Disabilities Claims Reviewer Resume Example Wisconsin Disability Determination Services Bureau

DISABILITIES CLAIMS REVIEWER

Professional Summary

Driven, high performance professional with excellent analytical, communication and problem solving skills. Dedicated to achieving client satisfaction and surpassing agency expectations. Experienced human services manager with over 14 years of successful experience managing and facilitating State and Federal services for the aging and disabled population. Recognized consistently for performance excellence and contributions for team success and customer service.

Skills

Facilitator
Problem Solver
Advocate
Community Engagement
Compassionate

Analytical skills
Relationship-Building
Written Communication
Multidisciplinary Team Collaboration

Work History

November 2016-CurrentDisabilities Claims Reviewer | Wisconsin Disability Determination Services Bureau | Madison, Wisconsin

Managed Social Security Disability Claims and apply medical knowledge and skills to carry out disability evaluations of initial, appealed, and benefits review claim applications under Titles II, XVI, and XIX of the Social Security Act and Amendments.
Manage and adjudicate disability applications under Social Security, Supplemental Security Income, and Medical Assistance programs.
Developed, maintained and adjudicated Social Security Disability claims through technical write up's of cases utilizing confidential medical records.
Submitted written summaries to appropriate doctors regarding decisions of disability and reviewed applications and made recommendations to the Social Security Administration.
Interpret and relay complex Social Security Administration technical rules, regulations, and medical terminology for legal purposes and claimant understanding.
Consult with medical professionals to make decisions on disability according to state law and definition.
Identified file/fact discrepancies and outstanding issues and secured additional documentation as needed while acting within prescribed timeframes and service expectations.
Maintained knowledge of disability benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
Promoted to this position.

February 2013-November 2016Disabilities Specialist Objective | Wisconsin Disability Determination Services Bureau | Madison, WI

Develop Social Security Disability Claims and apply medical knowledge and skills to carry out disability evaluations of Initial claim applications for disability benefits under Titles II, XVI, and XIX of the Social Security Act and Amendments.
Processed applications for Social Security, Supplemental Security Income, and Medicaid claimants
Prepared vocational referrals and prepared disability determinations that adhered to Federal regulation coding and decision guidelines and rationales.
Consult with medical professionals to make decisions on disability according to state law and definition.
Review of medical and mental health records to determine eligibility for social security disability
Managed 100 - 120 monthly medical claims for Social Security Disability.
Maintained knowledge of disability benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.

October 2011-February 2013Administrative Programs Officer | OKDHS Developmental Disabilities Services Division | Tulsa, Oklahoma

Responsible for individualized programing development, monitoring, and ﬁscal management of disability service recipients with accordance to state and federal guidelines.
Auditing and reporting on contractual obligations and compliance with laws, rules, and regulations.
Managing contracts including contract development and negotiation.
Providing technical assistance and consultation to contracted vendors and program staff.
Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows to meet any daily demand.
Successfully managed high volumes of client-facing interactions and established strong rapport with service recipient, medical professionals, disability services staff and service providers.
Directed staff of three personnel and managed state funded budget of $3,000,000 annually.

November 2006-October 2011Disability Case Manager | OKDHS Development Disabilities Services Division | Tulsa, Oklahoma

Developed and facilitated individualized programs for average of 50 service recipients per year.
Secured home care services, medical care and employment for clients by collaborating with various community agencies.
Obtained and supplied information to coordinating agencies to provide best possible guidance to clients.
Visited individuals in homes and attended group meetings to provide information on agency services, requirements and procedures.
Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork.

Education

August 2020Master of Science: Human ServicesUniversity Of Wisconsin - Platteville, Platteville, WI

December 2007Bachelors of Fine Arts: Visual CommunicationsState University Of New York, Buffalo, NY

Additional Information

State of Wisconsin Governor's Recognition Award 2016

Resume Overview

Companies Worked For:

Wisconsin Disability Determination Services Bureau
OKDHS Developmental Disabilities Services Division
OKDHS Development Disabilities Services Division

School Attended

University Of Wisconsin - Platteville
State University Of New York

Job Titles Held:

Disabilities Claims Reviewer
Disabilities Specialist Objective
Administrative Programs Officer
Disability Case Manager

Degrees

Master of Science : Human Services
Bachelors of Fine Arts : Visual Communications

Disabilities Claims Reviewer Resume Example

Resume Score: 80%

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