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Skills

  • Problem resolution
  • Case traceability enhancement
  • Operational improvement
  • Cross-functional team collaboration
  • Multi-departmental collaboration
  • Relationship development
  • Process improvement
  • First Aid/CPR
  • Procedure equipment
  • Communication template improvements

Work Experiences

  • Achieved a 70% decrease in communication with claimants.
  • Achieved settlements on average 29% higher.
  • Identified insurance coverage limitations with a thorough examination of claims documentation and related records.
  • Achieved 'Employee of the Month' award for 12 months.
  • Determined liability as outlined in the coverage and assessed documentation from police and healthcare providers to understand the damages incurred.
  • Had an excellent attendance record and was always on time for work.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Solved program issues, improved operations, and provided excellent customer service.
  • Collaborated with category customers to determine their needs and deliver program service.

Summaries

  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Adept at evolving claim-handling methods.
  • Assessed documentation effectively.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the standard business.
  • Achieved 39% customer satisfaction improvement through empathy-driven interactions and first-call resolution process enhancements.
  • As a Telephone Claims Representative, I'm skilled in optimizing workflows and processing high-volume claims with a 22% reduction in errors.
  • Certified in procedure.
  • Adhered to service-level agreements.
  • Adept at handling sensitive data.
  • Adept at evolving claim-handling methods to reflect industry trends while maintaining a 21% service-level adherence in high-pressure environments.

Accomplishments

  • Resolved high-value claims within two years, ensuring customer retention and securing positive feedback from claimants.
  • Led a team of 2 claims representatives to a 28% reduction in processing time through process improvements.
  • Resolved escalated claims, resulting in recovering $6 in previously disputed payouts, thus safeguarding company resources.
  • Contributed to an overall processing output increase of 70% by utilizing advanced time management techniques in high-volume periods.
  • Facilitated interdepartmental collaboration for complex injury claims, reducing overall processing errors by 61%.
  • Oversaw a portfolio of 6 priority claims, achieving a 16% increase in resolution speed compared to department benchmarks.
  • Processed an average of 7 claims per day, consistently meeting or exceeding company-set service level agreements (SLAs).
  • Utilized advanced reporting software to track monthly claims performance, providing data that led to the optimization of claims workflow by 33% hours per cycle.
  • Documented and resolved process which led to category.
  • Assisted fraud detection teams to uncover and deny false claims, saving the company over $14 annually.

Affiliations

  • American Marketing Association
  • American Association of Insurance Services (AAIS)
  • National Association of Independent Insurance Adjusters (NAIIA)
  • State Claims Adjusters Licensing Boards
  • Workers’ Compensation Insurance Rating Bureau (WCIRB)
  • Association for Supply Chain Management (APICS)
  • Association of Governmental Risk Pools (AGRiP)
  • Insurance Regulatory Examiners Society (IRES)
  • American Academy of Professional Coders (AAPC)
  • Association of Certified Fraud Examiners (ACFE)

Certifications

  • Certified Insurance Fraud Investigator (CIFI)
  • ISO ClaimSearch Certified User
  • Fraud Examiner Certification (CFE)
  • Cisco Certified Internetwork Expert (CCIE)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Google Certified Professional Cloud Architect
  • Salesforce
  • Negotiation and Mediation Certification
  • Certified Public Accountant (CPA)
  • Licensed Claims Adjuster (All Lines) North Carolina

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