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Skills

  • Automated claims systems proficiency (SAP)
  • Claims submissions streamline methods
  • Data-driven decision making
  • Case prioritization strategies
  • Data integrity checks for case reviews
  • Cross-functional collaboration with legal teams
  • Business operations
  • Damage itemization
  • Relationship development
  • Operational improvement

Work Experiences

  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Collaborated with stakeholders to reach settlements in over 2 disputed claims, achieving a success rate of 63%.
  • Achieved favorable outcomes in 37% of cases.
  • Achieved a 52% accuracy rate.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Conducted investigations into high-profile claims.
  • Solved procedure issues, improved operations, and provided excellent customer service.
  • Cemented consistent improvement practices.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Achieved a Innovation Award in 2016 for reducing the frequency of escalated claims to senior management by 23%.

Summaries

  • Costs were consistently reduced while profits were increased.
  • Special Claims Representative with exceptional customer service, time management, and service coordination skills.
  • Committed to excellence in fraud detection and prevention, allowing for the identification of over $15 in insurers' savings through fraud-aversion methods.
  • Consistently recognized for exceeding case resolution targets.
  • Adept at resolving complex Salesforce claims.
  • Advanced case prioritization strategies.
  • Achieved results within the last 8 months.
  • Critical thinker with a history of identifying process bottlenecks and improving claims processes to reduce unresolved cases by 66% each quarter.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Awarded Top Performer for significant improvement in claims processing efficiency.

Accomplishments

  • Established working relationships with key industry experts, reducing overall claims assessment time by 17%.
  • Developed a specialized claims handling procedure for Miscellaneous, reducing customer escalations by 59%.
  • Collaborated with 6 teams to automate claims reporting, reducing manual entry errors by 53%.
  • Revamped claims auditing processes that resulted in a 59% decrease in claims review backlog.
  • Successfully negotiated settlements for 10 high-risk claims, saving the company $15 in potential legal expenses.
  • Increased the efficiency of claims investigations, reducing the average handling time by 11% over 2020.
  • Contributed to a company-wide initiative on digital transformation in claims handling, reducing total claims processing time by 13%.
  • Worked on post-incident reports that led to policy changes, contributing to a 37% reduction in similar claims occurrences.
  • Identified trends in claims fraud, implementing preventive measures that saved over $5 in false claims payouts.
  • Assisted in implementing a new claims tracking system that enhanced data reliability by 63%, minimizing reporting errors.

Affiliations

  • Society for Human Resource Management (SHRM) - Legal Specialties
  • International Association of Administrative Professionals
  • Society of Claim Law Associates (SCLA)
  • National General Adjuster Association (NGAA)
  • International Association of Privacy Professionals (IAPP) - Insurance Section
  • International Association of Special Investigation Units (IASIU)
  • American Marketing Association
  • National Association of Insurance Commissioners (NAIC)
  • Risk and Insurance Management Society (RIMS)
  • Freemason

Certifications

  • ServSafe
  • SHRM Certified Professional (SHRM-CP)
  • Associate Insurance Regulatory Compliance (AIRC) by The Institutes
  • Cisco Certified Network Associate (CCNA)
  • General Insurance Certificate (INS) by The Institutes
  • Associate in Insurance Services™ (AIS™) by The Institutes
  • Certificate in Claims Management (CICM) by International Claim Association
  • Certified Public Accountant
  • Certified Litigation Management Professional (CLMP) by Claims and Litigation Management Alliance
  • CompTIA A+ Technician

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