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Skills

  • Handling of high-risk, complex claims
  • Client and stakeholder relationship building
  • Data tracking and trend analysis
  • Multistate workers’ compensation experience
  • Vendor relationship management
  • Claims audit and analysis
  • Claims process streamlining
  • Advanced knowledge of insurance underwriting processes
  • Adaptive problem-solving in high-stress situations
  • Process equipment

Work Experiences

  • Achieved a 73% decrease in litigation-related claims expenses.
  • Assessed workers' compensation cases and successfully negotiated settlements, saving the company $16 in the first 2018 of initiating new strategies.
  • Audited claim histories.
  • Achieved 42% reduction in file reopenings.
  • Analyzed the data gathered during the investigation and wrote a report with my findings and recommendations.
  • Adjudicated over 10 claims per week.
  • Assessed workers' compensation cases.
  • Achieved consistent savings.
  • Audited policy renewals.
  • Oversaw claim negotiations within a $9 budget and assisted in successful litigation for complex issues.

Summaries

  • Excellent communication skills as evidenced by 12 years of experience interviewing experts, witnesses, and claimants in order to compile data.
  • Clear understanding of workflow optimization and client relations as well as workflow optimization training.
  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Accomplished within one year.
  • Review documentation and assess properties efficiently to determine damage levels, complete cost estimates, and maintain liability control.
  • Adept at regulatory compliance.
  • Achieved Innovation Award for initiative compliance excellence.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.
  • Proven track record of using excellent negotiating skills to speed up settlements.
  • Adept at managing complex cases involving third-party contractors and investigators, often cutting service provider costs by 29%.

Accomplishments

  • Introduced early intervention strategies for injured employees, facilitating faster return-to-work timelines and reducing lost time benefits by 63% hours on average.
  • Assisted in the development and execution of a new claims review protocol that directly reduced open claims duration by an average of 11 days.
  • Conducted detailed reviews of high-value claims, including thorough medical record analysis, leading to denial of improper claims and saving $9 in 2022.
  • Reduced claim closure time from 13 days to 4 through hands-on case management and constant follow-up with involved stakeholders.
  • Documented and resolved procedure which led to metric.
  • Partnered with human resources to improve injury incident reporting procedures, decreasing delays in workers’ compensation claim submissions by 22%.
  • Assisted in developing company guidelines for managing permanent disability claims, which resulted in consistent and fair outcomes for all employees.
  • Tracked departmental key performance indicators, identifying areas for improvement that decreased the overall duration of claims settlement by 49%.
  • Partnered with legal counsel to successfully challenge 6 fraudulent claims, saving a total of $10 in financial liabilities.
  • Worked closely with occupational health professionals to maintain accurate records, reducing erroneous benefit payments by 26% annually.

Affiliations

  • Accredited, National Academy of Social Insurance (2016)
  • Lions Club
  • Certified Professional, Institute of WorkComp Professionals (IWCP)
  • Active participant, Workers’ Compensation Claims Professional Network
  • Affiliate, Occupational Health and Safety Section, American Public Health Association (APHA)
  • Membership, The American Staffing Association (related to workers' compensation compliance)
  • Professional education, National Alliance for Insurance Education & Research (2018)
  • Toastmasters
  • Professional member, National Association of Subrogation Professionals (NASP)
  • National Association of Social Workers

Certifications

  • Workers' Compensation Law Certification
  • Certified Workers' Compensation Professional (CWCP)
  • First Aid/CPR Certified
  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Return to Work Coordinator
  • ServSafe
  • Certified Business Analysis Professional (CBAP)
  • Certified Occupational Health Nurse Specialist (COHN-S)
  • Workers' Compensation Claims Administration Certification
  • Certified Public Accountant (CPA)

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