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Skills

  • Compliance with state and federal regulations
  • MS Office
  • Conflict resolution
  • Supervision
  • Attention to detail in complex claims reviews
  • Litigation cost reduction
  • Client relationship management
  • Team management
  • Strategic planning
  • Project organization

Work Experiences

  • Accelerated the claims appeals process, achieving a favorable resolution for 50% of appealed cases within three years.
  • Achieved quicker claim resolutions.
  • Achieved this in 2020.
  • Solved system issues, improved operations, and provided excellent customer service.
  • Made significant improvements to reporting processes, resulting in a 17% reduction in errors.
  • Authored and standardized claim reporting templates, cutting down administrative processing time by 52%.
  • Collaborated with risk management team on loss control strategies, significantly minimizing future risk exposure for the company.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Collaborated with medical professionals.
  • Contributed to the development of industry best practices.

Summaries

  • Achieved a 7 reduction of illegitimate payouts.
  • Diplomatic, articulate, and decisive, with the ability to establish and maintain productive working relationships with both internal and external stakeholders.
  • Adept at collaborating with insurance adjusters and legal professionals to ensure proper documentation, reducing claims delays by 48%.
  • Within Miscellaneous, senior Workers' Compensation Claims Representative and outstanding performer in workflow optimization and performance reporting.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • A skilled investigator, able to resolve claims quickly by interviewing witnesses and analyzing security footage to provide accurate assessments.
  • Costs were consistently reduced while profits were increased.
  • Proficient at onboarding, orienting, and training employees, as well as managing enrollments and resolving issues.
  • Interested in applying my field expertise and sound judgment to a challenging role with Beacon Labs.
  • Collaborated with legal partners.

Accomplishments

  • Collaborated with team of 17 in the development of category.
  • Reduced company exposure to fraudulent claims by initiating early fraud detection processes and training staff on identifying suspicious activities.
  • Drove a 61% increase in claims processing speed by refining the workflow between adjusters, attorneys, and third-party administrators.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Audited claimant records and medical documents, identifying billing inaccuracies that saved the company 16.
  • Resolved high complexity workers’ compensation claims efficiently while maintaining a customer satisfaction rate of 46%.
  • Collaborated with cross-functional teams to identify claim irregularities, leading to the detection of 6 fraudulent claims.
  • Improved claims processing accuracy by 16% by conducting regular team training on new state and federal guidelines.
  • Reduced caseload length by focusing on early intervention strategies and thorough initial investigations.
  • Provided key input for policy amendment that improved compliance with state regulations and reduced company liability by 29%.

Affiliations

  • National Association of Subrogation Professionals (NASP)
  • Association for Supply Chain Management (APICS)
  • Advisory Board for Phoenix Workers’ Compensation Forum
  • Toastmasters
  • State Workers' Compensation Self-Insurers Association
  • Risk & Insurance Management Society, Inc. (RIMS)
  • Society of Women Engineers
  • American Society of Safety Professionals
  • Member, Claims and Litigation Management Alliance (CLM)
  • American Board of Workers' Compensation Professionals (ABWCP) Certification

Certifications

  • Certified Business Analysis Professional (CBAP)
  • Certified Regulatory Compliance Professional (CRCP)
  • Medicare Set-Aside Certified Consultant (MSCC)
  • Subrogation Certified Recovery Professional (SCRP)
  • Salesforce
  • Chartered Property Casualty Underwriter (CPCU)
  • CompTIA A+ Technician
  • Certified Workers' Compensation Professional (CWCP)
  • Associate in Risk Management (ARM)
  • Project Management Professional (PMP)

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