Juan Santiago

Accomplishments:

• Achieved 3rd ranking in the department of 35 plus individuals in key performance metrics 2022.

• Improved to 2nd ranking overall 35 plus individuals in key performance metrics in 2023.

Tasks Performed

• Administer and resolve claims with high diligence in a timely manner in accordance with legal statutes, policy provisions, and company guidelines.

• Analysis of billing notes along reported injuries and facts of loss to manage the file appropriately medically.

• Accurately maintains an up-to-date diary / schedule for each claim in case inventory.

• Interacts and communicates effectively with customers, peers, and vendors.

• Efficiently manages high volumes of first party medical claims.

• Proficient in CPT and procedure code knowledge, ensuring accurate claim assessment.

• Coordinates medical treatment updates with attorneys and healthcare providers.

• Reduced fraudulent claim payouts by diligently identifying potential fraud indicators and collaborating with the Special Investigation Unit.
• Increased customer satisfaction with timely and accurate claim settlements, adhering to company guidelines and state regulations.
• Collaborated with legal counsel for effective litigation management, resulting in favorable outcomes for the company.

• Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
• Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
• Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
• Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.

• Developed strong working relationships with clients, adjusters, and other stakeholders in the claims process by maintaining open lines of communication and providing consistent updates on claim status.
• Achieved positive results under pressure by successfully managing large workloads during peak seasons without sacrificing quality or attention to detail.
• Actively contributed ideas during team meetings aimed at enhancing overall department efficiency and effectiveness.
• Performed initial set-up and continuously managed claims in the Atlas and Kana databases.
• Managed and resolved claims at the customer service representative level.
• Determined whether an auto loss is covered and appropriate compensation.