.

Summaries

  • Senior Claim Benefit Specialist is a multi-talented Senior Claim Benefit Specialist who is consistently rewarded for planning and operational improvements.
  • Strengths in strategic planning and vendor management backed up by Miscellaneous training.
  • Within Miscellaneous, senior Senior Claim Benefit Specialist and outstanding performer in vendor management and quality assurance.
  • Achieved 24% improvement in claim accuracy.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Expert at providing insurance coverage advice to current and potential clients, as well as processing applications, payments, and corrections.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Approved claims ensuring regulatory alignment.
  • Achieved reduction in resolution time by 10 days.
  • Senior Claim Benefit Specialist with 5 years of successful process improvement and project management experience.

Accomplishments

  • Implemented new best practices within the team, increasing claims processing accuracy from 59% to 52% within the past year.
  • Formulated risk-based strategies to reduce fraudulent claims, saving the company approximately $3 over one year.
  • Orchestrated client communications during sensitive appeals, resulting in positive resolution and retention of $17 worth of business each year.
  • Drafted detailed case reports for complex claims investigations, contributing to the recovery of over $10 due to detected fraud.
  • Used Power BI to conduct data-driven analysis that resulted in identifying system inefficiencies, saving the company 69% in operational costs.
  • Analyzed trends in denied benefits to proactively address policyholder misunderstandings, reducing appeals by 31% over one year.
  • Prevailed in 42% of case appeals through diligent review and analysis, recovering over $10 in disputed claims annually.
  • Reduced a backlog of over 17 claims by streamlining internal procedures, closing cases faster while maintaining policyholder satisfaction rates of 69%.
  • Processed high-value claims with a focus on accuracy and integrity, preventing an estimated $4 in incorrect payouts over three years.
  • Partnered with IT department to implement automated reporting tools, reducing manual data entry and increasing department productivity by 34%.

Affiliations

  • Association for Computing Machinery
  • National Alliance of Healthcare Purchaser Coalitions (NAHPC)
  • Case Management Society of America (CMSA)
  • Accredited Health Care Fraud Investigator (AHFI)
  • International Council of Nurses
  • Freemason
  • Toastmasters
  • Healthcare Financial Management Association (HFMA)
  • American Claims Management Association (ACMA)
  • The American Institute For Chartered Property Casualty Underwriters (CPCU)

Certifications

  • Apple Certified Associate (ACA)
  • Project Management Professional (PMP)
  • CompTIA Network+
  • Certified Public Accountant
  • Cisco Certified Internetwork Expert (CCIE)
  • Health Claims Associate (HCA) Certification
  • Compliance and Ethics Professional (CCEP) Vantage
  • Certified Professional in Healthcare Quality (CPHQ)
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Business Analysis Professional (CBAP)

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