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Skills

  • Data analysis and trends reporting
  • Compliance with federal and state regulations
  • Interdepartmental collaboration
  • Fraud detection methodologies
  • Effective communication skills
  • Supervision
  • Documentation collection and verification
  • Applicant engagement
  • Claims eligibility assessment
  • File audit preparedness

Work Experiences

  • Chose qualified applicants to refer to potential employers for job placement.
  • Assisted in the resolution of over 8 high-priority cases, consistently meeting deadlines while maintaining 100% compliance with federal and state regulations.
  • Documented accurate descriptions of required job duties, working hours, and wages by writing job orders for employers.
  • Achieved results within the first 2018 of operation.
  • Used computer-assisted guidance packages such as skills assessment tools, career planners, psychometric tests, and personal inventories to help clients determine their strengths and weaknesses.
  • Analyzed claim data using Jira.
  • Achieved a Innovation Award for exceptional customer service.
  • Achieved a 50% successful approval rate.
  • Audited Jira payments for discrepancies, recovering $11 in overpayments and preventing further financial loss.
  • Boosted success rates by 22%.

Summaries

  • Dedicated to learning, growing, and succeeding in Customer Service.
  • Applied project management expertise.
  • Adept at mediating conflicts.
  • Adhered to regulatory frameworks.
  • Aligned efforts with client satisfaction goals.
  • Accomplished Social Insurance Specialist adept at leading process redesign initiatives, reducing benefit claim processing times by 66%, and achieving compliance with federal and state regulations.
  • Accomplished this within the past year.
  • Adept at upgrading benefits programs that prioritize customer satisfaction and policy compliance; consistently meeting regulatory standards with zero discrepancies.
  • Adhered to compliance.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.

Accomplishments

  • Assisted in designing training materials for claim specialists, contributing to a 40% growth in team productivity.
  • Spearheaded the successful implementation of the program initiative, which increased service provision to underserved communities by 65%.
  • Generated detailed reports for senior management that tracked claim trends, helping to adjust focus areas and decrease delays by 38%.
  • Successfully improved client communication systems, resulting in a 31% increase in claim clarification prior to submission.
  • Consistently monitored and adapted to changes in federal and state insurance regulations, ensuring full compliance across all claims processed.
  • Negotiated with state and federal agencies to streamline dual-beneficiary cases, reducing cross-agency processing times by 44%.
  • Collaborated in a monthly review team to meet a 40% error-free target on claim assessments, leading to decreased client complaints.
  • Prepared presentations and delivered public briefings to over 16 stakeholders on changes in insurance policies and procedures.
  • Maintained an up-to-date record of policy changes and ensured seamless integration into daily operations with a 3-stakeholder team.
  • Led cross-departmental efforts to develop more robust fraud detection systems, resulting in the detection of 11 fraudulent claims worth $8.

Affiliations

  • National Association of Social Insurance (NASI) Membership
  • Public Human Services Association (APHSA) Committee Member
  • International Association of Administrative Professionals
  • Social Security Administration (SSA) Compliance Review Board Advisor
  • Association of Information Technology Professionals
  • Institute of Healthcare Improvement (IHI) Payer and Social Insurance Sector Member
  • Jaycees
  • International Council of Nurses
  • American Marketing Association
  • National Association of Social Workers

Certifications

  • Certified Public Sector Manager (CPSM)
  • Certified Employment Support Professional (CESP)
  • Certified Information Systems Auditor (CISA)
  • Social Insurance Benefits Analyst (SIBA)
  • Salesforce
  • Certified in Social Insurance Law (CSIL)
  • Cisco Certified Network Associate (CCNA)
  • Certified Case Manager (CCM) – Commission for Case Manager Certification
  • Certified Social Insurance Specialist (CSIS)
  • Certified Public Work Supervisor (CPWS)

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