Richa Sinha
Plano,United States
Summary
Claims professional with over 12 years of experience, well-versed in intricacies of claim management and resolution. Known for strategic approach to resolving disputes and ensuring compliance with industry standards. Reliable team collaborator with focus on achieving optimal outcomes and adapting to changing requirements. Skilled in negotiation and critical thinking.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Claim Specialist- SIU
State Farm Mutual Automobile Insurance Company
Richardson, TX
08.2018 - Current
- Lead and manage projects as an SIU Investigator, collaborating with Project Specialists to handle the entire project lifecycle, including evidence gathering, claim decisions, and progress updates.
- Coordinate multi-party investigations involving fraud identification and avoidance, utilizing industry-standard tools such as ISO Claim Search, Accurint, and Vehicle Sightings.
- Conduct detailed interviews with claimants, witnesses, and other stakeholders to collect critical information, ensuring accurate fraud identification and resolution.
- Manage and prioritize multiple complex claims, ensuring alignment with project timelines and efficient allocation of resources to meet project objectives.
- Oversee communication with internal teams, clients, and external stakeholders to provide regular project updates and resolve inquiries.
- Ensure compliance with state and federal fraud reporting requirements, making necessary referrals to NICB and Department of Insurance.
- Mentor and train new team members and colleagues on investigation protocols, claim handling procedures, and best practices in fraud prevention.
- Maintain high levels of organization and time management while managing multiple projects and claims simultaneously.
- Power User for Hercules Rep Desktop, training team on the new system, coordinating with telephony, resolving coworker issues and supporting the team during rollout.
- Piloted Skopenow investigative tool during testing, providing feedback to optimize functionality.
Subject Matter Expert (SME)
DXC Technology
Bangalore, Karnataka
08.2012 - 09.2017
- Led the investigation, review, and analysis of workers’ compensation claims for US-based clients, ensuring compliance with American Medical Association (AMA) guidelines.
- Part of the pilot team that traveled to Scotland to learn and implement the claims processes transitioned from AON UK to DXC Technology, and subsequently applied and optimized these processes back in India to improve operational workflows and efficiency.
- Served as a liaison between medical providers, employees, and legal professionals to facilitate efficient claims processing.
- Reviewed and analyzed complex claims data, processed indemnity payments, and ensured the accuracy of outgoing payments.
- Assisted with training programs for new claim examiners and customer service representatives, ensuring that the team adhered to industry standards and client expectations.
- Conducted quality reviews of claims files to ensure accurate investigations and client satisfaction.
Education
Bachelors in Engineering - Electrical Engineering
Sapthagiri College of Engineering
Bangalore, Karnataka04-2011
Associate of Science -
Collin County Community College District
Plano, TX02-2026
Skills
- Fraud Detection
- Claims analysis and investigation
- Verbal communication
- Policy interpretation
- Settlements & negotiations
- Compliance management
- Claims trend analysis
- Decision-making
- Claims processing
Certification
- Agile at Work: Building Your Agile Team
- Learning GitLab
- Microcertification in ServiceNow
- Agile Foundations
- Project Management Foundations
- Agile Product Owner Role: Foundations
- Agile Product Owner Role: Techniques
Languages
English (Proficient), Hindi (Proficient).
Timeline
Claim Specialist- SIU
State Farm Mutual Automobile Insurance Company
08.2018 - Current
Subject Matter Expert (SME)
DXC Technology
08.2012 - 09.2017
Bachelors in Engineering - Electrical Engineering
Sapthagiri College of Engineering
Associate of Science -
Collin County Community College District