Claims Specialist Resume Example Social Security Administration

CLAIMS SPECIALIST

Summary

Reliable professional offering an extensive career promoting positive customer experiences. Sharp Eligibility Specialist boasting expertise in managing and eligibility information for members and groups. Client-centered Eligibility Specialist with a career spent accurately managing records, handling appointment scheduling and overseeing other administrative tasks in fast-paced settings. Bilingual individual committed to engaging others and delivering exceptional service. Ready to tackle new challenges in an office-based environment.

Skills

Microsoft Word, Excel, PowerPoint, Access and Web Design.
Excellent mathematical knowledge with strong numerical skills. Customer service oriented with strong problem solving and analytical skills.
Fluent communications abilities in reading, writing and oral communication in English in addition to Spanish.
Adapt easily to new concepts, regulations, environment and responsibilities. Excellent time management skills and organization structure to meet deadlines target goals.

Proficiency in phone inquiries and answering phone messages within 24 hours.
Skill in goal setting strategies and analyzing results. Skill in career awareness, exploration and planning. Knowledgeable in de-scalation techniques and managing difficult situation.
Ability to listen carefully to understand while been inquisitive to ask open questions to formulate clear understanding.

Experience

Claims Specialist | 05/2014 to CurrentSocial Security Administration - New York, NY

Cultivated effective fact-checking and research talents from daily reviews of program eligibility requirements.
Reviewed criteria for different aid programs to determine eligibility for various applicants.
Performed careful reviews of applicant data to ascertain compliance with eligibility criteria for economic assistance.
Inputted all communication with applicants into computer system to facilitate future clarification and knowledgeable support.
Analyzed information from interviews, educational, and medical records, consultation with other professionals, and diagnostic evaluations to assess clients' abilities, needs, and eligibility for services.
Called applicants to set up appointments and explain benefits processes.
Conducted interviews with applicants, explaining benefits process and which programs were available.
Demonstrated self-reliance by meeting and exceeding workflow needs.
Recognized by management for providing exceptional customer service.
As a Social Insurance Specialist (Claims Specialist), I conduct interviews in person and/or by phone to obtain, clarify, and verify information about initial and continuing eligibility for Social Security (Retirement, Survivors, Child, Spousal, Disability, Medicare benefits) as well as Supplemental Security Income (SSI) while
My responsibility consists of resolving discrepancies, clarifying information, and making final decisions for initial and resuming benefits and payments.
Identifying and investigating potential program abuse by following proper protocol and making appropriate referrals to the Office of Inspector General.
Performing interviews and examining capability development and suitable payee representation by always demonstrating empathy and professionalism regardless of adversities ahead.
Assisting to solve and answer any concerns related to beneficiaries' benefits along with supporting my peers in times of uncertainty.
Evaluate evidence and statements of all facts to determine what benefits is most advantageous to our fellow claimants.
Proficient in post-adjudicative action, preparing formal and/or informal special determinations and upholding Social Security policy and procedures when making precedent cases determinations.
Adaptable when it relates to workload management and emergency matters by using effective time management skills and useful communication abilities.
My most current workloads consist of, however, does not limit, administrative judge decisions, court appointed cases, updating to retirement and survivor's insurance listings, reviewing my corresponding MCS tickles list, analyzing title XVI underpayment diaries, investigating reasons for unpaid attorney fees, conducting and enrolling individual into Medicare coverage, requesting assistance request, and improving EDCS listings.
Past workloads included, but did not limit to, completing internet claims, determinations for initial title II and XVI allowances and denials.
Special assignments included outstanding listings, manager to manager assistances, congressional case and potential public relations cases.
Also, I have translated written and official documents and assisted interviews that required translation support.
As part of the offices staff, I am responsible for participating in community campaigns such as FEDS fees and family & disaster aid food collection.
I served as an agency liaison for multiple organizations like, One Stop agency, Center for Urban Community Services, Manhattan Psychiatric Center and FEDCAP Wecare Maximus.
Developed revisions to help assist with improving office workflow, provided technical support, trained staff members on offices expectation and job duties. Constantly promote positive working relationships with related agencies, claimants, personnel, and management officials.

Personal Banker | 01/2006 to 05/2014Citibank, NA - New York, NY

At Citibank, as a personal banker I was responsible for creating and managing sales plan and delineating optimal methods to achieve sale goals.
Created respectful and meaningful relationships through social interactions with current and prospective clients, internal partners, and other external contacts by communicating and engaging at community events and marketing activities.
Supervised employees and coached them on strengthening their interpersonal skills in relations to developmental strategies.
Served as an interpreter for non-English speaking clients when required and/or requested.
Providing bank tellers and other branch staff members guidance and referrals on products and special programs within the agency to better assure clients' needs were prioritized.
Managed client ‘s portfolio to meet their financial needs and expectations. I supervised integrated sales, to assure that credit strategies aligned with the financial center business plan to achieve desired revenue and services
Responsible for following up with client's feedback and/or complains regarding bank tellers' behaviors, professionalism, and helpfulness.
Participated in presentations and discussions with prospective clients by providing general information regarding the agency's mission and overview.
Guided individuals to make appropriate financial decisions, inquiries related to loans, credits cards, credit scores, banking verification and financial overpayments plans.
Managed customer services request related to fraud investigations, title change, issuing ATM and debit cards, and financial transactions.
Adhered to all operational controls to ensure the safety and security of client's personal identifiable information.
Responsible for training branch staff on first-time homebuyer's and how to develop financial planning seminars. Also, responsible for hosting agency related branch events to expand our mission and goal within the community.
Conducted outbound sales activities (e.g., phone out-reach, community events, meetings with local businesses) to establish visibility in the community and drive business to the branch.
Bridging the gap between segment partners (e.g. commercial and small business, home lending, financial advisors, to obtain and provide appropriately qualified referrals and meet periodically with updated goals and strategies.
Scheduled one-on-one meeting with clients and business partners regarding commercial business, insurances, and investment to assure the best customer service.
Devised targeted solutions for various customers, including deposit, lending and investment services.
Improved decision-making by using current data on market conditions and individual financial situations.
Met with clients to facilitate budget management and financial guidance.
Performed cash and check balancing to verify all daily and monthly cash accounts for accuracy.
Helped customers open and close accounts, apply for loans and make sound financial decisions.
Created strategic financial solutions to suit individualized client needs.
Processed invoices and checks and maintained daily cash logs and deposits.
Created detailed financial models and applied analytical tools to facilitate variance analysis.
Exercised judgment when dispensing information to maintain confidentiality of sensitive information.

Financial Associate | 05/2005 to 01/2006Citibank, NA - New York, NY

Mentored and trained newly hired tellers to familiarize each with job responsibilities and organizational procedures.
Completed comprehensive tasks by implementing customer service initiatives, audit and restock ATMs and keep records on accounts.
Supervised tellers to verify compliance with both federal and local regulations.
Adhered to regulatory and company security and audit procedures.
Assisted client transactional activities, which included deposits, payments and withdrawals.
Responsible for handling financial transactions as per the policies and procedures of the bank.
Handled responsibilities of solving issues and responded to customer inquiries in an efficient and time effective manner.
Assisted clients to understand products, services and operating channels like telephone banking, Automated Teller Machines and Online Banking.
Handled responsibilities of identifying customer requirements to provide services that meet customer satisfaction.
Performed the tasks of supporting sales activities of the bank by participating in seminars, promotional campaigns, and product initiatives.
Responsible for setting individual goals and achievement plans that are connected with the bank's overall target.
Performed responsibilities of educating clients on Citibank financial products and services to clients.
Responsible for referring sales prospect to the proper specialists.
Handled responsibilities of ensuring safety and security of Citibank assets by adhering to the policies, procedures and regulatory requirements.
Performed tasks of calling customers on advertising the products and services of the bank.
Cultivated lasting partnerships, which led to lucrative opportunities as result of consistently following up with clients and providing exemplary service.
Performed site evaluations, customer surveys and team audits.
Improved operations by working with team members and customers to find workable solutions.
Worked closely with team members to deliver project requirements, develop solutions and meet deadlines.
Created agendas and communication materials for team meetings.

Education and Training

Hunter College of The City University of New York - - New York,NY | | Advance Master's Certificate in Bilingual EducationBilingual Education, 01/2016

Herbert H Lehman College - - Bronx,NY | | Master of ScienceEducation in Counselor Education/ School Counselin, 05/2013

Herbert H Lehman College - - Bronx,NY | | Bachelor of ArtsBusiness Administration , 01/2006

Resume Overview

Companies Worked For:

Social Security Administration
Citibank, NA

School Attended

Hunter College of The City University of New York
Herbert H Lehman College
Herbert H Lehman College

Job Titles Held:

Claims Specialist
Personal Banker
Financial Associate

Degrees

Hunter College of The City University of New York - New York , NY | Advance Master's Certificate in Bilingual Education
Herbert H Lehman College - Bronx , NY | Master of Science
Herbert H Lehman College - Bronx , NY | Bachelor of Arts

Claims Specialist Resume Example

Resume Score: 80%

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