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Skills

  • Appeals case handling
  • Cross-functional team collaboration
  • Accuracy in documentation
  • MS Office
  • Customer service
  • Business operations
  • Disability claims processing
  • Team building
  • Project organization
  • Regulatory compliance

Work Experiences

  • Transported QuickBooks to 6 months customer locations.
  • Assisted in creating a disability claims review protocol.
  • Collaborated with process customers to determine their needs and deliver system service.
  • Conducted agent and claimant interviews to review questionable claims to correct omissions and errors.
  • Solved framework issues, improved operations, and provided excellent customer service.
  • Built and maintained relationships with key stakeholders, including medical consultants and vocational experts, to ensure comprehensive evaluations for each claim.
  • Gathered and tracked evidence in support of legal processes.
  • Achieved a 47% decrease in rejections over 6 months.
  • Oversaw claim negotiations within a $9 budget and assisted in successful litigation for complex issues.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.

Summaries

  • Costs were consistently reduced while profits were increased.
  • Collaborated with medical consultants and vocational experts to ensure comprehensive evaluations, resulting in more accurate decision-making across 4 cases.
  • Bringing a proven track record of success in Disability Claims Representative roles throughout a progressive insurance industry career.
  • Listening to customers, meeting productivity goals, and staying current on company offerings are all skills she possesses.
  • Hardworking Disability Claims Representative with 6 years of telecommuting experience meeting customer needs.
  • Review documentation and assess properties efficiently to determine damage levels, complete cost estimates, and maintain liability control.
  • Proven track record of using excellent negotiating skills to speed up settlements.
  • Collaborated with medical consultants and vocational experts.
  • Built relationships with key stakeholders.
  • Disability Claims Representative is a multi-talented Disability Claims Representative who is consistently rewarded for planning and operational improvements.

Accomplishments

  • Conducted peer review audits that identified process improvement opportunities, increasing team accuracy by 21%.
  • Collaborated with rehabilitation specialists to prepare personalized return-to-work plans, seeing a success rate increase of 53%.
  • Developed an automated tracking system using Tableau that enhanced transparency and reduced errors by 55%.
  • Collaborated with insurance underwriters to refine risk assessments, leading to a better balance of liability and claimant benefits.
  • Successfully utilized vocational data to contest incorrect denials, and overturn decisions, improving client outcomes in 69% of cases.
  • Collaborated with vocational experts and healthcare providers to expedite return-to-work solutions, leading to a 49% increase in rehabilitation success rates.
  • Documented and resolved system which led to process.
  • Increased claimant satisfaction by 56% by revamping communication channels and ensuring timely updates.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Regularly exceeded departmental service level agreements while handling 15 active claims at any given time.

Affiliations

  • National Organization of Social Security Claimants' Representatives (NOSSCR)
  • American Medical Informatics Association
  • Professional Association of Resume Writers and Career Coaches (PARW/CC)
  • Council of Disability Claims Professionals (CDCP)
  • Health Care Compliance Association (HCCA)
  • Lions Club
  • Society of Human Resource Management (SHRM)
  • National Association of Public Insurance Adjusters (NAPIA)
  • Project Management Institute
  • International Association of Administrative Professionals

Certifications

  • Cisco Certified Internetwork Expert (CCIE)
  • Workers' Compensation Claim Specialist (WCCS)
  • Certified Disability Management Specialist (CDMS)
  • First Aid/CPR Certified
  • Certificate of Professional Achievement in Disability Claims Management standard
  • CompTIA Network+
  • CompTIA Security+
  • Google Certified Professional Cloud Architect
  • Disability Examiner Certification process
  • Claim Handling Practices Certification Northwind

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