Service Executive Resume Sample
Phone # / Cell Phone #
Diligent and goal-driven professional, offering practical experience in overseeing corporate claims and insurance coverage, coupled with outstanding record of success in winning settlements and reducing claims payouts to acceptable and reasonable amounts. Possess solid background in the investigation and settlement of complex claims issues. Demonstrate ability to evaluate claims and formulate courses of actions needed to resolve each claim. Apply expertise in critical thinking and problem resolution to all projects handled. Exemplify capability to provide solutions as well as to deliver superior and personalized client services. Exemplify proven record of performance, reliability, confidentiality, and ethical business standards. Thrive in performing under stress and taking pressure of superiors and peers; maintain flexibility to multitask and meet stringent deadlines. Innovative and self-motivated team player and team builder, establishing efficiency even within high-stress, fast-paced environments while juggling numerous priorities. Display proficiency in Microsoft Office Suite (Word, PowerPoint, Outlook, and Excel).
- Outstanding Customer Relation
- Leadership and Team Building
- Problem-Solving and Decision-Making
- Contract Development and Negotiation
- Strategic and Tactical Planning
- Administrative Management
ABC LIFE INSURANCE COMPANY, NORRISTOWN, PA
Service Executive | 2011-2018
- Assumed full responsibility in checking e-mail to identify assigned department, director, and client needs and expectations for the day.
- Held accountable for sending payment for the HCRA reports.
- Administered the processing of payment for Anthem JAA overdue.
- Managed high-dollar hospital billing and occasionally negotiated a lower settlement.
- Provided distinctive customer service for at-risk clients who would leave the company if claims were still unsettled.
- Immediately addressed claims inquiry for supervisors and claims examiners.
- Collaborated with the department to maintain policy provisions payment on time; worked on requesting medical records for long-term care and costly care to be monitored by case manager.
- Rendered direct communication to multi-million-dollar clients to resolve complex claims issues and ensure account loyalty.
- Served as a liaison between providers and clients to negotiate dollar settlement, eventually reducing clients’ liabilities.
- Effectively met clients’ turnaround time on claims processing by establishing and executing new processing procedures as well as by developing and maintaining constant communication.
- Successfully decreased complaints by 80%.
DEF LABOR LIFE INSURANCE CO., NEW YORK, NY
Customer Service Supervisor | 2012
- Managed and monitored calls volumes while maintaining the average handling time
- Handled escalated calls from attorney or other agencies transferred by staff.
- Facilitated training regarding new plan and schedule; prepared reviews and disciplinary action.
- Employed effective communication skills in ensuring strong working relationship with clients and staff to determine sensitive issues with positive feedback or additional training.
- Spearheaded customer service staff and handled the schedule during supervisor’s absence
- Assisted coworker regarding unsure questions on plans.
- Efficiently maintained call volume within the standard; performed follow-up on issue in regard to completion.
Disability Analyst/Stop Loss Analyst/Quality Assurance | 1998-2012
- Provided expert oversight in maintaining and administering reinsurance for self-funded clients.
- Ensured that catastrophe claims did not exceed predetermined amount quantified by setting contract limitations.
- Managed administrated disability benefits in conformity with state regulations across New Jersey, Pennsylvania, and New York.
- Conducted audit for claims to attain a 99% financial and 96% procedural accuracy rate.
- Played a vital role in processing short-term disability for approximately 30 clients as well as the manual tracking of leave and return dates by corresponding with employers and state agencies, such as the Workers’ Compensation Board of New York and New Jersey to identify the liability to pay compensation.
- Earned a Star Award for $250.00 in recognition of outstanding customer service to clients.
COMPANY GHI , VAN NUYS, CA
Senior Claims Analyst
COMPANY JKL, NEW YORK, NY
Coursework in Nursing (2011)
XYZ COLLEGE, BLUE BELL, PA
Health Insurance Association of America (HIAA)
Various Trainings with Outside Vendors