Beverly Eggleston
Roanoke,VA
Summary
Reliable professional familiar with federal programs, legal terminology and state laws affecting its citizens. Offering over nine years of hands-on experience advising clients on matters pertaining to entitlement of benefits. Skillful in preparing claims, obtaining supporting documents and evidence and performing investigations to determine eligibility. Friendly and compassionate professional with positive attitude and strong customer service skills.
Overview
12
12
years of professional experience
Work History
Veteran Service Representative
U.S. Department of Veterans Affairs
08.2023 - Current
- Serves as an Authorizer reviewing all required work of other Veteran Service Representatives when a second signature is required.
- Reviews and approves work for technical accuracy, clarity, thoroughness, and sensitivity of notification.
- Makes administrative decisions and special determinations relating to qualifying military service, character of discharge, domestic relations contested claims, homicide, presumed death, line of duty, or willful misconduct violations.
- Explains a final decision if a veteran expresses an indication of dissatisfaction with a determination.
- Uses electronic data processing systems for inputting data related to claims adjudication, processing, monitoring and correspondence preparation.
- Acts as an advocate for veterans and their beneficiaries in their dealings with other VA elements.
- Maintained up-to-date knowledge of federal regulations, policies, and procedures related to veteran benefits administration.
Senior Ability Analyst
The Hartford
09.2022 - 08.2023
- Review and adjudicate short term disability and absence management claims.
- Utilize critical thinking and mathematical skills to gather information, and to apply reasoning and appropriate adjudication for each claim.
- Review medical documents from the attending physicians that support the claim.
- Identify when subrogation and other recovery opportunities may need to be assessed.
- Review and process FMLA claims.
- Correspond with customers verbally and via written communication regarding their claim status by maintaining a dedication to meeting the expectations of the client and their employees.
- Maintain up to date claims metrics.
- Collaborated with cross-functional teams to identify opportunities for process improvement and increased efficiency.
- Initiate new claims for leave of absences for employees.
Disability Determination Analyst
Department of Aging and Rehabilitation Services
04.2021 - 05.2022
- Provided accurate and efficient determinations of social security disability claims (long term disability claims -LTD) by analyzing objective medical records, vocational assessments, and other specialized data in accordance with federal and state regulations.
- Conducted investigations regarding claims.
- Reviewed medical records from physicians regarding claimants’ health history.
- After claim analysis is complete, submit claims for medical review.
- Maintained case load of over 120 claims - data management.
- Utilize verbal and numerical critical thinking skills to gather information and data to make sound decisions based on analysis and judgment.
- Identify fraud indicators
- Communicated with disability law attorneys regarding claim status and missing documents.
Intake Coordinator and Billing Specialist
Commonwealth Care of Roanoke
01.2017 - 11.2020
- Provided insurance verifications for incoming patient referrals.
- Correlated with Admissions on residence acceptance into the nursing facilities.
- Collected, verified, recorded and processed client demographics, insurance payments, and referral information.
- Updated daily census reports, monitored, and reconciled monthly reports for each assigned facility.
- Audited accounts and posting insurance remits accurately.
- Trained new employees.
- Assisted in Special Projects assigned by Manager.
- Processed skilled nursing claims and workers compensation claims.
- Provided account reconciliation.
- Investigated claims for accuracy of payments and denials.
- Maintained requests for authorizations for skilled services.
Enrollment and Billing Representative II
Anthem Blue Cross Blue Shield
01.2012 - 10.2016
- Processed medical claims for supplemental policies.
- Eligibility determination for medical benefits and claims.
- Worked effectively with medical payers such as Medicare, Medicaid, commercial insurances to obtain timely and accurate payments.
- Trained new hires on company-specific billing software, policies, and procedures, promoting team cohesion and productivity.
- Maintained customer and provider enrollment database.
- Maintained and reconciled premium bills, and self-bill accounts.
- Assisted management with month-end close activities, ensuring accurate financial reporting within set deadlines.
Education
Associates Degree -
Virginia Western Community College
05.2004
Advanced Diploma -
Franklin County High School
06.2001
Skills
- Disability Evaluation
- Claims Processing
- Benefits Administration
- Staff education and training
- Community Outreach
- Documentation Management
- Administration and management
Accomplishments
Member of the National Honors Society
Key Qualifications
- Detailed experience in claims adjudication with a keen ability to analyze payment accuracy and proper reimbursement. More than nine years of claims handling and billing experience.
- Excellent verbal and written communication abilities.
- Highly organized and detail oriented with comprehensive knowledge of Accounting, Accounts receivable and A/R denials.
- Strong interpersonal skills and customer relationship skills.
Timeline
Veteran Service Representative
U.S. Department of Veterans Affairs
08.2023 - Current
Senior Ability Analyst
The Hartford
09.2022 - 08.2023
Disability Determination Analyst
Department of Aging and Rehabilitation Services
04.2021 - 05.2022
Intake Coordinator and Billing Specialist
Commonwealth Care of Roanoke
01.2017 - 11.2020
Enrollment and Billing Representative II
Anthem Blue Cross Blue Shield
01.2012 - 10.2016
Associates Degree -
Virginia Western Community College
Advanced Diploma -
Franklin County High School