Portia McBride
Rockwall
Summary
Analytical Insurance Claims Investigator recognized for exceptional productivity and efficient task execution. Expertise in fraud detection, claim analysis, and regulatory compliance, leading to thorough investigations and precise reporting. Strong communication, problem-solving, and negotiation skills drive effective resolutions that safeguard company interests. Dedication to confidentiality and integrity in all professional interactions.
Overview
16
16
years of professional experience
Work History
Insurance Claims Investigator
State Farm Insurance
Richardson
01.2016 - Current
- Delivered training programs for new investigators on effective investigation techniques.
- Conducted interviews with claimants and witnesses to gather information.
- Analyzed data trends to identify potential fraud patterns.
- Prepared detailed reports summarizing investigation findings.
- Maintained knowledge of current industry trends including changes in state statutes that may affect the handling of claims.
- Provided expert witness testimony in support of cases involving fraudulent claims or suspected fraud.
- Researched legal precedents for use in determining liability issues related to complex claims.
- Provided technical guidance and assistance to junior staff members when needed.
- Analyzed medical records and documents for accuracy and completeness.
- Prepared detailed investigative reports summarizing findings, conclusions and recommendations.
- Advised management on strategies for mitigating risk associated with fraudulent activity.
- Interviewed claimants, witnesses, medical personnel and other involved parties to obtain additional evidence or clarification of facts.
- Completed required investigations on referred files within established timeframes.
- Maintained thorough understanding of fraudulent and illegal practices.
- Consulted accountants, engineers, lawyers and physicians when needed.
Call Center Director
Orion Global Communications
Dallas
04.2014 - 06.2016
- Achieved a 7% increase in first-contact conflict resolution rates through effective attribute routing.
- Formulated compliance policies and procedures consistent with industry standards.
- Standardized incoming call responses by developing comprehensive agent scripts.
- Implemented tracking systems for customer feedback to enhance service quality.
- Monitored adherence to laws regarding privacy protection, consumer rights, and workplace safety.
- Elevated customer service delivery by implementing targeted call center strategies.
- Facilitated hiring processes by conducting onboarding training sessions and creating job descriptions.
- Analyzed current practices to pinpoint improvement opportunities within the call center environment.
Assistant Call Center Manager
Teleperformance
Shreveport
01.2010 - 03.2014
- Oversaw operations for 500-seat contact center, driving results for 18-22 inbound/outbound campaigns.
- Achieved exceeding performance metrics consistently by balancing business needs with operational goals.
- Facilitated transition of teams beyond traditional call center roles through advanced customer care integration.
- Provided leadership development for Team Leaders and agents, fostering a supportive growth environment.
- Elevated second lowest performing teams to top rankings in 90 days through targeted improvements.
- Lowered employee turnover from 65% to 25% by enhancing leadership structure and workplace stability.
- Established clear performance management system and rewards to improve attendance and service quality.
- Clarified expectations, managed poor performers, and incentivized high achievers to maximize operational effectiveness.
Education
MBA - Business Administration
University of Phoenix
Irving, TX10-2010
Skills
- Lean and Six Sigma practices
- Operational turnaround management
- Performance enhancement
- Leadership training and development
- Communication effectiveness
- Conflict resolution strategies
- Strong analytical capabilities
- Compliance with regulations
- Investigative interviewing skills
- Proficiency in Microsoft Office Suite
- Documentation and reporting in legal contexts
- Collaboration within teams
- Expertise in legal proceedings
- Fraud investigation
References
References available upon request.
Timeline
Insurance Claims Investigator
State Farm Insurance
01.2016 - Current
Call Center Director
Orion Global Communications
04.2014 - 06.2016
Assistant Call Center Manager
Teleperformance
01.2010 - 03.2014
MBA - Business Administration
University of Phoenix