Solutions-focused leader who contributes strong knowledge of the insurance industry, claims, and legal / regulatory compliance eager to offer 16 years of team training, process improvement, business communications, administrative support, and customer relations experience toward maximizing a progressive employer s success.
Integral leader who analyzes and interprets statistical data to deliver solid assessments and procedural recommendations for cost-effective claims processes, along with anticipating customer needs while optimizing products / services delivery.
Top performer who demonstrates strong experience with claims processing and can train company teams on major steps of claims adjustments processes while utilizing major tools and techniques for efficiently and accurately processing claims.
Out-of-the-box thinker who proactively resolves technical issues by identifying root causes and providing key solutions, including educating multiple parties on various areas of claims processes and thoroughly training claims staff members.
Fluent in Polish and English languages.
Bodily Injury Appraisals
Physical Damage Appraisals
Jurisdictional / Procedural Law
Low- / Medium-Level Litigation
Team Building / Training
Negotiations / Settlements
Needs Analysis / Assessment
Process / Product Improvement
SBU Management Support
Statutory Forms Completion
Insured / Claimant Relations
Claims Specialist I (2005 C Present)
Utilize broad scope of industry knowledge toward handling a high-volume of worker s compensation claims (e.g. bodily injury, physical damage), including interpreting policy language, verifying coverage, and applying company standards.
Contribute strong communication skills toward contacting insureds and claimants, gathering key information, interviewing witnesses, documenting claim files pursuant to best practices, and providing updates to multiple parties.
Anticipate, recognize, and respond to customer needs while cost-effectively negotiating settlements within authority limit.
Improve processes, procedures, and / or products by providing recommendations and / or resolving technical problems.
Recognize subrogation and fraud, and report activities to proper departments for further investigation and review.
Healthcare Cost Specialist (1997 C 2005)
Applied sharp analytical abilities toward evaluating medical bills for accuracy of billing amounts, duplicate payments, and general appropriateness, including verifying missing data with medical providers and claims adjusters and investigating provider medical bills for payment adjustment in accordance with strict jurisdictional laws and / or diverse regulations.
Wrote and updated detailed guidelines for workers compensation fee schedules and U&C states, along with demonstrating knowledge of medical terminology and medical specialties to promptly resolve customer / billing issues.
Guaranteed medical records confidentiality and proper release of information by observing all policies and procedures.
Supported the improvement of a new bill review system by identifying critical errors and system-wide queries.
Optimized administrative processes by efficiently handling all secretarial and business support functions, including drafting correspondence, scheduling appointments, filing and producing reports, completing invoices, and expediting deliveries.
Expertly performed wide-ranging accounting functions (e.g. journal entry postings, AP / AR, billing, bank deposits).
Liaised among company president, operations manager, and various vendors to ensure seamless processes.
Bachelor of Arts Degree
Extensive Business Studies
College of DuPage
Certified Professional Coder (Since 2004)
Physician Office Coding & Billing Certificate
American Academy of Professional Coders
Licensed Workers Compensation Adjuster
Texas / Oklahoma / Rhode Island / North Carolina / Kentucky / Florida
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