Debbie Chmiel
Ilion,NY
Summary
Friendly insurance professional examines claims, negotiates and processes settlements and verifies insurance coverage. Attentive team player consistently treats clients fairly and equitably. Motivated to succeed in fast-paced and deadline-driven professional environment.
Overview
9
9
years of professional experience
Work History
Long Term Disability Claim Specialist
Metropolitan Life Insurance - MetLife
11.2021 - 01.2023
- Provided timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-past environment and in accordance with state and department of insurance regulations
- Communicated with a variety of constituents (claimants, doctors, nurses, employers, and attorneys) to gather information relevant to rendering decisions based on the provisions of the policy
- Clarified and reconciled inconsistencies when gathering information during claim evaluations and collaborates with Fraud Waste and Abuse resources as needed and addresses/resolves escalated customer complaints in a timely and thorough manner
- Compiled file documentation and correspondence requiring extensive policy and factual detail
- Analyzed information to determine if additional information was needed to make a reasonable and logical claims determination based on information available.
Appeals Coordinator
Med-Scribe, Inc.
01.2021 - 05.2021
- Facilitated the administration of insurance appeals after a denial
- Analyzed and assessed facts that pertained to the case to make decisions in a timely manner
- Communicated with policyholders and or insurance companies to acquire missing information for appeal consideration.
Claims Examiner
MedPro Group
05.2014 - 08.2020
- Adjudicate claims based on the sold policy
- Consistently meet or exceed processing goals
- Manage agent and claimant phone calls
- Work effectively with Team Lead & QA Auditor regarding claim questions
- Request additional data necessary to process claim.
Education
Associate's - Computer Electronics Engineering Technology
ECPI University
Greensboro, NC05.2007
Skills
- Medical Terminology-ICD 9 & 10, CPT Coding (10 years)
- Microsoft Office (Word, Excel and Powerpoint) (10 years)
- Claims Processing (10 years)
- Customer Service (10 years)
- Data Entry (10 years)
- Insurance Coverage Limits (10 years)
- Medical coding
Timeline
Long Term Disability Claim Specialist
Metropolitan Life Insurance - MetLife
11.2021 - 01.2023
Appeals Coordinator
Med-Scribe, Inc.
01.2021 - 05.2021
Claims Examiner
MedPro Group
05.2014 - 08.2020
Associate's - Computer Electronics Engineering Technology
ECPI University
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