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Skills

  • Team building
  • Claims Investigation Interviews
  • Budgets
  • Claim Escalation Management
  • Customer service
  • Problem resolution
  • Process improvement
  • Effective communication skills
  • Data-driven decision making
  • Regulatory compliance

Work Experiences

  • Used social media platforms such as category and method to promote and market services.
  • Provided career-related consulting services to over 13 people and communicated with them to determine their needs and goals.
  • Assisted legal teams with case summaries.
  • Coordinated follow-ups with claimants and health professionals leading to accurate determinations for over 2 ongoing disability cases.
  • Achieved an average 28% increase in claimant satisfaction by providing timely updates and clear explanations regarding the claims process.
  • Coordinated follow-ups with claimants.
  • Conducted interviews with applicants and explained the scope of various benefits that were available.
  • Achieved over 58% of appealed decisions overturned.
  • Identified job seekers who were having difficulty finding work and devised strategies to help them succeed.
  • Adhered to program rules and regulations.

Summaries

  • 79% of denials overturned.
  • Achieved 54% increase in efficiency.
  • Through dynamic communication and exemplary engagement skills, a confident Eligibility Specialist is committed to promoting positive customer outcomes.
  • Within Miscellaneous, senior Disability Claims Specialist and outstanding performer in risk assessment and budget management.
  • Professional with experience in job interview techniques and SAP who is responsive and dependable.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Adhered to program guidelines.
  • Considered a team player who excels at multitasking.
  • Achieved a 45% reduction in overdue case reviews.
  • Recognized on a regular basis for outstanding performance and contributions to the Miscellaneous industry's success.

Accomplishments

  • Drafted detailed case summaries and recommendations that were instrumental in the successful mediation of 3 disputed claims.
  • Handled sensitive claimant medical information in compliance with HIPAA regulations, avoiding any legal complications or breaches.
  • Reduced operational costs by 80% by identifying process inefficiencies and implementing technology-driven solutions.
  • Led risk assessments for high-value disability claims, identifying potential red flags and reducing overall claim risks by 37%.
  • Reviewed and processed 5 disability claims monthly, ensuring adherence to up-to-date local, state, and federal regulations.
  • Developed a claimant feedback program, resulting in a 38% increase in claimants' overall satisfaction scores.
  • Trained and mentored junior claims specialists in efficient claims processing, increasing departmental throughput by 46%.
  • Played a key role in rolling out new claims management systems, enabling a 66% improvement in data tracking and reporting accuracy.
  • Facilitated the integration of telemedicine consultations into the disability claims process, reducing case wait times by method.
  • Collaborated with legal teams to resolve contentious disability denials, successfully reversing 48% of dispute outcomes.

Affiliations

  • Society of Human Resource Management
  • Authorized Instructor for Disability Benefit Programs at Brightline
  • Presenter at the Annual Employee Disability Conference, 2020
  • National Association of Benefits and Disability Professionals (NABDP)
  • Project Management Institute
  • Co-founder of Employee Assistance Program at Vantage
  • American Society of Safety Professionals
  • Certified Long-Term Disability Specialist (CLTDS), Completed Certification in 2024
  • Disability Insurance Law Forum, Active Participant Since 2022
  • Licensed Insurance Claims Adjuster in Georgia since 2022

Certifications

  • Medical Disability Advisor Certification (MDAC)
  • Certified Public Accountant
  • Certified Public Accountant (CPA)
  • Advanced Social Security Disability Examiner Certification
  • Life and Health Insurance Law Certification
  • Apple Certified Associate (ACA)
  • Social Security Claim Expert (SSCE) Certification
  • Accredited Case Management (ACM)
  • Cisco Certified Network Associate (CCNA)
  • Specialized Disability Law Certification

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