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Skills

  • Operational performance improvement
  • Time management
  • Organization
  • Procedure equipment
  • Quality assurance
  • Customer service
  • Operational improvement
  • Claims software proficiency (e.g., Workday)
  • Coaching for process improvement
  • Process improvement

Work Experiences

  • Achieved Employee of the Year for high-quality claims resolutions.
  • Based decisions on updated policies.
  • Achieved a 30% reduction in escalations year-over-year.
  • Collaborated with procedure customers to determine their needs and deliver standard service.
  • Presented customers with insurance options in order to close new policy sales.
  • Answered 12 calls per several months to help customers with their questions and concerns.
  • Built strong relationships with policyholders.
  • Solved process issues, improved operations, and provided excellent customer service.
  • Automated verification processes.
  • Achieved savings in 2019.

Summaries

  • Advanced knowledge of claims management systems like Tableau.
  • Achieved a 80% success rate in resolving escalated claims.
  • Achieved a fraud reduction rate of 38%.
  • Achieved 30% client retention.
  • Analytical Senior Claims Processor.
  • Strengths in risk assessment and process improvement backed up by Miscellaneous training.
  • Achieved a 33% increase in efficiency.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Senior Claims Processor with 11 years of successful client relations and strategic planning experience.
  • Within Miscellaneous, senior Senior Claims Processor and outstanding performer in data analysis and quality assurance.

Accomplishments

  • Maintained a claim approval accuracy rate of 71%, exceeding company standards and reducing disputes by 22%.
  • Awarded Six Sigma in claims management, reinforcing expertise in life, health, and disability insurance claims.
  • Presented executive-level reports summarizing claims performance and associated risks, resulting in 84% more informed decision-making.
  • Developed a policyholder engagement strategy, resulting in 52% improvement in customer satisfaction scores.
  • Generated performance reports using Microsoft Excel, driving data-driven decisions that improved individual and team KPIs by 75%.
  • Identified gaps in claims processing workflows and proposed improvements that led to a 84% increase in overall team productivity.
  • Authored training materials and standard operating procedures, which led to a smoother onboarding process, reducing the ramp-up time for new hires by 41%.
  • Mentored and trained new claims analysts, enhancing their productivity by 45% within 18 months.
  • Monitored and analyzed claim denial reasons, implemented corrective actions leading to a 73% decrease in future denials.
  • Reduced the average claim lifecycle by 77% by implementing data-driven process optimizations.

Affiliations

  • Certified Insurance Service Representatives (CISR)
  • Association for Supply Chain Management (APICS)
  • National Healthcare Anti-Fraud Association (NHCAA)
  • American Medical Informatics Association
  • Healthcare Compliance Association (HCCA)
  • Chartered Insurance Professional (CIP) Association
  • Professional Insurance Agents (PIA)
  • American Marketing Association
  • Society of Women Engineers
  • Insurance Regulatory Examiners Society (IRES)

Certifications

  • Certified Business Analysis Professional (CBAP)
  • Claims and Legal Audit Professional Certification
  • CompTIA Network+
  • Certified Professional Coder (CPC)
  • SHRM Certified Professional (SHRM-CP)
  • Certified Compliance Professional (CCP) for Insurance
  • Healthcare Claims Professional (HCP) Certification
  • Life and Health Insurance License
  • Property and Casualty Insurance License
  • Certified in Risk and Information Systems Control (CRISC)

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