Dynamic Veteran Claims Examiner with extensive experience at the Department of Veterans Affairs, adept at claims processing and data verification. Proven track record in reducing claim processing time and mentoring junior staff. Exceptional verbal communication skills enhance customer service, ensuring compliance and accuracy in complex claims evaluations.
Overview
19
19
years of professional experience
Work History
VETERAN CLAIMS EXAMINER INSURANCE
Department Of Veterans Affairs, Veterans Benefits Admin
07.2009 - Current
Analyze life insurance death claims to ensure the claim is adjudicated in compliance with federal regulations. Process life insurance payments to named beneficiaries
Evaluate documentation for accuracy and completeness,
Coordinate with external shareholders to obtain necessary information for claims adjudication.
Review policy changes and implemented updates into existing processes, maintaining alignment with federal guidelines and standards.
Handle sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claims examination process.
Mentor junior examiners on best practices in claims processing, fostering knowledge sharing and skill development.
Reduce claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
Maintain detailed records of all claims activities, ensuring compliance with regulatory requirements and company policies.
Interpret policy provisions, endorsements, and exclusions to accurately determine coverage for claims.
Provide exceptional customer service by empathetically addressing claimants'' concerns and effectively explaining the claims process to them.
Mitigate fraud risks by identifying suspicious patterns in claims data and escalating concerns to appropriate teams for further investigation.
Conduct thorough investigations of complex claims, gathering relevant documentation and interviewing witnesses when necessary.
Consult police and hospital records when needed.
Commercial Lines Underwriter
Excel Insurance Services
03.2006 - 07.2009
Evaluated and analyzed commercial insurance applications for risk exposure and underwriting guidelines.
Collaborated with brokers to develop tailored insurance solutions that meet client needs.
Conducted thorough reviews of policy terms, conditions, and pricing adjustments for accuracy.
Mentored junior underwriters on best practices in risk assessment and decision-making processes.
Developed strong relationships with clients and agents to foster long-term partnerships and retention strategies.
Achieved performance benchmarks consistently throughout tenure as Commercial Lines Underwriter, demonstrating commitment to excellence in role responsibilities.
Maintained current understanding of industry and underwriting procedures.
Participated in industry conferences and networking events to increase visibility of the company within the marketplace.
Evaluated applications to determine insurance coverage and appropriate risk classifications.
Education
Bachelor of Arts - Sociology
State University of New York
Fredonia, NY
Skills
Claims processing
Verbal communication
Data verification
Disability claims process
Claims evaluation
Customer service and support
Claim form analysis
Timeline
VETERAN CLAIMS EXAMINER INSURANCE
Department Of Veterans Affairs, Veterans Benefits Admin
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