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Skills

  • Accident scene investigations
  • MS Office proficiency (system)
  • Client satisfaction management
  • Microsoft Office Suite
  • Risk assessment and mitigation
  • Hail and wind damage specialist
  • Active listening in customer service settings
  • Database management for claims tracking
  • Customer service excellence
  • Insurance policy coverage knowledge

Work Experiences

  • Investigated and analyzed insurance claims that appeared to be suspicious or potentially fraudulent.
  • Analyzed complex cases.
  • Achieved favorable outcomes in 70% of contested cases.
  • Looked at the data to see what the underlying principles were.
  • Calculated the quantifiable features of framework products.
  • Fixed metric codes so that framework claims could be properly classified.
  • Analyzed financial exposures.
  • Investigated potentially fraudulent claims that claims representatives had initiated.
  • Looked into legal issues surrounding framework claims.
  • Achieved recovery in 2022.

Summaries

  • Achieved results within method.
  • Achieved consistent results in closing complex claims.
  • Strong conflict resolution and negotiation skills, as well as excellent reporting and research abilities.
  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Solid skills in formulating goals and strategies for resolving program claims.
  • Achieved significant results in reducing settlement times by 18%.
  • Claims Adjuster with a passion for helping others and a knack for coming up with novel solutions to problems.
  • Achieved a 19% reduction in unresolved cases.
  • Achieved a 41% decrease in claim resolution times.
  • Clear understanding of data analysis and strategic planning as well as client relations training.

Accomplishments

  • Performed quarterly financial reconciliations of claims reserves, identifying cost-saving opportunities and minimizing unnecessary capital expenditures.
  • Successfully managed sensitive workers’ compensation appeals and ensured all legal deadlines were met, resulting in 79% resolution favorability.
  • Facilitated communication between claimants, employers, and healthcare providers, securing timely medical treatment and adherence to return-to-work schedules.
  • Monitored settlement negotiations and collaborated with claims adjusters, securing settlements below allocated reserve amounts, saving the company $3.
  • Trained and mentored new Claims Assistants on core operational procedures, ensuring the team maintained a consistent policy adherence and workflow efficiency.
  • Collaborated with team of 16 in the development of method.
  • Authored detailed denial letters for unsubstantiated claims, ensuring clarity in communication and reducing further litigation risks.
  • Developed onboarding materials for new hires, ensuring all claims assistants were well-versed in both legal compliance and best practices for managing claims.
  • Reviewed and processed claims within 13 days of submission, maintaining compliance with state and federal Workers’ Compensation laws and reducing administrative backlogs.
  • Regularly audited closed workers' compensation claims to ensure compliance, identifying discrepancies and reducing potential legal penalties by $17.

Affiliations

  • Workers’ Compensation Section of the American Bar Association (ABA)
  • Rotary International
  • Healthcare Financial Management Association (HFMA)
  • Association for Supply Chain Management (APICS)
  • Insurance Information Institute (III)
  • International Association of Insurance Professionals (IAIP)
  • National Council on Compensation Insurance (NCCI)
  • National Association of Health Underwriters (NAHU)
  • Jaycees
  • International Association of Administrative Professionals

Certifications

  • First Aid/CPR Certified
  • Associate in Claims (AIC) – 2021
  • General Insurance Certificate (INS) - 2024
  • Health and Life Insurance License - Illinois
  • Certified Disability Management Specialist (CDMS) - 2022
  • Certified Litigation Management Professional (CLMP) - Cedar Works
  • Certified Case Management (CCM) - 2017
  • Workers' Compensation Professional (WCP) - Meridian
  • Certified Workers' Compensation Adjuster (CWCA) - 2019
  • Salesforce

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