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Skills

  • Data entry
  • Valuation knowledge
  • AMS360
  • Familiar with fraud statutes
  • Personal, casualty and property loss
  • User interface understanding
  • Process implementation
  • Insurance policy coverage knowledge
  • Food preparation
  • Conflict resolution

Work Experiences

  • Looked into and assessed property damage, as well as reviewing property damage estimates.
  • Investigated and analyzed insurance claims that appeared to be suspicious or potentially fraudulent.
  • Reconciled data in the direct collection system with the accounting system to address discrepancies.
  • Looked into legal issues surrounding procedure claims.
  • Ensured that all filed hazard and special hazard claims were properly managed.
  • Investigated claims and incident data in order to provide solutions and resolve issues.
  • Started two key partnerships that resulted in a 54% increase in revenue.
  • Was in charge of maintaining a suspicious claims database and preparing quarterly reports for supervisors.
  • Conducted in-depth interviews with witnesses and claimants to gather facts and information.
  • Worked with the claims department and industry anti-fraud organizations to resolve claims.

Summaries

  • Clear understanding of vendor management and strategic planning as well as data analysis training.
  • Achieved a 41% improvement in customer satisfaction.
  • Workers' Compensation Claims Adjuster with 7 years of successful budget management and risk assessment experience.
  • Complete knowledge of the claims process and process improvement.
  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Solid skills in formulating goals and strategies for resolving metric claims.
  • Achieved a 21% success rate in mediated claims.
  • Achieved a 21% success rate in arbitrated claims.
  • Expert at creating profitable and high-quality processes.

Accomplishments

  • Implemented a new fast-track process for clear-cut claims, reducing resolution time by 17 days and improving claimant satisfaction by 19%.
  • Developed and conducted internal training sessions on new state workers’ compensation regulations, raising team compliance levels to 20%.
  • Generated comprehensive reports to forecast liabilities for high-value claims, successfully contributing to financial department budgeting and improving accuracy by 77%.
  • Stayed up-to-date with the latest in workers' compensation laws, enabling the firm to maintain a 77% compliance rate across all regions.
  • Increased sales 17% over several months.
  • Created risk analysis reports that facilitated informed decision-making by senior management, improving reserve allocation accuracy by 61%.
  • Reviewed and closed 14 claims monthly, maintaining a 80% accuracy rate in documentation and audit compliance.
  • Proactively reviewed and processed 3 claims per week, ensuring precise calculation of benefits and timely updates to claimants and stakeholders.
  • Maintained a comprehensive knowledge base of state Workers' Compensation laws and legal precedents, directly contributing to a 53% reduction in appeals.
  • Collaborated with team of 6 in the development of metric.

Affiliations

  • Certified Workers Compensation Professional Program Completion, Beacon Labs 2016
  • Jaycees
  • Lions Club
  • Advisor, Workplace Injury Network 2023–Present
  • International Council of Nurses
  • Associate Member, American Bar Association (ABA), Tort Trial and Insurance Practice Section (2019–Present)
  • Affiliation, National Council on Compensation Insurance (NCCI), Ongoing
  • American Society of Safety Professionals
  • International Association of Administrative Professionals
  • American Medical Informatics Association

Certifications

  • Risk Adjustment Coding Certification (CRC)
  • Cisco Certified Internetwork Expert (CCIE)
  • CompTIA Security+
  • Certified Professional in Workers' Compensation (CPWC)
  • Chartered Wealth Manager (CWM), certified by the American Academy of Financial Management (AAFM)
  • Certified Insurance Consultant (CIC)
  • Workers' Compensation Specialist (WCS) Certification
  • Digital Claims Process Improvement Certification
  • Cyber and Privacy Liability Risk & Insurance Certificate
  • Associate in Insurance Data Analytics (AIDA)

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