edmondweb

Accurately captured all relevant risk information into appropriate systems, ensuring compliance with established protocols. Conducted detailed financial analysis and risk assessments to inform strategic decision-making. Developed and maintained financial models to support actuarial calculations. Collaborated with cross-functional teams to provide insights on investment strategies and risk management. Utilized analytical skills in assessing insurance claims and identifying trends in claims data. Applied risk analysis skills to support the development of comprehensive risk management strategies.

Collaborated with cross-functional teams to perform claim analysis to identify trends, anomalies, and potential fraud or abuse. Determined the eligibility of claims and assessed whether they meet the guidelines and policies. Addressed inquiries from policyholders and healthcare providers regarding claims status, payments, and documentation requirements. Generated reports on claims processing and payment activities for management and regulatory purposes. Collaborated in developing risk mitigation strategies and recommendations for the management.

Facilitated best user experience using statistical software and MS Office through network support and optimization control. Worked closely with teams to plan, develop, coordinate, and execute technical strategies aligned with members’ vision, mission, and purpose. Developed new processes and procedures to enhance project operations, streamlining workflows and increasing organizational efficiency. Evaluated the effectiveness of newly implemented processes, making necessary adjustments for continuous improvement. Conducted data analysis and provided recommendations for process improvements through annual reports and portfolio reviews. Assisted in the development and implementation of data visualization dashboards to enhance organizational choices and improve services.