Caterina Christian
Alexandria,VA
Summary
A seasoned Claim Processing Specialist with a proven track record at ACME Technology, I excel in claims analysis and fostering team collaboration. My expertise in optimizing claims processing systems and enhancing customer satisfaction by 30% showcases my ability to merge technical skills with exceptional service.
Personable and analytical, equipped with strong foundation in data management and customer service. Possesses solid understanding of claims processing procedures and essential hard skills of data entry and documentation review. Capable of ensuring accurate and efficient claim resolutions to enhance organizational efficiency.
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Consummate Claims Associate knowledgeable in insurance coverage, policy terms and conditions. Facilitates claims processing by cultivating productive relationships with stakeholders. Blends analytical and administrative acumen throughout investigations and recommendations.
Overview
8
8
years of professional experience
Work History
Claim Processing Specialist
ACME Technology
03.2022 - 01.2025
- Developed comprehensive reporting systems to track key performance indicators for the claims department.
- Conducted regular audits of processed claims to maintain a high level of accuracy and compliance with industry standards.
- Maintained detailed records for all processed claims, facilitating easy retrieval for future reference or analysis.
- Improved customer satisfaction by efficiently addressing inquiries and resolving disputes.
- Expedited urgent claims, ensuring swift processing and payment to clients during critical situations.
- Streamlined communication between departments, ensuring timely resolution of complex claims.
- Ensured rigorous adherence to privacy regulations when handling sensitive client information during claim reviews.
- Mentored junior claim processing specialists, sharing valuable expertise and guidance on career growth within the industry.
- Coordinated cross-functional efforts between various departments during large-scale claim investigations.
- Reduced claim errors by providing thorough training for team members on policy changes and regulations.
- Enhanced claim processing efficiency by implementing new software and optimizing workflows.
- Provided exceptional support to underwriting teams by carefully reviewing policy applications for adherence to approval guidelines.
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures.
- Evaluated and settled complex insurance claims in strict timeframes.
- Followed up with customers on unresolved issues.
- Checked documentation for accuracy and validity on updated systems.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Generated, posted and attached information to claim files.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Prepared insurance claim forms or related documents and reviewed for completeness.
- Identified fraudulent activities through meticulous review of claim submissions, saving company resources from potential losses.
- Assisted colleagues with complex cases, sharing expertise and knowledge to achieve favorable outcomes for clients and the company.
- Implemented effective time management strategies within the team, allowing a higher volume of processed claims without sacrificing quality.
- Stayed current on industry trends and regulatory changes, informing team members about relevant updates that could impact their work processes.
- Contributed to the development of user-friendly online claim submission tools, simplifying procedures for clients while increasing data accuracy.
Claims Examiner Representative
Acaas-systems
11.2016 - 08.2020
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Interpreted policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
- Researched claims and incident information to deliver solutions and resolve problems.
- Finalized files for insurance claim payment release.
- Collected information from customers to complete claims and legal files.
- Determined liability outlined in coverage and assessed documentation such from police and healthcare providers to understand damages incurred.
- Identified suspicious losses and contacted manager for investigative assistance.
- Visited customer locations to evaluate damage and provided cost estimates for remediation.
- Testified on behalf of agency as part of criminal and civic proceedings.
- Followed up on potentially fraudulent claims initiated by claims representatives.
- Prepared documents for managers or legal personnel.
- Clarified coverage of losses to policyholders and provided assistance in itemizing damages and finding alternative living arrangements.
- Handled calls from customers and other stakeholders about processes.
- Investigated and assessed damage to property and reviewed property damage estimates.
- Directed and coordinated various investigations conducted by field investigation team.
- Increased customer satisfaction by addressing and resolving complaints in a timely manner.
- Provided exceptional customer service by empathetically addressing claimants'' concerns and effectively explaining the claims process to them.
- Improved overall efficiency within the department by streamlining processes and eliminating redundancies where possible.
- Identified opportunities for subrogation recovery through careful analysis of third-party liability cases, facilitating successful recoveries from at-fault parties or their insurers.
- Interviewed claimants and witnesses to gather factual information.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Followed up with insured individuals regarding premium and deductibles payments.
- Verified accuracy of records to maintain accuracy of records database.
- Assisted homeowners by coordinating vendor services, emergency repair, cleaning and contractors.
- Directed claims negotiations within allowable limit and supported successful litigations for advanced issues.
- Communicated with clients and customers to gather, provide and share updated information on products and services.
- Collaborated with team members to achieve monthly sales targets.
- Finalized files for insurance claim payment release.
- Negotiated settlements with claimants'' attorneys when needed, achieving favorable outcomes for both parties while minimizing costs.
- Conducted thorough investigations of complex claims, gathering relevant documentation and interviewing witnesses when necessary.
- Consulted police and hospital records when needed.
- Achieved streamlined communication between departments by collaborating closely with underwriters, agents, and other stakeholders throughout the claims handling process.
- Served as a mentor to junior examiners, sharing expertise and providing guidance on best practices within the field of claims examination.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
Education
Master of Arts - Billing And Coding Specialist
Moreno Valley College
Moreno Valley, CA10-2024
Bachelor of Arts - Business Management
Central University College
09-2011
Skills
- Claims processing software
- Claims analysis
- Policy interpretation
- Insurance regulations
- Confidentiality
- Claims investigation
- Teamwork
- Teamwork and collaboration
- Customer service
- Problem-solving
- Time management
- Attention to detail
- Problem-solving abilities
- Multitasking
- Multitasking Abilities
- Organizing and prioritizing work
- Reliability
- Excellent communication
- Critical thinking
- Organizational skills
- Team collaboration
- Effective communication
- Adaptability and flexibility
- Active listening
- Verbal and written communication
- Claims processing
- Microsoft office
- Computer proficiency
- Documentation skills
- Team building
- Data entry
- Claims adjustment
- Reporting skills
- Task prioritization
- Self motivation
Timeline
Claim Processing Specialist
ACME Technology
03.2022 - 01.2025
Claims Examiner Representative
Acaas-systems
11.2016 - 08.2020
Master of Arts - Billing And Coding Specialist
Moreno Valley College
Bachelor of Arts - Business Management
Central University College
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