Open to opportunities

KiWi LoveMe

@kiwiloveme

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Strategic claims manager and compliance specialist transitioning into healthcare operations and policy.

United States

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What I'm looking for

I am seeking healthcare operations or policy roles where I can apply my claims, compliance, and audit expertise to improve processes, ensure regulatory adherence, and drive operational excellence while growing into leadership.

I am a strategic, detail-oriented claims manager and compliance specialist with 13+ years of experience handling disability claims, customer service, and quality assurance while pursuing a Bachelor of Science in Healthcare Administration.

I currently manage 90+ active long-term disability claims, maintain audit-ready documentation, exceed service metrics, coordinate IMEs and return-to-work planning, and identify fraud and elder-abuse concerns. I have led internal audits, coached teams to 98%+ audit scores, negotiated settlements, performed financial and escrow calculations, and located 10+ debtors daily through skip tracing.

I bring analytical precision, empathetic communication, and cross-functional collaboration to operations and policy roles in healthcare, and I am eager to apply my compliance, case-management, and quality-assurance expertise to drive process improvements and regulatory adherence.

Experience

Work history, roles, and key accomplishments

Current

Associate LTD Claims Manager

Current

Prudential

Feb 2024 - Present (1 year 8 months)

Manage 90+ active long-term disability claims, analyze medical records to determine eligibility, coordinate IMEs and return-to-work planning, and identify fraud or elder abuse while maintaining audit-ready documentation and exceeding service metrics.

Disability Claims Case Management IME Coordination Fraud Detection Documentation

Senior Account Resolution Specialist

Wells Fargo

Jan 2015 - Jan 2024 (9 years)

Negotiated settlements and resolved delinquent auto and mortgage accounts, locating 10+ debtors daily and supporting repossession and collateral recovery. Led internal audits, coached new hires, and maintained 98%+ audit scores while delivering ADA education and facilitating accommodations.

Collections Skip tracing Loss Recovery Internal Audit Risk Mitigation Coaching

Education

Degrees, certifications, and relevant coursework

University of Phoenix

Bachelor of Science, Healthcare Administration

Activities and societies: Relevant Coursework: Accounting I & II; Organizational Behavior; Conflict Resolution; Business Communications; Economics & Finance; Computer Applications. Projects: Excel Budget Management & Finance Tracker; Cost-Utility Analysis comparing economic systems.

Pursuing a Bachelor of Science in Healthcare Administration with expected completion in July 2026.

University of Phoenix

Associate of Arts, Business Fundamentals

Activities and societies: Relevant Coursework: Accounting I & II; Organizational Behavior; Conflict Resolution; Business Communications; Economics & Finance; Computer Applications.

Completed an Associate of Arts in Business Fundamentals in February 2024.