ABBEY LAMB
Omaha,NE
Summary
Dynamic leave claims specialist with extensive experience at Mutual of Omaha, excelling in claims analysis and customer service. Proven track record in policy interpretation and relationship building, enhancing team performance through effective coaching. Adept at navigating regulatory compliance, ensuring timely and accurate claims processing while fostering positive client experiences.
Overview
6
6
years of professional experience
Work History
Paid Family Medical Leave Claims Specialist
Mutual of Omaha
05.2025 - Current
- Makes sound recommendations and independent decisions throughout the claims process, using thorough evaluation, relevant facts, and information to create action plans.
- Develops claims files demonstrating decision-making based on documented procedures, policy provisions, regulations, and customer expectations.
- Builds professional relationships with claimants, brokers, vendors, internal teams, and other partners, ensuring communication aligns with Mutual of Omaha's values.
- Ensures consistent communication with claimants, employers, and medical professionals, while thoroughly documenting actions and rationales for clarity.
- Accurately calculates financial liabilities, determines eligibility based on contracts and regulations, and manages claims in compliance with federal and state laws, providing timely updates to stakeholders.
- Comprehends and applies insurance regulations, analyzing vocational and medical information to make claims decisions.
- Skilled in task management, utilizing multiple systems, with strong analytical and critical thinking capabilities.
- Communicates professionally with excellent customer service, both written and verbal, while maintaining a high level of accuracy.
- Calculate benefits based on contract provisions, demonstrating strong organizational skills, attention to detail, and the ability to work independently.
- Adapt to change, manages claims long-term, and uses technology (Microsoft apps, GSAP, Fineos) to ensure deadlines are met and situations are diffused when necessary.
LIFE CLAIMS ANALYST II
Mutual Of Omaha
06.2023 - 04.2025
- Accurately determines complex claim benefits payable based on medical records, contract language, and any additional information needed to reach the appropriate decision in a timely manner by analyzing claims documentation and correspondence. This includes both payment and denial of benefits.
- Communicate with external and internal customers to obtain specific claim information in order to finalize claims, and to explain claim handling.
- Provide effective customer service via multiple channels, including phone (to include inbound and outbound calls), written/email correspondence, etc.
- Performs service recovery techniques to resolve requests.
- Provides compliant and easily understood resolution options, with the desired outcome of creating a positive customer experience.
- Utilizes resources to support service delivery, resulting in retaining and/or growing the business.
- Makes appropriate referrals to legal, underwriting, and special investigations as needed.
- Create written letters to provide concise explanations to customers regarding claim determinations.
- Stays abreast of and adheres to company processes and procedures, industry changes, federal and state legislation, and regulations.
CUSTOMER SERVICE REPRESENATIVE
Blue Cross Blue Shield of Nebraska
08.2022 - 02.2023
- Act as a service relationship management professional
for BCBSNE customers, employer groups and providers
to successfully service healthcare insurance needs - Document corrective measures and provide instructions
as needed to internal business areas to ensure prompt
resolution and response to customer inquiries - Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Responded to customer requests for products, services, and company information.
- Enhanced customer satisfaction by promptly addressing concerns and providing accurate information.
- Identify, understand and anticipate providers'
unexpressed needs and concerns in a caring manner.
Life Claims Coach
Mutual Of Omaha
02.2020 - 06.2022
- Mentored new hires, resulting in stronger staff development and increased productivity.
- Provided one-on-one mentoring to help individuals reach their full potential within the organization.
- Coached employees on best practices, providing constructive feedback to support their professional growth.
- Enhanced team performance through ongoing training, coaching, and feedback.
- Attended and participated in training, meetings and workshops.
- Provide effective feedback to help analysts and trainees
learn and grow - Participate in monthly calibration meetings to ensure
our team is on the same page when reviewing and
providing feedback regarding our quality assurance
standards - Provide hands-on coaching and daily support
- Live monitoring trainee's calls to ensure they are fully supported and feel comfortable on the floor
- Stay current on company products, services, and industry regulations, participate in special projects, and handle claims overflow.
CUSTOMER SERVICE REPRESENATIVE
Physicians Mutual
08.2019 - 01.2020
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Entered customer interaction details in Service Desk to
track requests, document problems and record solutions
offered. - Educated customers on promotions to enhance sales.
Responded to customer requests for products, services
and company information. - Answered customer telephone calls promptly to avoid
on-hold wait times. - Contributed to departmental goals by participating in cross-training initiatives to support team members during peak times or absences.
- Expedited financial transactions by coordinating wire transfers, ACH payments, and checks for domestic and international clients.
- Improved customer satisfaction by efficiently addressing inquiries about billing, payments, and account statuses.
- Minimized late fees on overdue accounts through consistent follow-up and timely resolution of outstanding balances.
Education
Bachelor of Science - Business Management And Leadership
Bellevue University
Bellevue, Nebraska, NE05-2026
Skills
- Claims analysis
- Interpersonal and written communication
- Policy interpretation
- Coaching and mentoring
- Customer service and support
- Team collaboration
- Relationship building
- Effective communication
- Adaptability and flexibility
- Insurance policy and PFML knowledge
- Regulatory compliance
- Claims investigation
Timeline
Paid Family Medical Leave Claims Specialist
Mutual of Omaha
05.2025 - Current
LIFE CLAIMS ANALYST II
Mutual Of Omaha
06.2023 - 04.2025
CUSTOMER SERVICE REPRESENATIVE
Blue Cross Blue Shield of Nebraska
08.2022 - 02.2023
Life Claims Coach
Mutual Of Omaha
02.2020 - 06.2022
CUSTOMER SERVICE REPRESENATIVE
Physicians Mutual
08.2019 - 01.2020
Bachelor of Science - Business Management And Leadership
Bellevue University