| | | 20,000+ Fresh Resumes Monthly | |
|
|
| |
Click here or scroll down to respond to this candidateOLIVIAKIMEMAIL AVAILABLEPHONE NUMBER AVAILABLEFort Lauderdale, FLStreet Address
Analytical Claims Adjudicator with 5+ years of positive experience. Adept at performing data acquisition And analysis to validate insurance claims. Bringing in-depth knowledge of claims negotiation And document processing to contribute positively to NY, Department Of Economic Opportunity. NJ, Department Of Community Affairs. and FL, DEO, RE 's growth And development. Inspect, Appraise,prepares appraisals and other consulting reports that aid clients with decision-making. Strong analytics,organizational and communication skills. Worksindependently and makes quality decisions whileprioritizing workload to meet deadlines.PROFESSIONAL SUMMARYACCOMPLISHMENTSAdvised a step by step Claims Analyst Procedure guide resulting in improved SLA time frames, and given to new Claims Analyst recruits as part of onboarding and training process. Resolved product issue through consumer testing. Running EDI mapping tables. ( Vendor Net)Received Accreditation for HIP Health Plan (VideoConferencing, planning install, and set up.)Researched, Set up, and installed IVR (Interactive Voice Recognition for HIP members, hospital, clinics and staff.)Evaluated Nortons Antivirus software, which automated many security tasks for HIP Health PlanCrum & Forster (Travel Insured International, TII) - Claims AnalystMorristown NJ (100% Remote, FL) 12/2022 - Current WORK HISTORYMaintained strict confidentiality with all personal data as per company guidelines.Review, assess and process insured's claims in an timely manor. Serve as customer advocate in all interactions, providing SKILLSClaim ValidityDetermination Unemployment Claims Settlement Negotiation Client Interviewing Claims Evaluations Critical Thinking Inputting Claims Special Projects Systems Analysis Data Verification HIPAA RegulationsPast Due AccountManagement Policy Changes Active Learning Complex Problem-Solving Training Programs Superior Customer ServiceFlorida Atlantic UniversityEDUCATIONBoca Raton, FL 10/2013College of Business,Executive Programs:Certified Financial PlanningUniversity of LondonUK England 04/1978Bachelor of Arts: Business &Computer StudiesIBM, Global Business Services - Senior ClaimsAdjudicator/Trainer AssessorNew Jersey, FL 10/2018 - 12/2022outstanding customer experienceCorresponded through verbal, and writtencommunication with policyholders, claimants, and travel advisers, to gather Pertinent information to support claim decisionDelivered complete, timely and accurate work inaccordance with department metrics.Delivered solid knowledge of principles and process for claim examination, evaluation, and disposition.Demonstrated strong problem solving and decision-making skills, with an ability to work independently or as part of a team.Interacted with clients and employees, which helped cultivate positive working relationshipsParticipated in Operations and Company-wide initiatives(Focus Groups, Pilots, and System Enhancements)Collaborated with team members and management tomeet goals.Optimized organizational efficiency by mentoringpersonnel on customer service protocols.Executed claims processing, while generating increased revenue.Communicated with clients to explain policy coverage and regulations.Prepared and presented claims to other insurancecompanies and collaborated to gain necessaryinformation to resolve claims.Determined claim status and negotiated to reachreasonable settlements or denials.Interviewed claimants and witnesses to gather factual information.Finalized, Trade, Unemployment, Health, and Utility files for insurance claim payment release.Researched claims and incident information to deliver solutions and resolve problems.Investigated and processed Trade, Unemployment,Health and Utility insurance claims for policyholders.Handled complaints and grievances using negotiating and problem-solving skills.Convey Health Solutions - Application Support Analyst(Contractor)Sunrise, FL 12/2016 - 01/2017Ability Commerce - Application Support Specialist(Contractor)Delray Beach, FL 08/2014 - 11/2015Vendor Net - Technical Analyst, Account ManagerDelray Beach, FL 08/2012 - 08/2013Reviewed and analyzed suspicious and potentiallyfraudulent insurance claims. Managed department of 10 employeesCollaborated with developers, analysts and project managers to expedite incident resolutions.Performed software application and disaster recovery testing to guarantee business readiness followingfail-overs.Provided 24/7 support for web- and client-basedapplications, file and data feeds and batch processes to prevent impact to business.Analyzed and mapped data and wrote SQL scripts toextract data from SQL databases.Analyzed and troubleshot integration issues related to system configuration, data, maps and workflows.Analyzed and mapped data and wrote SQL scripts toextract data from SQL databases.Interfaced with customers and developers to diagnose problems and implement configuration requirements and solutions.Analyzed and troubleshot integration issues related to system configuration, data, maps and workflows.Installed, configured and provided ongoing configuration management for 50 custom applications.Collaborated with developers, analysts and project managers to expedite incident resolutions.Used Proprietary software to track, maintain and update 10 trouble tickets per day.Interacted with clients to resolve issues and answer software-related questions.Authored technical requirement documentation to suit business goals and technological limits.Citco Technology Hedge Funds Management Systems - IT Fund AnalystFort Lauderdale, FL 09/2007 - 03/2011Designed and maintained consistent data collection protocols and standards across numerous databases and projects.Improved account management by predicting potential competitive threats and outlining proactive solutions.Reinvented team interaction with prospective clients by developing innovative and creative sales pitch.Liaised between account holders and variousdepartments.Listened attentively to client feedback and worked with product development team to introduce new services.Addressed problems with accounting, billing and service delivery to maintain and enhance client satisfaction.Cultivated professional working relationships with internal personnel, vendors and suppliers.Undertook technical maintenance of various database systems.Diagnosed software issues and applied troubleshooting techniques to resolve problems.Collected and monitored incoming data from sources such as remote sensors, third party vendors and visual inspection. Managed client database of 75 High net worth accounts Developed spreadsheet models for diverse projects and analysis.Created and maintained precise and accurate models, charts and reports.Supported financial transactions and investment details by preparing supporting transactions. Monitored fund and equity investments.Tracked prices, yields and other trends to correctly interpret impacts on investment programs.Monitored developments in fields of industrialtechnology, finance and economic theory.Assisted in setting up Florida based 24x7x365 centralized Help Desk to support Citco Staff and external Hedge Fund Clients (World Wide) Manage and monitor, clients trade and price files Schedule and process trade files, processing using Putty, and CA7, and web-based API |
