Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
Home: (555) 432-1000
Cell:
resumesample@example.com
Career Focus
A professional with the strong knowledge of insurance and project management, seeking a position an organization where I can utilize my skills and knowledge and become an asset to the organization.
Summary of Skills
Process development
Conflict resolution
Complex problem resolution
MBA
Effective communication and team building skills,
Project management
Strategic planning
Professional Experience
Hazard Claims Analyst, 05/2009 to 08/2013 Leidos Holdings Inc. – Brooklyn, NY,
Mitigate losses and reduce investor risk by ensuring that Hazard Claims department is operating at top efficiency.
Verifying all loan products are handled professionally and appropriately.
High Level research and resolution of claims issues referred from other departments and outside sources.
Audit of claim/loan history for completeness or inaccuracies.
Ensure compliance with all company guidelines, through personal leadership and setting the example, with hands on management.
Assure proactive customer service for both external and internal customers that meets and/or exceeds established goals with accountability for results and responsibility for appropriate resolution.
Direct and manage all claims handling activities in regard to Attorney Represented Claims, and those that are Non-Attorney Represented and assigned to this departments operation, to assure prompt and appropriate resolution.
Mentor and train Team Members in an effort to drive excellence.
Collaborate with other departments to drive and deliver overall company success.
Attend management meetings and facilitate monthly reporting to senior management.
Lead out as a member of the Claims Management Team, in all areas of performance and providing contributions.
Provide proactive direction in the area of Compliance through tracking and development of appropriate and timely responses to all requests for information and/or complaints, while being proactive in identification of areas for improvement.
Complete file re-inspections and audits as requested and needed.
Assist in review and creation of organization policies, workflows and insurance coverage.
Manage property claims recoveries and denials, including catastrophic claims.
Responsible for filling in for the Claims Manager in their absence.
Manage relationships with contracted vendors to ensure delivery of contracted services.
Negotiate and settle claims professionally and ensure claim funds are applied correctly to servicing system.
Ability to professionally interact and negotiate with attorneys, paralegals, insurance company claims examiners and adjusters effectively.
Mortgage Servicing Specialist, 01/2011 to 06/2011 StaffMark - Bank Of America – City, STATE,
Implement quality control measures.
Conduct in-depth root cause analyses of customer problems and issues.
Propose solutions.
Facilitate implementation.
Research complex issues that arise during the foreclosure process as requested.
Prepare loan file and documents for HAFA & HAMP government submission Handles routine level transactions in a timely and professional manner overseen by senior staff and management.
Training of others within this department to assure they are capable of completing job functions successfully.
Research and Review Analyst, 05/2005 to 2009 MHN – City, STATE,
Research and Review (Equivalent to Senior Claims Analyst), MHN, Irving, Tx Research/adjust all difficult, urgent & complex requests & claims for overpayment, underpayment, refunds, contract issues, and stop loss to ensure compliance with departmental and company policies and procedures.
Implement new processes and procedures when applicable.
Train all new staff to the department as well as any ongoing training needs for the department.
Process all adjustment issues, as they occur to comply with company service standards and to ensure achievement of company goals.
Determine level of reimbursement based on established criteria, contracts, plans, employer groups, coordinates special payment agreements with providers based on contract terms.
Maintain/update knowledge of all claims products, contracts and standard reference materials.
Develop/maintains effective business relationships with internal and external clients.
Ensure compliance with government regulations and requirements.
Review appeals and complaints as well as research any missing or required information.
Process all claims eligible/ineligible for payment accurately and conforming to quality, production standards and specification.
Matches authorizations to claims, maintains current desk procedural and reference materials.
Responds by telephone or in writing to providers, members, or other company departments to process and resolve the claim issue.
Perform special projects as assigned.
Claims Customer Service, 03/2014 to 06/2014 MHN – City, STATE,
Receive high volume of inbound calls from beneficiaries and providers.
Assist with any & all issues regarding claims, eligibility, authorization issues and etc.
Adhere to all department guidelines and policies.
Research & follow up on inquiries, handle complaints & requests with regards to each individual member's coverage and benefits.
Facilitate training sessions for new employees and assist others as necessary with the ongoing functions of the position.
Education
MBA: Business Administration, Expected in 2014 Texas Women's University - Denton, TX GPA:
3.9 GPA
Coursework in Project Management
Project Management Certificate: Project Management, Expected in 2013 Collin County Community College - Frisco, TX GPA:
BS: Organizational Leadership, Expected in 2012 Bethel University - Frisco, TX GPA:
Associate of Science: Health Information Management, Expected in 2010 Mountain View College - Dallas, TX GPA:
Professional Affiliations
Project Management Institute
National Association of Black Accountants
Golden Key Honor Society
Society for the Advancement of Management
Skills
Effective written and oral communication, Team Player, Computer Literate, Customer Focused
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