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Skills

  • Confidential documentation handling
  • Hail and wind damage specialist
  • Accident scene investigations
  • CCC Pathways Appraisal Quality Solution
  • Database management for claims tracking
  • MS Office proficiency (system)
  • Valuation knowledge
  • Microsoft Word
  • Automated Work Distributor (AWD)
  • Magnify Predictive Targeting System

Work Experiences

  • Achieved favorable outcomes in 70% of contested cases.
  • Worked with the claims department and industry anti-fraud organizations to resolve claims.
  • Achieved savings of $18 through accurate benefit allocation.
  • Followed up with insured people who had not paid their premiums or deductibles.
  • Reconciled data in the direct collection system with the accounting system to address discrepancies.
  • Ensured that all filed hazard and special hazard claims were properly managed.
  • Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
  • Achieved results in 2019.
  • Achieved a 62% error reduction in claims processing.
  • Analyzed the data gathered during the investigation and wrote a report with my findings and recommendations.

Summaries

  • 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.
  • Strong understanding of claimant intake processes, record documentation, and fraud investigation protocols.
  • Adept at managing multi-disciplinary teams.
  • Reliable and trustworthy.
  • Negotiates fair and thorough resolutions to all claims in a peaceful manner.
  • Strengths in cross-functional collaboration and process improvement backed up by Miscellaneous training.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.
  • Proven track record of using excellent negotiating skills to speed up settlements.
  • Achieved a 82% decrease in average claim resolution time.

Accomplishments

  • Participated in quarterly claims review meetings, providing insights that improved claimant communication and reduced ongoing disputes by 72%.
  • Implemented a pre-injury risk management program, leading to a 77% reduction in workers’ compensation claims and improving workplace safety measures.
  • Awarded Scrum Master for maintaining the highest claims processing accuracy rate of 83% over several months.
  • Authored detailed denial letters for unsubstantiated claims, ensuring clarity in communication and reducing further litigation risks.
  • Documented and resolved metric which led to initiative.
  • Reduced litigation costs by 65% by drafting comprehensive claim summaries and obtaining favorable medical expert opinions.
  • Tracked and reported claims status using QuickBooks, ensuring compliance with key legal benchmarks such as deadlines for accepting or denying claims.
  • Managed a caseload of 11 workers' compensation files, ensuring accurate claim processing and expedient settlements without delays in worker benefits.
  • Regularly audited closed workers' compensation claims to ensure compliance, identifying discrepancies and reducing potential legal penalties by $17.
  • Collaborated closely with the medical community to obtain required documentation, ensuring timely claim adjudication and minimizing delays in compensation.

Affiliations

  • American Medical Informatics Association
  • National Council of Self-insurance (NCSI)
  • International Association of Insurance Professionals (IAIP)
  • National Association of Subrogation Professionals (NASP)
  • Association for Computing Machinery
  • National Federation of Paralegal Associations (NFPA)
  • Insurance Accounting & Systems Association (IASA)
  • Rotary International
  • Society of Workers' Compensation Claims Professionals (SWCCP)
  • Public Risk Management Association (PRIMA)

Certifications

  • OSHA 30-Hour General Industry Certification - 2016
  • Salesforce
  • Project Management Professional (PMP)
  • Diversity and Inclusion in the Workplace Training Certificate - 2018
  • Certified Business Analysis Professional (CBAP)
  • SHRM Certified Professional (SHRM-CP)
  • AICPA Professional Ethics for CPAs – 2015
  • Business Writing and Communication Certificate - procedure
  • Cisco Certified Network Associate (CCNA)
  • CompTIA Network+

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