Amanda Richards
Pine Island,NY
Summary
Experienced Claims Examiner with over 10 years of experience with Leave of Absence with FMLA and State laws. Organized and dependable candidate successful at managing high volume claims while multitasking, with a positive attitude. Great interpersonal skills and dependable. Willingness to take on added responsibilities to meet company goals while being a team player. Skilled at applying creative approaches to solving complex problems. Adaptable and always eager to learn new things.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Claims Examiner-2
Matrix Absence Management Inc.
05.2015 - Current
- Reviewed new files to determine current status of claim and to develop plan of action.
- Collaborated with disability, ADA specialists on different leaves
- Reviewed and analyzed suspicious and potentially fraudulent activity and took appropriate actions
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Conducted Intro Calls
- Multitasking high volume clients
- Training New Hires
- Performed 2nd and 3rd opinion on cases
- Overseeing work of my colleagues and ensuring high standards are always met
- Setting up team with phone systems
- Providing excellent customer service to HR partners and claimant
- Accuracy of Audits and customer satisfactory surveys
- Maintains Matrix best practice on all PGs and clients
- Understanding of Federal and state Laws
- running reports such as orphan report and open claims
- Maintained respect for sensitive cases practiced HIPPA when review sensitive information and medical
Claims Assistant
Matrix Absence Management Inc.
01.2013 - 05.2015
- Processed Claims in Leave link bonding, newborn, pregnancy, military leaves, serious health condition own, bereavement,
- intro calls,
- Created and updated tracking spreadsheets in Excel, orphan reports, open leaves,
- Logged, allocated and managed claims.
- Helped with tasks in PACS
- Prepared files, letters and notices.
- Worked productively in fast-moving work environment to process large volumes of claims.
- return to work calls/ 5 day RTW
- confirming delivery
- uploading medical or documents to claim
Education
Bachelor of Science - Business Administration Minor HR
Southern New Hampshire University
Hooksett, NH08.2023
Associate of Science - Business Administration -
Southern New Hampshire University
Hooksett, NH08.2022
Skills
- Legal Documentation
- Faxing
- State and Federal Laws
- Administering Claims
- Customer Satisfaction
- Clerical Support
- Training Programs
- Claims Adjustments Review
- Complex Problem-Solving
- Team Training
- Medical Billing and Coding
- Claims Understanding
- Claims Evaluations
- Reading Comprehension/ writing
- Microsoft office
- ICD 10 codes
- administrative experience
- Excel
- power point
- Training new hires
- Data Entry
- Interpersonal skills
- Team player
- time management
- detail oriented
- dependable
- Hard working
- patient
Certification
The National Society of Leadership and Success, Sigma Alpha Pi
Fraud Training
California Fair Claims Settlement
Timeline
Claims Examiner-2
Matrix Absence Management Inc.
05.2015 - Current
Claims Assistant
Matrix Absence Management Inc.
01.2013 - 05.2015
Bachelor of Science - Business Administration Minor HR
Southern New Hampshire University
Associate of Science - Business Administration -
Southern New Hampshire University
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