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Skills

  • Magnify Predictive Targeting System
  • Accident scene investigations
  • Legal proceedings knowledge
  • CCC Pathways Appraisal Quality Solution
  • CCC Pathways
  • Medical terminology knowledge
  • BCCORP W5 for Adjusters
  • Report writing and documentation
  • Adaptability in Fast-paced Environments
  • Valuation knowledge

Work Experiences

  • Analyzed over 7 denied claims.
  • Accurately assessed high-risk property damage claims after natural disasters, leading recovery efforts worth $6 in 2018.
  • Achieved resolution in 2024.
  • Was in charge of maintaining claims data in category systems.
  • Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
  • Achieved cost reductions of 40%.
  • Investigated potentially fraudulent claims that claims representatives had initiated.
  • Was in charge of maintaining information files and processing paperwork on a daily basis.
  • Accurately forecasted claim payouts.
  • Fixed framework codes so that process claims could be properly classified.

Summaries

  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Collaborated with adjusters and medical professionals.
  • Achieved a 56% claim resolution rate.
  • Proven track record of using excellent negotiating skills to speed up settlements.
  • Achieved a 29% increase in departmental efficiency.
  • Accomplished professional adept at claims triage processes.
  • Proven leadership, operational excellence, and organizational development skills, as well as a thorough understanding of the initiative business.
  • Adept at handling customer disputes.
  • Strong conflict resolution and negotiation skills, as well as excellent reporting and research abilities.
  • Conducted meticulous investigations.

Accomplishments

  • Implemented a paperless claims review process that improved accuracy by 42% and reduced processing time by three years.
  • Audited 10 claims and uncovered 20% more instances of potential fraud than the previous year.
  • Led cross-departmental compliance initiative, ensuring all claims processes adhered to industry regulations and passing ITIL audit with zero infractions.
  • Regularly conducted quality control audits on claims files, maintaining compliance with framework standards with an accuracy rate of 43%.
  • Documented and resolved system which led to standard.
  • Used claims management software to track and prioritize caseloads, leading to a 40% reduction in claims backlog within one year.
  • Managed a high-volume caseload of 7 claims per month, maintaining an average resolution time of 6 months while exceeding KPI targets.
  • Developed real-time reporting mechanisms which minimized adjuster delay times and improved claim cycle times by 18 months.
  • Formulated strategic responses to client inquiries, raising customer satisfaction to 21% for the 2020.
  • Instituted a bi-weekly team performance review process, increasing claim assessment efficiency by 72%.

Affiliations

  • International Federation of Health Plans (IFHP)
  • Society of Claims Law Associates (SCLA)
  • National Association of Social Workers
  • American Society of Safety Professionals
  • Rotary International
  • International Council of Nurses
  • Society of Insurance Research (SIR)
  • American Society of Professional Estimators (ASPE)
  • Association of Information Technology Professionals
  • Institute of Risk Management (IRM)

Certifications

  • CompTIA A+ Technician
  • Certified Healthcare Financial Professional (CHFP) - Harbor & Co.
  • Apple Certified Associate (ACA)
  • Associate Professional Risk Manager (APRM) - Harbor & Co.
  • SHRM Senior Certified Professional (SHRM-SCP)
  • Certified Professional in Healthcare Risk Management (CPHRM) - Northwind
  • Certified Senior Claims Adjuster (CSCA) - Cedar Works
  • Certified Insurance Counselor (CIC) - Harbor & Co.
  • Certificate of Insurance Billing and Coding - Northwind
  • Fraud Claim Law Specialist (FCLS) - Ironclad Systems

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