Desired Job Title
Claims Examiner II, STDResearch SpecialistSpecial Accounts AgentProvider Relations AgentLocation Preference
RemoteHybridLocation: Chandler, AZTempe, AZ
Open to relocation: Yes
Open To Work
Barbara Norris
Chandler,AZ
Work Preference
Summary
Dynamic professional with a solid background in administrative support, specializing in high-volume claims processing and compliance. Consistently achieves service level agreements, resolving complex client issues effectively while maintaining exceptional service standards in fast-paced environments.
Overview
14
14
years of professional experience
Work History
Claims Examiner II, STD
LINCOLN FINANCIAL GROUP
05.2024 - 06.2026
- Collected information on complex short-term disability claims and state and federal benefits by engaging with claimants, employers, and medical professionals through phone, email, and fax, ensuring comprehensive claim evaluations.
- Analyzed medical records to provide critical insights for decision-making. Review with the clinical team for more complex medical issues.
- Ensure accurate and timely payments, calculate payments, process over and under payments, apply offsets (state and federal benefits when applicable) and other deductions to claims.
- Managed claims process and maintained accurate records of all actions and decisions to support compliance and streamline future claims handling.
- Work independently, multi-task using 3 screens, prioritize and meet deadlines in a fast-paced, high-volume environment.
- Review individual profiles and contracts and have an understanding of company benefits from FMLA to LTD.
Research Specialist
CENLAR FSB
Tempe, USA
03.2018 - 04.2024
- Promoted from customer service rep to research specialist.
- Managed high-volume research and resolution of issues such as escrow, taxes, monthly payment changes, and insurance, delivering detailed and professional written and verbal client responses post-resolution.
- Resolved all client issues in compliance with 95% standards, consistently achieving service level agreements of 65 issues per day.
- Deliver customer service outcomes and achieve top 5% of team metrics.
- Responded to client inquiries with professionalism, fostering positive client relationships.
Special Accounts Agent
ONTRAC
Chandler, USA
01.2016 - 03.2018
- Delivered consistent critical and effective customer issue resolution resulting to assignment to most elite customers such as Amazon and Staples.
- Managed escalated inbound and outbound calls to track packages and provide shipment updates.
- Coordinated parcel pickups and addressed general information inquiries to enhance customer service.
Provider Relations Agent
HUMANA
Tempe, USA
07.2012 - 04.2014
- Verified insurance for Medicaid and Medicare members, ensuring coverage for 60% elderly population.
- Reviewed and validated member’s explanation of benefits (EOB) including dates of service, location, cost of service and payments.
- Contacted physician’s offices to generate claims using RXclaim, place refill orders, and check schedule availability.
- Monitored medication deliveries to ensure timely arrival for members.
Education
Massage Therapy -
Globe College, Minnesota School of Business
Minnesotadiploma -
Champlin Park High School
Skills
- RxClaims software
- Claims processing
- EHR management
- Medicare plans
- Analytical research skills
- Medical documentation review
- Claim payment processing
- Time management
- Attention to detail
- Effective communication
- Independent work
- Adaptability in complex situations
Awards
- Quarterly True-Blue Award, 05/20
- Quarterly True-Blue Award, 10/21
- Wells Fargo customer service and 100% Chargebacks Award, 01/11
- Wells Fargo customer service and 100% Chargebacks Award, 04/11
- Wells Fargo customer service and 100% Chargebacks Award, 05/11
- Customer Confetti Award, 01/25
- Promoted to Case Manager II, 11/25
- Chosen to be a Mentor to new claims examiner, 03/26
Timeline
Claims Examiner II, STD
LINCOLN FINANCIAL GROUP
05.2024 - 06.2026
Research Specialist
CENLAR FSB
03.2018 - 04.2024
Special Accounts Agent
ONTRAC
01.2016 - 03.2018
Provider Relations Agent
HUMANA
07.2012 - 04.2014
Massage Therapy -
Globe College, Minnesota School of Business
diploma -
Champlin Park High School