Enthusiastic professional eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Clear understanding of managing a high-volume workload, meeting deadlines, and implementing company policy. Motivated to learn, grow, and excel in the human resource field by utilizing well developed transferable skills acquired in client and public facing positions. Bringing solid record of accomplishment in Claim Management roles during progressive insurance industry career. Efficiently reviewed and tracked documentation, conducted claimant interviews, and assessed policies to determine eligibility of benefits, independently managed and allocated over $700,000 in monthly claim benefits. Skilled at balancing business and customer interests by fairly applying all policies.
Managed claim adjudication, assessment of risks and development of strategic complex plans.
Key Job Functions:
• Verified disability benefit applicants' employment details, personal details, work history, income, and assets and completed file tracking sheet for each benefit applicant.
• Performed initial screenings, applicant intake and interviews.
• Prepared a variety of different written communications, reports, and documents to ensure compliance.
• Maintained confidential claimant information within applicant tracking system and database.
• Reviewed applicant resumes to identify qualified candidates for Return-to-Work Program.
• Met with managers to discuss vacancies, applicant qualifications and return to work options.
· Independently managed and approved the allocation of $700,000+ in claim benefits (monthly)
· Consistently delivered strong results by exceeding department metric standards of 90% in the areas of Quality Review (achieved 99%), Initial Decision (achieved 100%), Any Occupations Reviews (achieved 100%) and Mental Nervous Reviews (achieved 100%)
· Promoted twice during the span of 3 years with increased caseload and financial responsibility
· Received department recognition for Superior Customer Service Award
Liaised with claimants, physicians, and case managers to resolve claims, meeting or exceeding expectation.
· Selected to serve as team lead/point of contact for influential national account
Assisted multiple Account Executives responsible for expanding business with existing customers and developing new accounts. Key job functions included sourcing, event tracking, developing custom marketing materials and guiding customers through the Biometric Screening process and experience by setting appropriate expectations.
• Selected to serve as point of contact for multiple influential national accounts
• Built tracking system and successfully managed over 500 health-screening events monthly
• Created and maintained the online scheduler for client health-screening events
• Provided administrative support for Account Executives with key projects ranging from customizing marketing materials to problem solving logistics of the onsite events
• Provided support to Account Executives by performing research and sourcing for new business.
· 5+ years of experience conducting interviews with a focus on asking probing and meaningful questions to drive results
· Proficient organization skills to include the successful tracking of documentation and deadlines for 250+ claims monthly
· Experienced independent complex problem solver and decision maker
· Trained problem solver, critical thinker, and negotiator
· Educated in field and web-based sourcing
· Forward thinker with demonstrated foresight in risk management
· Experienced in interfacing with attorneys, executives, and client human resource department heads
· Gifted in areas of marketing and research resulting in client approved marketing materials
· Likable sales skills with the ability to relate to people and implement value-based selling
· Good listener and note taker who makes the speaker feel heard
· Proficient in administrative support to include customer service, logistic support, and strategic planning
· Astute relationship management skills with the ability to identify the needs of the client while upholding company policy
· Contract Analyst with the proven ability to implement and uphold contractual policies and provisions
· Proficient in claim investigations and research
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