long term disability specialist resume example with 8+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
Home: (555) 432-1000
Cell:
resumesample@example.com
:
Professional Summary
Service-oriented Claims Adjuster skilled at applying creative approaches to solving complex problems. Negotiates peaceful resolutions of all claims with emphasis on fairness and thoroughness. Trustworthy and dependable.
Skills
Quality Customer Service
Time Management
Accident Investigations
Medical Terminology
Claims File Management Processes
Advanced Oral and Written Communication Skills
Interviewing Techniques
Insurance Industry Experience
Negotiate Settlements
Insurance Coverage Verification
Documentation Review
Workers Compensation Claims
Proficient In Microsoft Office Suite
Policy Understanding
Coverage Assessments
Work History
Long Term Disability Specialist, 05/2021 to 02/2022 City Of Jacksonville, Fl – Jacksonville, FL,
Reviewed and processed increasingly complex assigned claims for payment or denial independently in accordance with established procedures and guidelines, in a timely manner and meeting departmental quality/production standards
Interacted with claimants to ensure awareness and understanding of the Long-Term Disability escalation process, requirements, and entitlements
Conducted comprehensive interviews of witnesses and claimants to gather facts and information
Responsible for employer Long Term Disability contract review
Developed and maintain internal systems for data collection
Responsible for managing clerical duties for all assigned escalated Short-Term Disability and Long Term Disability Claims
Managed 100 claims in pended or approved status
Demonstrated ability to use sound judgment and discretion regarding confidential information
Maintained strong knowledge of basic medical terminology to better understand services and procedures
Clinical claim consultations to assess initial and ongoing claims management
Directed and coordinated various investigations conducted by field investigation team
Substantiated legitimate claims and denied unjustified claims.
CSR for Lincoln Financial Group
Reviewed police reports, medical treatment records and physical property damage to determine extent of liability
Actively listened to customers, handled concerns quickly and escalated major issues to supervisor
Claims Assistant, 03/2016 to 04/2018 Sedgwick CMS – City, STATE,
Adjusted medical-only claims and minor lost-time workers compensation claims
Interacted with claimants to ensure awareness and understanding of the workers compensation process, requirements, and entitlements
Ensured claim files were properly documented
Coordinated medical treatment for injured employees and provided information to treating physicians regarding employee’s medical history, health issues, and job requirements
Served as a liaison between medical providers, employees, employers, and government agencies
Inform departments of injured employee’s work restrictions and coordinate appropriate accommodations
Processed routine payments and status reports for lifetime medical claims and/or defined period medical claims
CSR for Sedgwick CMS Columbia
Processed workers compensation claims determining compensability and benefits due
Monitored reserve accuracy, and filed necessary documentation with state agency
Developed and maintain internal systems for data collection and entry, financial analysis, and diary as necessary
Responsible for managing clerical duties for 500 Lost Time claims
Examined reports, accounts and evidence to determine integrity and accuracy of information
Worked productively in fast-moving work environment to process large volumes of claims
Modeled exceptional customer service skills
Oversaw claim recoveries and subrogation
Posted payments to accounts and maintained records
Maintained strong knowledge of basic medical terminology to better understand services and procedures
Followed up with customers on unresolved issues
Prepared insurance claim forms or related documents and reviewed for completeness
Senior Workers Compensation Examiner, 07/2007 to 03/2011 Florida Department Of Financial Services – City, STATE,
Entered, recorded, and reviewed claims into claims information management system
Processed routine claims transactions related to reserves
Utilized outstanding communication and interpersonal skills to maintained strong and positive relationships with providers, claimants, and lost time adjusters
Performed verification checks on customer/claimant loss-claims following Bureau standard policies and procedures
Responsible for managing clerical duties for three state agencies.
Managed 300 low touch medical only claims
CSR for Workers Compensation claims department
Reviewed new files to determine current status of injury claim and to develop plan of action
Evaluated original investigation reports and documents to resolve secondary concerns
Reviewed Incident reports, police reports and medical treatment records to determine extent of liability
Researched claims and incident information to deliver solutions and resolve problems
Conducted comprehensive interviews of witnesses and claimants to gather facts and information
Maintained contact with claimants and medical providers to determine treatment status
Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues
Analyzed information gathered by investigation and report findings and recommendations
Claims Examiner/ Senior OCR Operator, 03/2003 to 02/2005 AmeriHealth Administrators – City, STATE,
Adjudicating medical and dental claims
Monitoring claims and reviewing for accuracy
Responsible for key contextual and update edits on fields not passing programming edits at a performance rate of 100%
Keyed video repair and reject re-entry corrections on unscannable data elements with 100% performance rate
Data Entry 10-Key Numeric 10,000 KPH and Alpha Numeric
ICD-9 Coding
Corrected CPT codes to properly classify Medical and Dental claims
Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations
Managed large volume of medical claims on daily basis.
Paid or denied medical claims based upon established claims processing criteria
Collaborated with claims department and industry anti-fraud organizations to resolve claims
Education
Associate of Arts: General Studies , Expected in 12/2003 to Florida Community College - Jacksonville, FL, GPA:
Certifications
Licensed SC All Lines Insurance Adjuster 2015-2019
Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.