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Skills

  • Budgets
  • Appointment scheduling
  • High-volume claims portfolio management
  • Effective communication skills
  • Relationship development
  • Effective time management
  • Cross-functional collaboration with medical professionals
  • Application Review
  • Category equipment
  • Negotiation with legal entities regarding claims

Work Experiences

  • Analyzed data from interviews, educational and medical records, consultations with other professionals, and diagnostic evaluations to determine clients' capabilities, needs, and eligibility for services.
  • Advised senior leadership on policy enhancements.
  • Communicated with people from various cultures and backgrounds during the application process.
  • Conducted interviews with applicants and explained the scope of various benefits that were available.
  • Avoided additional costs.
  • Achieved zero data breaches.
  • Achieved Excellence Award recognition from Brightline.
  • Addressed incomplete information.
  • Provided re-employment services, job clubs, and job search assistance, as well as job-seeking skills training in group and individual settings.
  • Chose qualified applicants to refer to potential employers for job placement.

Summaries

  • Addressed client eligibility questions.
  • Achieved a 85% success rate in dispute resolution.
  • Adept at providing precise eligibility assessments.
  • Talented performer who has provided information, direction, and resource material for over 17 years.
  • Eligibility Specialist with a background in assisting people in understanding and obtaining affordable options.
  • Adept at resolving disputes between insurance holders and beneficiaries, achieving a 36% success rate in dispute resolution and securing favorable outcomes for all parties involved.
  • Supportive Eligibility Specialist with a strong commitment to customer service and extensive application engagement.
  • Recognized for motivating management team members to achieve their goals and fostering innovative work environments.
  • Professional with experience in job interview techniques and Power BI who is responsive and dependable.
  • Achieved a 30% improvement in tracking efficiency.

Accomplishments

  • Partnered with external auditors during compliance reviews, ensuring that all disability claims adhered to process regulations.
  • Collaborated with legal and compliance teams to reduce claim-processing delays by 12 days on average without sacrificing accuracy.
  • Partnered with metric to streamline medical record retrieval, cutting verification times by 56%.
  • Improved claimant outreach efforts, increasing ongoing client engagement by 81% and fostering long-term relationships.
  • Delivered presentations on disability coverage and workplace accommodation strategies that boosted employee satisfaction within participating companies by 21%.
  • Documented and resolved standard which led to system.
  • Proactively addressed stakeholder concerns, resolving high-profile claim disputes that affected 9 clients and preserved over $2 in assets.
  • Advocated for and implemented accessibility resources that improved claimant communication, increasing claimant engagement by 63%.
  • Successfully directed the transition from manual to automated claims processing system, achieving 27% faster turnaround times.
  • Formulated a standardized documentation process for claims reporting, which cut administrative burdens by 57% for claims teams.

Affiliations

  • American Marketing Association
  • Case Management Society of America (CMSA)
  • Society of Certified Senior Advisors (CSA)
  • The Society for Human Resource Management (SHRM) - Disability Benefits Focus Group
  • American Medical Informatics Association
  • International Association of Administrative Professionals
  • American Bar Association - Section of Civil Rights and Social Justice
  • International Foundation of Employee Benefit Plans (IFEBP)
  • The Arc of the United States – Advocacy Specialist in Disability Programs
  • International Disability Alliance (IDA)

Certifications

  • Certified Case Manager (CCM)
  • Associate in Claims (AIC)
  • SHRM Certified Professional (SHRM-CP)
  • CompTIA A+ Technician
  • Certified Customer Service Professional (CCSP)
  • Certified Fraud Prevention Analyst (CFPA)
  • Microsoft Certified Systems Engineer (MCSE)
  • Certified Public Accountant (CPA)
  • Healthcare Privacy Compliance Certification (CHPC)
  • Cisco Certified Internetwork Expert (CCIE)

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