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Skills

  • Operational improvement
  • Cross-departmental collaboration
  • Category equipment
  • Internal Audits of Claims and Discrepancy Resolution
  • Benefit Disbursement Optimization
  • Business operations
  • Customer service excellence
  • Claim Processing Automation Implementation
  • Conflict resolution and mediation
  • MS Office

Work Experiences

  • Broadened coverage options.
  • Avoided 14 regulatory penalties.
  • Collaborated with finance to set annual reserves targets based on in-depth claims forecasting, reducing over-reserving by $15.
  • Accurately assessed risk.
  • Championed an injured worker advocacy program.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Accomplished this over 14 years.
  • Looked for industry trends on social media and through online sources.
  • Achieved PMP compliance award.
  • Was in charge of a variety of benefit programs, including 401K, medical, dental, and vision coverage.

Summaries

  • Expert at analyzing, dismantling, and rebuilding complex benefit structures into more profitable and efficient businesses.
  • Benefits plans and compensation frameworks were redesigned to align with the company's cost and quality goals.
  • Client-focused professional who consistently resolves escalated claims at a 71% resolution rate within the past year, ensuring high client satisfaction.
  • Interested in applying my field expertise and sound judgment to a challenging role with Meridian.
  • Achieved cost savings of $16.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.
  • Achieved results over 18 years.
  • Achieved a 50% reduction in costly disputes.
  • Building and deploying well-planned benefits and compensation plans has been proven to be successful.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.

Accomplishments

  • Effectively managed post-injury case coordination with third-party vendors and legal teams, maintaining a 23% closure rate for high-exposure cases.
  • Resolved product issue through consumer testing.
  • Implemented advanced fraud detection protocols, identifying high-risk claims and reducing fraudulent payouts by 25%.
  • Collaborated with external medical providers to develop a streamlined medical review process, producing a 57% decrease in medical expenses.
  • Maintained compliance with regional and national workers’ compensation regulations, minimizing audit findings to zero over three years.
  • Developed performance metrics for claims processing, resulting in a 74% improvement in meeting service level agreements (SLAs).
  • Engaged in negotiations with third-party administrators (TPAs) to expedite claims settlements, achieving a 61% faster turnaround.
  • Collaborated with HR and medical professionals to assess cases and reduce workers’ compensation reserve estimates by 73%.
  • Partnered with external legal teams and vendors to negotiate a 34% reduction in open litigation cases related to workers' compensation claims.
  • Reduced litigation-related workers' comp expenses by $246,000 annually by implementing proactive risk assessment strategies.

Affiliations

  • Contributor, National Workers' Compensation Defense Network (NWCDN) Journal
  • Society of Human Resource Management
  • International Council of Nurses
  • Member, National Workers' Compensation and Disability Conference
  • Participant, Association for Workers' Injuries Appreciation Awards
  • Active Member, Society for Human Resource Management (SHRM)
  • American Marketing Association
  • Committee Chair, Workplace Injury Risk Management Forum 2021
  • Affiliate, Workers' Compensation Fraud Task Force
  • Member, Public Agency Risk Management Association (PARMA)

Certifications

  • Certified Business Analysis Professional (CBAP)
  • CPR and First Aid Certification from Lakeside Partners
  • Certified in Healthcare Compliance (CHC)
  • Workers' Compensation Claims Law Specialist (WCLS)
  • Certified Return to Work Coordinator (RW-C™) from IARP
  • Project Management Professional (PMP)
  • Workers' Compensation Claims Audit Certification from Cedar Works
  • Chartered Property Casualty Underwriter (CPCU) - Workers' Compensation Track
  • Power BI & Data Analytics Certification for Claims Processing
  • Advanced Workers' Compensation Strategy Certification from ReedGroup

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