Supervise day-to-day operations for five claim professionals. Establish priorities, evaluate workflow, manage team schedule and assignments. Create a high performing, results-oriented staff through candidate selection, onboarding, and managing individual performance. Coach and develop staff on quality claims handling (behavioral and technical) and compliance via file reviews involving analysis, investigation, negotiation, and claim settlements. Develop and sustain acceptable loss reserves.Key Responsibilities & Achievements  Increased team members’ business acumen by conducting daily team huddles on goals, organizational changes, claim trends, and updated / new policies and procedures. Analyzed employee results, identified problematic trends, and created action plans to improve performance. Lead and contribute to a culture of continuous improvement. Utilize tools and behaviors that foster critical thinking and innovation around problem solving and development of standard work. Managed and reviewed claims files (non-litigated or litigated) to measure quality. Coordinate work activities to achieve expected operational goals. Recognize and recommend operational improvements to drive down cost per claim. Used common reporting of data analytics to monitor claim production, inventory management, financial and quality compliance, claim volume trends and results. Report and evaluate team performance using key performance metrics.Promotes the prompt and efficient handling of claims by minimizing the Average Days to Close for Property damage, Comprehensive, and Collision claim within the Unit.Maximizes customer satisfaction by promptly and effectively handling customer complaints.

Promoted senior management claims department vision of excellent customer service. Execute operational plan for claims and prioritizes member satisfaction. Interpret and utilize property and casualty claims contract knowledge to comply with internal and external regulations to efficiently process soft-tissue evaluations and medical bills. Negotiate fair settlements with attorneys, claimants, and insureds. Key Responsibilities & Achievements Created a new model to track and respond to digital complaint by members which contributed to a 30% increase in member satisfaction. Selected for the "Rollout Team" responsible for the efficiency of the new claim system implementation project (Guidewire) and identify training opportunities. Collaborate with peers and business partners to achieve objectives.  Lead in initiating the investigation of claims involving complex coverage claims, complex liability, and bodily injury claims, as well as questionable claims for possible SIU referral. Resolve complaints by approving or denying the documentation. Consistently ensure legal compliance by following guidelines, company policies, and state and federal insurance regulations.

Led and managed a team of 14 handling multi-state property damage claims in a high-paced, high-volume environment. Led team to deliver a fair resolution through diligent investigation, reasonable evaluation, and prompt explanation of claim processes. Collaborated with peers, leadership, and business partners to meet quantifiable goals. Communicated, administered, and implemented claim programs, policies, and procedures according to applicable federal / state laws.Key Responsibilities & Achievements▪ Consistently received high ratings on team survey for “management effectiveness”. Recognized for developing a high-performing team by holding the team accountable to achieve results and provide exceptional customer service. Created and implemented an employee development program focusing on succession planning, soft skill training, and fostering mentor relationships. Implementation target date: 3rd Quarter 2019. Created onboarding materials for the company’s "Change Champions" for new team members. The materials assist with creating buy-in amongst new team member assigned departments. Recognized opportunity to realign complexity of claims with adjusters based on skillset. Created and lead task force aimed at aligning volume of express claims with all other lines of business. Rolled out strategic plan to shift an additional 12% of volume to express adjusters. Identified backlog of claims that would become litigious if not addressed timely. Isolated claims by state to specific adjusters, provided updated payment guidelines and targeted list of claims that needed to be addressed. Resolved 100% of inventory, roughly 400 claims, within 1 week eliminating a potential $200,000 in attorney fees.  Collaborated with Recruiting and Learning & Development to select, train and place top talent according to strengths.

Conducted internal audits to evaluate the risk and controls of business areas including property & casualty underwriting, actuarial, claims, agency, vendor management, customer call centers, and enterprise compliance. Assisted in developing audit scope and testing strategies.Key Responsibilities & Achievements Coordinated $500K operational spending for department projects within scope, budget, and executive leadership vision. Reviewed acceptance criteria generated by business stakeholders to evaluate the level of cogency with internal standards. Identified opportunity to enhance results by providing training on reports to leadership after transition to new claims system. Collaborated and communicated with business partners regarding specific data pulls to build out Tableau report. Created and hosted training for Express leaders. Achieved increase of 15% in contact result. Served as the Subject Matter Expert for the Claims Communication Center metrics, issues, and enhancement projects. Lead in generating professional correspondences to communicate changes and updates for department projects and initiatives. Collaborated with IT staff operations personnel to review business rules, processes for inefficiencies, and claims management system gaps. Ensured the audited property and casualty department followed the regulatory requirements. Analyzed review findings to the Chief Audit Executive (CAE) and business stakeholders, which included opportunities for improvement to the design and effectiveness of critical processes, innovation opportunities, risks, and controls. Provide active participation in working with the IT partners to implement new workflows to increase claims processing time. Supervise and plan training for system updates and conduct feedback sessions with the stakeholders and end-users. Leveraged analytical and leadership skills to complete audit assignments in an independent and team environment.

Supported and coached clam associates to provide a remarkable customer experience across 50 states. Handled escalated technical system and claim handling issues. Trained and mentored less experienced associates. Used policy, procedure, law, statute and insurance regulations knowledge to determine and investigate coverage, liability, and property damage.Key Responsibilities & Achievements Tested and piloted new phone system provided feedback on shortfalls of the system. Served as rollout committee member and subject matter throughout implementation. Provided technical coaching and monitored success to new adjuster in Initial New Employee Training. Shared learnings with peers across the department and other sites. Utilized jurisdictional aides to assist employees to resolve complex and escalated claim issues. Monitored and provided live call assistance. Identified and communicated trends to training department and management. • Served as the Project Lead for Claims Medicare Lien Compliance Project chartered to reduce $5M company fines and sanctions.

• Displayed exceptional ability in documenting letters to complete the dispute process in conjunction with Regulation Z.• Contacted vendors to discuss charges and gathered data for reasonable investigation. Assisted clients and merchants with billing code error resolution. Evaluated vendor consistency with customer accounts to ensure transaction accuracy. • Was responsible for efficiently operating First Assist and TSYS systems to track and evaluate customer accounts and transactions. Utilized systems, including Reporting Solutions, One View, and ESL, to complete audits on client accounts.• Actively participated in leading the identification of fraudulent activity with other departments to protect client accounts.

• Led in critical troubleshooting issues while sourcing appropriate support channels to resolve problems and move forward with new initiatives. Escalated issues appropriately and effectively when necessary throughout all levels of the organization.• Headed the development and maintenance of positive relationships with clients within the organization at various levels. • Was in-charge of planning and monitoring staff schedules while adjusting it accordingly to ensure adequate staffing levels.• Supported demands and business objectives through staff development. Managed admin functions to ensure all paperwork was processed efficiently and in a timely manner. Ensured customer satisfaction through effective communication.

• Acted as liaison with the University sub-systems regarding compliance with policies, rules, and regulations pertaining to grant administration. Independently resolves and develops recommendations for unprecedented issues and problems.• Served as a point of contact within the department for faculty, staff, students, and the public, interpreting system processes and administrative policies. Supervised and facilitated the creation and distribution of all the informational materials.• Forecasted expenditure patterns, reconciled financial records, and interpreted system approved budget guidelines.• Identified issues and solutions for budget discrepancies. Reallocated expenditures to comply with state and university system policy while leading the preparation of written reports to evaluate and track student progress and program impact.