Aisha Gant
Summary
Professional with comprehensive experience in claims processing and evaluation. Demonstrates strong analytical skills, thorough knowledge of insurance policies, and consistent track record of identifying and resolving complex claims. Valued team player with strong focus on collaboration and results, adaptable to evolving work environments. Known for reliability, problem-solving abilities, and effective communication with stakeholders.
Overview
17
17
years of professional experience
Work History
Claims Examiner
Social Security Administration, SSA
08.2022 - Current
- Adjudicate claims for federal benefits such as Supplemental Security Income & Social Security Retirement & Disability benefits
- Respond to claimants in person, by phone & mail regarding a broad range of benefits such as Medicare, SSI, retirement & disability
- Conduct fact finding to obtain information that is material in properly analyzing & adjudicating claims according to Federal, State & agency regulations & guidelines
- Communicate with attorneys & representatives regarding status of claimants application and appeal process
- Reviews evidentiary documents such as medical records, medical forms, statements/forms from employers, job descriptions, narrative information from claimants, employment records & other documents related to allegation of disability
- Prepare correspondence relating to determination of claims to individual claimants, third party agencies & attorneys when applicable
- Handled sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
- Participated in cross-functional team meetings to address organizational challenges related to claims management and develop solutions collaboratively.
- Reduced claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Enhanced customer satisfaction by promptly addressing inquiries and providing accurate information on claim status.
- Maintained detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
- Researched claims and incident information to deliver solutions and resolve problems.
- Maintained current knowledge of industry developments, regulations, and best practices through continuous professional development activities.
Legal Administrative Specialist
Social Security Administration, SSA
09.2019 - 08.2022
- Authorize social insurance benefits to claimants & beneficiaries
- Review and evaluate documents for accuracy to ensure proper case adjustments
- Utilized automated systems to input & process case changes
- Make determinations regarding eligibility & verify payment rates utilizing calc tools, spreadsheets & automated system tools
- Review a broad range of regulations, policies & procedures to verify correctness of claim record & benefits
Claims Specialist
Health Advocate
09.2018 - 08.2019
- Managed a high volume of claim cases effectively by prioritizing tasks and maintaining excellent organizational skills.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Developed strong working relationships with internal staff & external agencies such as insurance company representatives and medical office professionals to facilitate efficient claim resolution processes.
- Settled complex claim cases fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
- Maintained confidentiality of patient finances, records, and health statuses.
- Streamlined follow-up processes for increased efficiency and effectiveness in handling customer concerns.
Human Services Eligibility Specialist
Dept of Disabilites & Special Needs
10.2017 - 05.2018
- Operated within the Intellectual Disability & Related Disability Waiver Unit to assess and determine eligibility for waiver programs for applicants.
- Conducted interviews and maintained effective communication with claimants, employers, medical staff, family members, and relevant third-party individuals/agencies as necessary.
- Verified active Medicaid enrollment to facilitate the initial review of eligibility for applicants.
- Reviewed and evaluated evidentiary documentation, including medical records, forms, disability and health history of claimants, claimant statements, employment records, and medical necessity forms.
- Prepared and issued correspondence regarding waiver determinations to individual claimants, third-party agencies, and attorneys when applicable.
- Developed strong rapport with clients by effectively communicating complex program requirements and processes.
Eligibility Specialist/Registrar
Community Health Systems- Chestnut Hill Hospital
11.2014 - 05.2017
- Interview patients within the hospital to obtain information needed to apply for various programs such as Medicaid and charity programs
- Communicate with physicians, hospital staff, patients’ family members as well as internal & external parties to complete the application process
- Request, obtain & review documentation such as medical forms, pay & income statements, bank statements in addition to other evidence needed
- Enhanced client satisfaction by providing timely and accurate eligibility determination for various assistance programs.
- Communicate with physicians, hospital staff, patients’ family members as well as internal & external parties to complete the application process.
- Reduced errors in eligibility determinations by maintaining thorough knowledge of program guidelines and regulations.
- Ensured compliance with local, state, and federal regulations during all phases of the eligibility determination process.
- Interviewed applicants and explained scope of different available benefits.
- Streamlined application process for clients by implementing efficient case management techniques, improving overall service.
- Established trust with clients by consistently demonstrating empathy, professionalism, and a commitment to their wellbeing.
- Collaborated with multidisciplinary teams to ensure comprehensive support for clients in need of assistance.
- Optimized workflow processes through proactive identification of inefficiencies and implementation of targeted improvements.
Income Maintenance Casework Supervisor
Dept. of Public Welfare
10.2007 - 12.2013
- Ensured accuracy and adherence to federal, state and local program regulations
- Determined eligibility and entitlement to benefits according to regulations and policies.
- Distributed casework assignments and managed staff caseloads to ensure efficient workflow and service delivery.
- Implemented new initiatives and procedures to increase knowledge and availability of client services.
- Ensured accuracy and compliance with federal, state, and local program regulations throughout the eligibility determination process.
- Promoted a positive work environment by mentoring and supporting team members in their professional development.
- Initiated changes in medical coverage, processed enrollments, and updated system records for case closures.
- Boosted staff morale through regular recognition of hard work, dedication, and achievements.
- Conducted interviews and maintained effective communication with claimants, employers, family members, and relevant third-party individuals/agencies as necessary.
- Assessed eligibility and entitlement to benefits in accordance with established regulations and policies.
- Reviewed evidentiary documents, including medical forms, employer statements, pay statements, claimant information, employment records, and other relevant documentation to support benefit applications.
- Communicated effectively with claimants, internal and external staff, hearing and appeal officers, and investigators regarding applications for various benefits.
- Prepared and issued correspondence related to the determination of applications for individual claimants and third-party agencies.
- Represented the Department of Public Welfare during formal appeal hearings with claimants, advocating for the agency's position and ensuring compliance with regulations.
- Supervised and trained staff on the processes for determining eligibility for Medicaid, SNAP, and cash benefit programs, fostering a knowledgeable and efficient team.
Customer Service Associate
Cigna Tel-Drug
09.2009 - 05.2011
- Initiated home delivery pharmacy orders via telephone, ensuring a seamless ordering process for patients.
- Verified patients' insurance and confirmed all necessary details to accurately process pharmacy orders.
- Communicated effectively with internal staff, including pharmacists and lead personnel, and facilitated internal warm transfers when required.
- Assisted a large volume of customers daily with a positive attitude, maintaining a strong focus on customer satisfaction and service excellence.
- Handled customer complaints professionally, resulting in satisfactory outcomes and positive feedback.
- Maintained a high level of product knowledge, providing accurate information to customers.
- Answered customer telephone calls promptly to avoid on-hold wait times.
- Collaborated with team members to achieve monthly targets and optimize workflow efficiency.
- Achieved consistently high levels of customer satisfaction by prioritizing empathy, patience, and effective problem-solving skills during interactions.
Education
No Degree - Public Health
Capella University
No Degree - Nursing
Harcum College
Bryn Mawr, PABachelor of Science - Speech Communications
Millersville University of Pennsylvania
Millersville, PA12-2000
Skills
- Conflict Resolution Skills
- Effective Communication
- Investigative skills
- Critical thinking
- Team Training
- Teamwork and collaboration
- Problem-solving abilities
- Reliability
Accomplishments
- Coordinated and implemented refresher training programs for office staff to enhance knowledge and performance.
- Operated as a Certified ACA Specialist within the hospital patient access environment, providing expertise in Affordable Care Act-related inquiries.
- Contracted as a site inspector for medical offices to ensure compliance with relevant regulations and standards.
- Successfully completed an overpayment Medicaid project that significantly reduced the number of outstanding cases within the office, improving operational efficiency.
Timeline
Claims Examiner
Social Security Administration, SSA
08.2022 - Current
Legal Administrative Specialist
Social Security Administration, SSA
09.2019 - 08.2022
Claims Specialist
Health Advocate
09.2018 - 08.2019
Human Services Eligibility Specialist
Dept of Disabilites & Special Needs
10.2017 - 05.2018
Eligibility Specialist/Registrar
Community Health Systems- Chestnut Hill Hospital
11.2014 - 05.2017
Customer Service Associate
Cigna Tel-Drug
09.2009 - 05.2011
Income Maintenance Casework Supervisor
Dept. of Public Welfare
10.2007 - 12.2013
No Degree - Public Health
Capella University
No Degree - Nursing
Harcum College
Bachelor of Science - Speech Communications
Millersville University of Pennsylvania