Claims Analyst (Remote)
Resume:
OLIVIA
KIM
*******@*****.***
Fort Lauderdale, FL
33312
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. Works
independently and makes quality decisions while
prioritizing workload to meet deadlines.
PROFESSIONAL SUMMARY
ACCOMPLISHMENTS
Advised 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.
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• Resolved product issue through consumer testing.
• Running EDI mapping tables. ( Vendor Net)
Received Accreditation for HIP Health Plan (Video
Conferencing, planning install, and set up.)
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Researched, Set up, and installed IVR (Interactive Voice Recognition for HIP members, hospital, clinics and staff.)
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Evaluated Nortons Antivirus software, which automated many security tasks for HIP Health Plan
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Crum & Forster (Travel Insured International, TII) - Claims Analyst
Morristown NJ (100% Remote, FL) • 12/2022 - Current WORK HISTORY
Maintained strict confidentiality with all personal data as per company guidelines.
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Review, assess and process insured's claims in an timely manor.
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• Serve as customer advocate in all interactions, providing SKILLS
Claim Validity
Determination
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• Unemployment Claims
• Settlement Negotiation
• Client Interviewing
• Claims Evaluations
• Critical Thinking
• Inputting Claims
• Special Projects
• Systems Analysis
• Data Verification
• HIPAA Regulations
Past Due Account
Management
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• Policy Changes
• Active Learning
• Complex Problem-Solving
• Training Programs
• Superior Customer Service
Florida Atlantic University
EDUCATION
Boca Raton, FL • 10/2013
College of Business,
Executive Programs:
Certified Financial Planning
University of London
UK England • 04/1978
Bachelor of Arts: Business &
Computer Studies
IBM, Global Business Services - Senior Claims
Adjudicator/Trainer Assessor
New Jersey, FL • 10/2018 - 12/2022
outstanding customer experience
Corresponded through verbal, and written
communication with policyholders, claimants, and travel advisers, to gather Pertinent information to support claim decision
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Delivered complete, timely and accurate work in
accordance with department metrics.
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Delivered solid knowledge of principles and process for claim examination, evaluation, and disposition.
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Demonstrated strong problem solving and decision-
making skills, with an ability to work independently or as part of a team.
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Interacted with clients and employees, which helped cultivate positive working relationships
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Participated in Operations and Company-wide initiatives
(Focus Groups, Pilots, and System Enhancements)
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Collaborated with team members and management to
meet goals.
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Optimized organizational efficiency by mentoring
personnel on customer service protocols.
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Executed claims processing, while generating increased revenue.
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Communicated with clients to explain policy coverage and regulations.
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Prepared and presented claims to other insurance
companies and collaborated to gain necessary
information to resolve claims.
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Determined claim status and negotiated to reach
reasonable settlements or denials.
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Interviewed claimants and witnesses to gather factual information.
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Finalized, Trade, Unemployment, Health, and Utility files for insurance claim payment release.
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Researched claims and incident information to deliver solutions and resolve problems.
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Investigated and processed Trade, Unemployment,
Health and Utility insurance claims for policyholders.
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Handled complaints and grievances using negotiating and problem-solving skills.
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Convey Health Solutions - Application Support Analyst
(Contractor)
Sunrise, FL • 12/2016 - 01/2017
Ability Commerce - Application Support Specialist
(Contractor)
Delray Beach, FL • 08/2014 - 11/2015
Vendor Net - Technical Analyst, Account Manager
Delray Beach, FL • 08/2012 - 08/2013
Reviewed and analyzed suspicious and potentially
fraudulent insurance claims.
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• Managed department of 10 employees
Collaborated with developers, analysts and project managers to expedite incident resolutions.
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Performed software application and disaster recovery testing to guarantee business readiness following
fail-overs.
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Provided 24/7 support for web- and client-based
applications, file and data feeds and batch processes to prevent impact to business.
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Analyzed and mapped data and wrote SQL scripts to
extract data from SQL databases.
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Analyzed and troubleshot integration issues related to system configuration, data, maps and workflows.
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Analyzed and mapped data and wrote SQL scripts to
extract data from SQL databases.
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Interfaced with customers and developers to diagnose problems and implement configuration requirements and solutions.
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Analyzed and troubleshot integration issues related to system configuration, data, maps and workflows.
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Installed, configured and provided ongoing configuration management for 50 custom applications.
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Collaborated with developers, analysts and project managers to expedite incident resolutions.
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Used Proprietary software to track, maintain and update 10 trouble tickets per day.
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Interacted with clients to resolve issues and answer software-related questions.
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Authored technical requirement documentation to suit business goals and technological limits.
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Citco Technology Hedge Funds Management Systems - IT Fund Analyst
Fort Lauderdale, FL • 09/2007 - 03/2011
Designed and maintained consistent data collection protocols and standards across numerous databases and projects.
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Improved account management by predicting potential competitive threats and outlining proactive solutions.
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Reinvented team interaction with prospective clients by developing innovative and creative sales pitch.
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Liaised between account holders and various
departments.
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Listened attentively to client feedback and worked with product development team to introduce new services.
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Addressed problems with accounting, billing and service delivery to maintain and enhance client satisfaction.
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Cultivated professional working relationships with internal personnel, vendors and suppliers.
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Undertook technical maintenance of various database systems.
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Diagnosed software issues and applied troubleshooting techniques to resolve problems.
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Collected and monitored incoming data from sources such as remote sensors, third party vendors and visual inspection.
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• Managed client database of 75 High net worth accounts Developed spreadsheet models for diverse projects and analysis.
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Created and maintained precise and accurate models, charts and reports.
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Supported financial transactions and investment details by preparing supporting transactions.
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• Monitored fund and equity investments.
Tracked prices, yields and other trends to correctly interpret impacts on investment programs.
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Monitored developments in fields of industrial
technology, finance and economic theory.
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Assisted in setting up Florida based 24x7x365 centralized Help Desk to support Citco Staff and external Hedge Fund Clients (World Wide)
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• Manage and monitor, clients trade and price files
• Schedule and process trade files, processing using Putty, and CA7, and web-based API
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