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Skills

  • Analytics-based decision making
  • Insurance policy coverage knowledge
  • Fraud detection system utilization
  • Vendor relationship management
  • CCC EZNet
  • Automobile claims specialist
  • Personal, casualty and property loss
  • Claims Dispute Resolution
  • Accident scene investigations
  • BCCORP W5 for Adjusters

Work Experiences

  • Analyzed large sets of clinical and legal data.
  • Looked into legal issues surrounding initiative claims.
  • Achieved results within 18 months.
  • Looked at the data to see what the underlying principles were.
  • Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
  • Calculated the quantifiable features of category products.
  • Handled procedure calls about program processes from customers and other stakeholders.
  • Assisted in rolling out a claims tracking system upgrade that increased transparency and reporting efficiency for stakeholders.
  • Conducted in-depth interviews with witnesses and claimants to gather facts and information.
  • Investigated and analyzed insurance claims that appeared to be suspicious or potentially fraudulent.

Summaries

  • Claims Service Analyst with 6 years of experience.
  • Detailed Adjuster with 3 years of corporate insurance claims experience.
  • Achieved high audit scores.
  • Analytical Claims Service Analyst with robust problem-solving abilities, successfully implementing a digital review system that enhanced claims processing by 58% while minimizing manual errors.
  • Achieved a 51% increase in client satisfaction.
  • Strong understanding of claimant intake processes, record documentation, and fraud investigation protocols.
  • Claims Service Analyst with 5 years of experience in managing claims portfolios, optimizing client satisfaction by 78% through proactive communication and dispute resolution.
  • Collaborated with legal counsel and external providers.
  • Claims Adjuster with a passion for helping others and a knack for coming up with novel solutions to problems.
  • Dedicated to learning, growing, and succeeding in Shipping and Distribution.

Accomplishments

  • Compiled quarterly sector-specific risk analyses, directly contributing to updating internal guidelines for high-risk claims investigations.
  • Standardized risk assessment protocols that decreased high-liability claims by 18%, while ensuring full adherence to legal frameworks.
  • Drafted and presented monthly claims performance reports using Power BI, providing senior management with accurate KPIs that led to procedural improvements.
  • Part of the team awarded Top Performer in 2017 for implementing best-in-class service protocols, leading to a 29% boost in customer retention.
  • Spearheaded integration of AI-driven claims analysis, reducing processing time by 56% and enhancing accuracy by 58%.
  • Resolved product issue through consumer testing.
  • Analyzed claim trends to forecast future liabilities, contributing to a 51% reduction in potential risks over one year.
  • Restructured post-claim support processes, increasing customer satisfaction by 39% based on customer survey data.
  • Minimized processing delays by introducing standardized communication templates for customer service reps, cutting resolution time by 7 days.
  • Collaborated with actuarial teams on risk assessments, improving claims handling protocols and optimizing premium rates by 22%.

Affiliations

  • International Federation of Adjusting Associations (IFAA)
  • American Bar Association Section of Dispute Resolution
  • Legal Marketing Association (LMA)
  • Rotary International
  • National Association of Social Workers
  • Freemason
  • Lions Club
  • Toastmasters
  • Society for Healthcare Risk Management (ASHRM)
  • Society of Risk Management Consultants (SRMC)

Certifications

  • Cisco Certified Internetwork Expert (CCIE)
  • Certified Subrogation Recovery Professional (CSRP)
  • ISO 31000 Risk Management Certification
  • Loss Adjusting Insurance Certification
  • Fellow, Life Management Institute (FLMI)
  • Certified Claims Professional (CCP) - 2016
  • Certified Insurance Services Representative (CISR)
  • Certificate in Healthcare Claims Management
  • Certified Risk Management Professional (CRMP) - 2020
  • Senior Professional in Insurance Regulation (SPIR)

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