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Skills

  • Data analysis for claim validation
  • Administrative support
  • Disability claims processing
  • Dispute resolution for denied claims
  • Adjudication board presentation
  • Communications
  • Relationship development
  • Critical thinking for complex case resolution
  • Continuous improvement methodologies
  • Documenting decisions for adjudication

Work Experiences

  • Worked with others to brainstorm new system possibilities.
  • Learned data analysis and risk assessment to help with office needs.
  • Checked and removed unnecessary details from record copies before handing them over.
  • Working with team members and customers to find workable solutions improved operations.
  • Achieved a 17% improvement in claimant retention.
  • Achieved a 18-month record of meeting claims processing benchmarks.
  • Achieved a 23% reduction in claims adjudication time.
  • Achieved no findings in audits.
  • Devised and implemented techniques to improve the retrieval of medical records.
  • All requests for medical records were entered into spreadsheets.

Summaries

  • Disability Claims Analyst with strategic planning and vendor management abilities.
  • Achieved 16 consecutive quarters of processing claims.
  • Budget management Committed to identifying and leveraging opportunities for growth, with a proven ability to build effective teams.
  • Strategic thinker with expertise in process improvement.
  • Achieved a 75% improvement in staff adoption.
  • Program and procedure have a proven track record.
  • Looking forward to taking on a new challenge with a successful team.
  • Medical Records Specialist with over 16 years of experience in the processing of court orders and subpoenas.
  • Disability Claims Analyst is a hardworking and dependable Disability Claims Analyst who excels at stakeholder engagement and quality assurance.
  • Professional with experience in record filing and management.

Accomplishments

  • Reviewed and analyzed 10 disability claims per week, determining eligibility based on medical evidence and policy guidelines.
  • Independently evaluated and closed 9 claims per quarter, consistently exceeding department benchmarks for accuracy and claimant satisfaction.
  • Achieved OSHA to improve the quality and accuracy of disability assessments according to national standards.
  • Facilitated regular claims review meetings with multidisciplinary teams, ensuring claims were processed within target timelines 7 consecutive months.
  • Enhanced claimant experience by introducing automated status updates, which reduced inbound inquiries by 22%.
  • Reduced average processing time for high-priority claims by 53% through workflow enhancements and real-time data tracking tools.
  • Designed claim status tracking dashboards using Jira, enabling quicker resolution of open claims and reducing backlog by 69% in Raleigh.
  • Collaborated with cross-functional teams, including procedure, to validate medical documentation and expedite claims processing by 36%.
  • Managed escalated claims processes, collaborating with legal counsel and medical professionals to ensure adherence to process.
  • Reported departmental performance metrics to senior management, identifying key areas for improvement and enhancing throughput by 17%.

Affiliations

  • Certified Professional Disability Consultant (CPDC) designation
  • Member, International Claim Association (ICA)
  • Professional Member, National Association of Disability Examiners (NADE)
  • Volunteer, Columbus Disability Advocacy Network
  • Participant, Disability Law Issues seminars hosted by initiative
  • Collaborator, Professional Risk Managers' International Association (PRMIA)
  • Associate, Society of Financial Examiners (SOFE) to enhance compliance knowledge
  • Certification: Registered Disability Savings Plan (RDSP) Professional
  • Affiliate, International Foundation of Employee Benefit Plans (IFEBP)
  • Member, National Council on Compensation Insurance (NCCI)

Certifications

  • Certified Business Analysis Professional (CBAP)
  • American Academy of Case Management (AACM) Certification
  • Certified in Risk and Information Systems Control (CRISC)
  • Salesforce
  • Chartered Property and Casualty Underwriter (CPCU)
  • Associate in Claims (AIC)
  • Certified Case Manager (CCM)
  • Certified Fraud Examiner (CFE)
  • Certified Workers' Compensation Integrity Professional (WICP)
  • Disability Benefits Calculations Training

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