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Skills

  • Disability claims processing
  • Knowledge of disability law
  • Multitasking
  • Accuracy in documentation
  • Team building
  • Conflict resolution
  • Process automation
  • Customer service
  • Communications
  • Negotiation skills

Work Experiences

  • Applied advanced investigative techniques.
  • Assisted in creating and implementing a disability claims review protocol that became the department standard, reducing review times by 2 days.
  • Achieved a 47% decrease in rejections over 6 months.
  • Gathered and tracked evidence in support of legal processes.
  • Achieved a 62% reduction in appeals.
  • Transported QuickBooks to 6 months customer locations.
  • Conducted agent and claimant interviews to review questionable claims to correct omissions and errors.
  • Oversaw claim negotiations within a $9 budget and assisted in successful litigation for complex issues.
  • Achieved an Innovation Award for ‘Excellence in Customer Support’ for consistently earning high claimant feedback scores throughout 2020.
  • Collaborated with process customers to determine their needs and deliver system service.

Summaries

  • Achieved 23% claimant satisfaction.
  • Achieved results throughout 2019.
  • Adapted quickly to policy updates.
  • Bringing a proven track record of success in Disability Claims Representative roles throughout a progressive insurance industry career.
  • Adept at maintaining compliance with evolving disability laws, ensuring all policy updates were incorporated and leading to a 50% increase in decision compliance.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Collaborated with legal teams on disputed claims.
  • Achieved a 72% satisfaction rate among claimants.
  • Conducted comprehensive medical reviews.
  • Overall morale and productivity are boosted by experience in policy development and staff management procedures.

Accomplishments

  • Developed an automated tracking system using Tableau that enhanced transparency and reduced errors by 55%.
  • Resolved product issue through consumer testing.
  • Contributed to the revision of policy documentation, which enhanced clarity and reduced claimant confusion by 19%.
  • Implemented a claimant education initiative, which resulted in a 84% reduction in appeal submissions due to improved communication effectiveness.
  • Led training sessions for colleagues on new regulations and compliance requirements, which improved regulatory adherence by 78%.
  • Successfully utilized vocational data to contest incorrect denials, and overturn decisions, improving client outcomes in 69% of cases.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Earned ITIL to sharpen expertise in medical and vocational components of disability cases, contributing to more accurate claim determination.
  • Successfully resolved escalated claims appeals, with a success rate of 51%, while maintaining compliance with all industry regulations.
  • Provided detailed case analyses to legal and compliance teams, facilitating a 80% reduction in litigation risk.

Affiliations

  • Institute of Industrial and Systems Engineers (IISE)
  • Society of Human Resource Management (SHRM)
  • Disability Management Employer Coalition (DMEC)
  • Freemason
  • National Organization of Social Security Claimants' Representatives (NOSSCR)
  • Chartered Insurance Institute (CII)
  • American Health Care Association (AHCA)
  • Academy of Management (AOM)
  • National Association of Disability Examiners (NADE)
  • International Public Management Association for Human Resources (IPMA-HR)

Certifications

  • Certified Disability Management Specialist (CDMS)
  • Disability Examiner Certification process
  • Professional Disability Representative (PDR)
  • Advanced Social Insurance Specialist (ASIS-A)
  • Certificate of Professional Achievement in Disability Claims Management standard
  • Certified Social Insurance Specialist (CSIS)
  • Life and Health Insurance License Colorado
  • Associate in Insurance Services (AIS)
  • ServSafe
  • Certified Employee Benefits Specialist (CEBS)

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