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Skills

  • Cross-functional team collaboration
  • CCC Pathways
  • Magnify Predictive Targeting System
  • ClaimsPro
  • Financial analysis related to claims
  • Accident scene investigations
  • Adjuster coordination
  • Legal proceedings knowledge
  • Customer dispute resolution
  • Report writing and documentation

Work Experiences

  • Achieved $6 cost savings.
  • Testified on behalf of agency as part of criminal and civic proceedings.
  • Analyzed claim trends and financial implications.
  • Investigated and analyzed insurance claims that appeared to be suspicious or potentially fraudulent.
  • Analyzed documentation.
  • Achieved cost reductions of 40%.
  • Worked with the claims department and industry anti-fraud organizations to resolve claims.
  • Analyzed historical claims data to identify trends and adjust assessment strategies, reducing claim processing time by 23% on average.
  • Accurately assessed high-risk property damage claims.
  • Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.

Summaries

  • Claims Adjuster with a passion for helping others and a knack for coming up with novel solutions to problems.
  • Recognized on a regular basis for outstanding performance and contributions to the Real Estate industry's success.
  • Achieved a 56% claim resolution rate.
  • Achieved a 22% reduction in error rates.
  • Excellent communication skills as evidenced by 4 years of experience interviewing experts, witnesses, and claimants in order to compile data.
  • Criminal investigation, insurance fraud, and surveillance are all part of his background.
  • Adept at mitigating litigation risks.
  • Achieved a 29% increase in departmental efficiency.
  • Collaborated closely with adjusters and medical professionals.
  • Achieved resolution rates of 20%.

Accomplishments

  • Audited 10 claims and uncovered 20% more instances of potential fraud than the previous year.
  • Recovered over $16 in fraudulent claims through comprehensive analysis and cross-referencing of claims data using new fraud detection software.
  • Utilized Tableau to streamline fraud detection, decreasing fraudulent claims by 40%.
  • Collaborated with team of 16 in the development of framework.
  • Optimized workflow by introducing remote claims handling tools, reducing manual processing time by 15%.
  • Assisted in developing a comprehensive claims-handling training program which decreased onboarding time for new employees by 33% days.
  • Implemented a paperless claims review process that improved accuracy by 42% and reduced processing time by three years.
  • Tracked and managed appeal processes for denied claims, with a 50% success rate in reversing previously denied payouts.
  • Used claims management software to track and prioritize caseloads, leading to a 40% reduction in claims backlog within one year.
  • Resolved high-risk bodily injury claims totaling $11, significantly reducing loss ratio by 80% within several months.

Affiliations

  • National Association of Insurance Commissioners (NAIC)
  • Insurance Regulatory Examiners Society (IRES)
  • International Federation of Health Plans (IFHP)
  • Society of Women Engineers
  • Workers' Compensation Claim Professionals (WCCP) Association
  • Jaycees
  • Society of Insurance Research (SIR)
  • Global Association of Risk Professionals (GARP)
  • International Council of Nurses
  • Rotary International

Certifications

  • Certified Claims Professional (CCP) - Ironclad Systems
  • Life and Health Insurance License Washington
  • Medical Coding Specialist Certification (CPC) - Meridian
  • Health Care Anti-Fraud Associate (HCAFA) – Lakeside Partners
  • Certified Business Analysis Professional (CBAP)
  • Associate in Insurance Data Analytics (AIDA) - Lakeside Partners
  • Certified in General Insurance (Cert CII) - Vantage
  • Licensed Public Insurance Adjuster - method
  • Certified Legal Nurse Consultant (CLNC) - Harbor & Co.
  • Certificate of Insurance Billing and Coding - Northwind

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