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Skills

  • Dispute resolution and mediation
  • CCC Pathways Appraisal Quality Solution
  • Identifying fraudulent patterns in claims
  • CCC EZNet
  • Data integration for claims systems
  • Automobile claims specialist
  • Sales background
  • CCC Pathways
  • Litigation avoidance strategies
  • Catastrophic loss handling

Work Experiences

  • Kept track of 3-clients' caseload for each quarter.
  • Achieved 85%-lower premiums for Salesforce.
  • Organized method data in order to finish framework files.
  • Followed up with insured people who had not paid their premiums or deductibles.
  • Fixed program codes so that initiative claims could be properly classified.
  • Ensured that all filed hazard and special hazard claims were properly managed.
  • Reconciled data in the direct collection system with the accounting system to address discrepancies.
  • Achieved 49% compliance with state-mandated regulations.
  • Worked with the claims department and industry anti-fraud organizations to resolve claims.
  • Testified on behalf of the agency in criminal and civil proceedings.

Summaries

  • By applying all policies fairly, she is adept at balancing business and customer interests.
  • Exceptional at resolving claims to the mutual satisfaction of all parties.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • All state, federal, and local laws are well-trained and well-understood.
  • Criminal investigation, insurance fraud, and surveillance are all part of his background.
  • For 6 months, I've been a member of the National Society of Professional Insurance Investigators.
  • Complete knowledge of the claims process and performance reporting.
  • Negotiates fair and thorough resolutions to all claims in a peaceful manner.
  • Solid skills in formulating goals and strategies for resolving standard claims.
  • Senior Claims Adjuster, Automobile and Casualty with a passion for personal, property, and casualty losses and damages.

Accomplishments

  • Developed customized training materials for state-specific claims procedures, which led to a 85% improvement in certification pass rates for staff.
  • Researched and applied industry best practices which improved fraud detection accuracy by 25%, significantly cutting unnecessary payouts.
  • Analyzed intricate multi-state regulatory requirements to ensure all claims were handled in compliance with regional and federal laws, minimizing lawsuits by 27%.
  • Served as the key senior representative for high-profile claims and client interactions, ensuring a 54% increase in retention of corporate clients.
  • Collaborated with external vendors to negotiate reduced costs for auto repairs, ensuring savings of up to $5 on claims payouts annually.
  • Led the integration of a new claims management system that improved data accuracy across 9 states and reduced errors by 29%.
  • Coordinated with legal departments to deliver successful defense strategies for disputed claims, resulting in a 67% win rate in arbitration hearings.
  • Led 16-member team of adjusters to successfully meet a 16% compliance rate on all claims processed, while ensuring adherence to national standards.
  • Streamlined subrogation recovery efforts, recovering an additional $18 in overpaid claims in 2023 from at-fault third parties.
  • Introduced AI-driven predictive analytics for claims processing, leading to a reduction of manual review time by 4 hours per week.

Affiliations

  • Association for Supply Chain Management (APICS)
  • American Society of Safety Professionals
  • American Medical Informatics Association
  • Jaycees
  • Toastmasters
  • Rotary International
  • Society of Insurance Trainers and Educators (SITE)
  • Casualty Actuarial Society (CAS)
  • National Association of Social Workers
  • Association of Information Technology Professionals

Certifications

  • Associate in Risk Management (ARM) - The Institutes
  • Workers’ Compensation Professional (WCP) - Workers' Compensation Certification Institute
  • Salesforce
  • Senior Claim Law Associate (SCLA) - program
  • National General Adjuster (NGA) - National Association of Independent Insurance Adjusters (NAIIA)
  • Property and Casualty Insurance License - Illinois Department of Insurance
  • Professional Risk Manager (PRM) - Professional Risk Managers International Association (PRMIA)
  • SHRM Certified Professional (SHRM-CP)
  • Certified Fraud Examiner (CFE) – Association of Certified Fraud Examiners (ACFE)
  • CompTIA Security+

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