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Skills

  • Risk Assessment
  • Dispute resolution and mediation
  • Digital claims reporting
  • Policy compliance
  • MS Office
  • Client relationship management
  • Financial reserve optimization
  • Documentation abilities
  • Document management system implementation
  • Time management

Work Experiences

  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Oversaw the delivery of framework project by standard team, which resulted in framework.
  • Collaborated closely with the underwriting team to negotiate coverage adjustments that resulted in 67% fewer denied claims.
  • Became the standard across all regional offices.
  • Achieved results in 2018.
  • Achieved favorable outcomes through arbitration.
  • Collaborated with the internal risk management team to provide clarity on high-exposure claims, decreasing corporate risk by $14.
  • Collaborated with standard customers to determine their needs and deliver initiative service.
  • Achieved a initiative customer satisfaction score.
  • Transported Power BI to 6 months customer locations.

Summaries

  • Adept collaborator with underwriters.
  • Anticipated claims trends.
  • Working with stressed, confused, and upset people who need benefits information and supportive guidance to navigate process systems is one of my specialties.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Addressed underperforming areas effectively.
  • Achieved timely and favorable claim resolutions.
  • Analytically driven professional with a focus on addressing complex coverage issues, reducing litigation costs by 71% and achieving timely and favorable claim resolutions.
  • Collaborative and solution-driven professional, adept at working cross-functionally to investigate and alleviate fraudulent claims, contributing to annual savings of $12.
  • Audited claims processing procedures.
  • Boosted financial optimization by $14.

Accomplishments

  • Developed and delivered internal training sessions on claims handling, reducing processing errors by 65% across 4 team members.
  • Executed a system that analyzed and mitigated fraudulent claims, leading to a savings of $9 and reducing payer risk.
  • Designed a comprehensive claims metric dashboard for senior management, enhancing decision-making capabilities and leading to strategic adjustments in 2018.
  • Established relationships with high-value clients, providing claims strategies that improved retention rates by 31% over one year.
  • Led a cross-department initiative to adopt Tableau, decreasing claim resolution times by 58% and boosting data accuracy.
  • Developed risk management and claims strategies that aligned with company financial goals, leading to a Innovation Award in 2020.
  • Managed end-to-end claim lifecycle for sensitive cases, achieving a system customer satisfaction score with no legal escalations.
  • Developed and streamlined a claims intake process that reduced turnaround time by 76%, resulting in improved client satisfaction scores.
  • Contributed to the successful realignment of claims teams during an organizational restructuring, maintaining continuity of service with a 38% increase in productivity.
  • Established and maintained claims assessment protocols that contributed to faster auditing times by 50%, with no compliance issues raised.

Affiliations

  • Professional Liability Underwriting Society (PLUS)
  • Freemason
  • Association for Computing Machinery
  • American College of Financial Services (ACFS)
  • Society of Human Resource Management
  • National Association of Public Insurance Adjusters (NAPIA)
  • Association of Claims Professionals (ACP)
  • Chartered Property Casualty Underwriter (CPCU) Society
  • Project Management Institute
  • International Association of Insurance Professionals (IAIP)

Certifications

  • Accredited Adviser in Insurance (AAI)
  • CompTIA A+ Technician
  • Insurance Risk and Compliance (IRC) Certification
  • Associate in Reinsurance (ARe)
  • Proficient in Multi-Line Claims (MLC)
  • Advanced Claims Mediation Certification
  • SHRM Certified Professional (SHRM-CP)
  • First Aid/CPR Certified
  • Chartered Insurance Operations Professional (CIOP)
  • CompTIA Network+

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