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Skills

  • Attention to detail
  • Business operations
  • Compliance with OSHA and other regulations
  • Legal Compliance in Claim Processing
  • Procedure equipment
  • Team building
  • Ability to archive files
  • Negotiation and Conflict Resolution
  • Customer service and retention
  • Change Management and Process Improvement

Work Experiences

  • Assessed and implemented corrective actions for non-compliant claims processing, increasing overall compliance by 15%.
  • Achieved a 73% decrease in on-site accidents.
  • Consistently met budgetary parameters.
  • Boosted resource allocation accuracy by 79%.
  • Achieved audit success rates above 60% %.
  • Collaborated with 13 attorneys and medical professionals.
  • Communicated with clients, distributed mail, and scanned documents as part of my administrative duties.
  • Had an excellent attendance record and was always on time for work.
  • Answered phone calls from clients, vendors, and a variety of other callers looking for information.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.

Summaries

  • Knowledge of insurance guidelines and regulations for system and method.
  • Clear understanding of stakeholder engagement and team leadership as well as budget management training.
  • Costs were consistently reduced while profits were increased.
  • Achieved a 42% reduction in claims resolution time.
  • Achieved audit success of over 46%.
  • Within Miscellaneous, senior Workers' Compensation Claims Specialist and outstanding performer in process improvement and cross-functional collaboration.
  • 16 wpm typing speed with 8% accuracy and Power BI knowledge.
  • Achieved a 29% increase in task completion accuracy.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Over 9 years of experience obtaining information from policyholders and assisting with claim forms as an honest Insurance Clerk.

Accomplishments

  • Provided expert customer service for complex claims, increasing client retention by 35% over 2022.
  • Reduced claims dispute disputes by 33% by fostering clear communication with claimants and healthcare providers.
  • Collaborated with third-party medical providers to expedite claims processing, yielding an average saving of $92,000 per claim.
  • Utilized in-depth knowledge of insurance terminology to expedite complex claims approval process by 80%.
  • Collaborated with vocational rehabilitation experts to reduce the average duration of long-term disability claims by 28%.
  • Monitored and analyzed claims trends, providing actionable insights that led to a 59% reduction in fraudulent claims.
  • Conducted root cause analysis for non-compliant claims, implementing corrective measures that raised compliance rates by 31% within 5 months.
  • Drove continuous improvement initiatives that resulted in a 61% reduction in errors in claim documentation over 7 quarters.
  • Successfully executed subrogation cases, generating recovery of $123,000 of claims in collaboration with third-party vendors.
  • Analyzed complex medical and legal documents to accurately verify claims, preventing incorrect payouts and saving the company $64,000 annually.

Affiliations

  • International Association of Administrative Professionals
  • American Medical Informatics Association
  • Member of the Compensation & Benefits Labor Law Group with Northwind
  • Board Member of the Workers' Compensation Claims Professionals Group in Raleigh
  • Regular speaker at the National Council of Insurance Legislators (NCOIL) conference 2015
  • Regular attendee of the Annual Workers' Compensation Institute Conference in 2022
  • Jaycees
  • Toastmasters
  • Certified Workers’ Compensation Professional (CWCP) since 2020
  • Society of Human Resource Management

Certifications

  • Certified Public Accountant
  • Society for Human Resource Management - Certified Professional (SHRM-CP)
  • Certified Professional in Workers' Compensation (CPWC)
  • Associate in Claims Litigation Management (ACLM)
  • SHRM Senior Certified Professional (SHRM-SCP)
  • CompTIA Security+
  • Certified Claims Professional (CCP) – specializing in Workers’ Compensation
  • Certified Professional in Disability Management (CPDM)
  • National Institute for Workers' Compensation Management (NIWCM) Certification
  • Insurance Information Institute Workers' Compensation Training Certification

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