Claims examiner with strong abilities for problem solving while focusing on quality and customer experience. Action oriented with leadership and relationship-building skills work effectively both as a team member and individually, proficient with technology, and excellent skills in multi-tasking and relating to individuals at all levels, Strong intention for Quality compliance in all regulated environments.
Overview
19
19
years of professional experience
Work History
Medical Disability Examiner /Vocational Program Specialist
State of Florida Department of Disability Determination
04.2020 - Current
Review Disability Claims from Social Security’s Pool of disability requests
Obtain medical records from a wide variety of sources
Read and interpret medical documents
Multi-platform web applications including AS400, Policy.net, Outlook, WHAT, Occubrowse, Skype, Train and SSA.GOV
Contact Claimants and initiate medical exams
Process and obtain questionnaires from clients
Review claimants work history and determine work capability for social security benefits
Print, mail and fax medical record requests
Works efficiently without guidance
Currently Teleworking from home
Manage Claims Queue
Critical thinking
Problem solve
Maintain metrics in QA, 94% or above
Mean Processing manage workload of cases
Cost effectiveness medical costs 5% below state adjustor average
Evaluated medical records to determine eligibility for disability benefits.
Analyzed case files to assess applicants' qualifications for disability claims.
Customer Resolutions Team / Fraud and Disputes Supervisor -Sr. Fraud Specialist
CAPITAL ONE FINANCIAL
09.2006 - 08.2019
Assist agents with help desk questions via inbound que, maintain individual metrics, take over escalated call for customers, resolve fraud disputes and fraud claims, team player, multitasking web systems and programs
Problem solve
Critical thinking
Fraud and Disputes Specialist
Efficient in multi-platform systems
Improved team efficiency by coordinating daily operations and addressing issues promptly.
Supervised staff to ensure adherence to company policies and procedures.
HV- Elite- Sr Customer Service Representative
CAPITAL ONE FINANCIAL
06.2017 - 07.2018
Patience and understanding for resolving customer complaints, problem solving, usage of multi-platform web systems, process disputes and clear low level fraud concerns
CAAT – SR Frontline Specialist
CAPITAL ONE FINANCIAL
01.2015 - 06.2017
HVS-Assist agents on Chaat tool, maintain individual metrics, review call for escalated issues using NICE programs, Multitasking web systems and programs for rewards fulfilment
Manage Chaat tool at command center for HVS, Swap my card and Estates business lines
Agent Coaching
Escalated call Supervisor
Utilize nice program for call review
Multitask web based programs efficiently
Manage chaat tool/ make real time adjustments based on staffing needs
Front Line Manager
CAPITAL ONE FINANCIAL
12.2012 - 12.2014
Manage team of 15-20 associates for Tampa Core Services work group
Provide coaching and feedback to associates based on quality performance
Prepare and deliver performance sessions reviews of monthly metrics and annual reviews
Review time cards, perform weekly team meeting delivering necessary training material, and support team morale by engaging team in fun events and contests
Demonstrate excellent customer service skills, communication and organization, proper decision-making, analytical and multitasking skills
Team Development/ Morale Engagement
Agent Coaching/Quality Management
Communications of training material to management and associates
Manage staffing/schedule lines
Monitor call center metrics /Adhere and manage department policies and procedures
Developed and implemented strategies to improve customer service and increase sales.
Coordinated resource planning efforts to ensure adequate staffing levels during peak periods without sacrificing quality or efficiency standards in operations management tasks.
Drove process improvements by analyzing key performance metrics regularly and adjusting strategies accordingly.
Floor Supervisor
CAPITAL ONE FINANCIAL
03.2011 - 11.2012
Supervise and coach 10 or more collection agents for Loss Mitigation dialer work group
Established rapport with agents, and management team to improve overall collections effectiveness
Scored and documented quality calls for agents in manager’s absence
Temporarily managed team of fifteen or more agents for several months with outstanding results, and maintained schedules
Interface with agents and managers by facilitating team meetings, morale boosting contests and supervisor coaching lists
Coached agents to improve on adherence and stream goals
Provided Team Management during Managers absence
Created Supervisor Coaching Lists, Facilitated Supervisor Pull-Ups
Manage ISAR’s (Agent monitoring System), Created on phone Dialing Schedules for agents
Adjust Agents on Dialer when necessary for Real Time Lends on Dialer
Agent Coaching, Contest Planning, Developed Coaching Aids for agents
Sr. Risk Associate, Account Ownership COF
CAPITAL ONE FINANCIAL
07.2010 - 03.2011
Maintained Manual dialing queue between 150-200 accounts successfully each month finishing in top 5% of my peers
Completed skip work on accounts when necessary
Coached several associates on improving metrics, Team lead and go to person
Provided morale and contest support to collections floor
Ability to work multiple software systems simultaneously paying attention to detail and efficiency
Clerk III Repossession Agent
COAF
10.2008 - 07.2010
Responsible for Managing repossession queue at the end of the repossession collection cycle: servicing auto loans on accounts past 120 days past due, queue management, skip work, working multiple software systems, team partnering and peer coach
Risk Associate
COAF
09.2006 - 10.2008
Responsible for maintaining manual dialing queue for auto loans between 60 and 90 days past due
Performed skip work when necessary on auto loans to locate customers
Serviced multiple accounts both inbound and outbound call queues
Education
B.A - Business Administration/Management
St. Leo University
01.2016
A. A. S. - Business Administration/ Management
Ivy Tech State College
01.2007
Skills
Case assessment
Medical documentation
Decision making
Claim analysis
Timeline
Medical Disability Examiner /Vocational Program Specialist
State of Florida Department of Disability Determination
04.2020 - Current
HV- Elite- Sr Customer Service Representative
CAPITAL ONE FINANCIAL
06.2017 - 07.2018
CAAT – SR Frontline Specialist
CAPITAL ONE FINANCIAL
01.2015 - 06.2017
Front Line Manager
CAPITAL ONE FINANCIAL
12.2012 - 12.2014
Floor Supervisor
CAPITAL ONE FINANCIAL
03.2011 - 11.2012
Sr. Risk Associate, Account Ownership COF
CAPITAL ONE FINANCIAL
07.2010 - 03.2011
Clerk III Repossession Agent
COAF
10.2008 - 07.2010
Customer Resolutions Team / Fraud and Disputes Supervisor -Sr. Fraud Specialist
CAPITAL ONE FINANCIAL
09.2006 - 08.2019
Risk Associate
COAF
09.2006 - 10.2008
A. A. S. - Business Administration/ Management
Ivy Tech State College
B.A - Business Administration/Management
St. Leo University
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