Deborah Cooley
Indianapolis,IN
Summary
Adept at navigating complex insurance and program coordination, I leveraged strong analytical skills and professionalism at Renaissance Life and Health Insurance Co. to enhance claims processing efficiency. My expertise in relationship management and documentation significantly improved client satisfaction and operational workflows, marking me as a key contributor to team success.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Life and Disability Claims Examiner II
Renaissance Life and Health Insurance Co.
Indianapolis, IN
11.2019 - Current
- Responsible for the accurate review of claim applications for completeness and accuracy
- Evaluate claim documentation to determine relatedness; order medical records to rule out pre-existing conditions when illness/injury start date is not clear
- Respond timely to Employee and Employer inquiries
- Provide claim status to both employee and employer on claim process
- Apply payment offsets as needed to assure accurate payment
- Inform all parties of final claim decision in writing for both claim payments and claim denials
- Process claims according to written procedures and Claims Best Practice
- Examine claim materials to ensure insurance coverage and validity
- Serve as a Subject Matter Expert on two of the company’s disability products
- Provide virtual training to new hires on New York Disability and Paid Family Leave
- Mentor new hires as needed on claim reviews and processing
- Serve as department liaison assisting in onboarding of new employer groups
- Provide claims direction or updates in virtual weekly/bi-weekly meetings to new clients
- Work with Sales Representatives and Account Managers to assure smooth transition with claims submissions
- Assist claims manager with team escalations as needed
- Pay or deny claims in accordance to ERISA Law Guidelines
Program Coordinator (TANF, PCBHI)
Indiana Family and Social Services Administration
Indianapolis, IN
03.2019 - 11.2019
- Responsible for coordinating and managing program needs and quality assurance activities for TANF supported by PCBHI implementation
- Manage TANF reporting and client level data for all TANF supported program areas within DMHA
- Interface with various internal/external stakeholders utilizing both written and verbal communication
- Utilized critical and analytical abilities to translate program and data information into meaningful and useful communication across systems and knowledge levels
Claims Analyst
Seven Corners, Inc.
Carmel, IN
06.2014 - 01.2019
- Responsible for processing both foreign and domestic Travel Insurance claims accurately and timely
- Proactively adjudicated claims and maintained system follow ups
- Secured documentation to support claim payments for lost/damaged luggage, trip delay and cancellation claims along with death and medical claims
- Accurately processed claims for payment
- Notified claimants in writing or verbally of claim payment or claim denial as needed
- Actively participated in team meetings
- Assisted team manager with morale boosters in team meetings
- Assist with training of new employees on processes and procedures
- Coordinated with medical team for international medical repatriations
- Selected to serve as claims point of contact for new account acquisitions
- Obtained and maintained Property and casualty claims professional licensing in 17 states
Retirement Plan Specialist
Indiana Public Retirement System
Indianapolis, IN
03.2013 - 05.2014
- Responsible for explaining complex plan provisions to members
- Challenged to maintain a high-level understanding of plan provisions and laws governing the system to include computation of the defined benefit pension for retirement, disability and survivor benefits; the self-directed investment options of the members Annuity Savings Account and sustain a thorough understanding of Quarterly member statements of Accounts
- Assist members with service credit questions and issues
Senior Casualty Claims Adjuster
American Family Insurance Company
Indianapolis, IN
01.1998 - 08.2012
- Company Overview: (Indiana office closed due to corporate reorganization)
- Challenged to conduct investigations, document information, analyze loss and exposure by obtaining information from the insured, claimants, vendors, and field personnel
- Negotiate settlements with injured party or their attorney based on physical damage, bodily injury and errors and omission claims
- Investigated cause and origin of claims by contacting the appropriate parties
- Recognized when to secure additional documents from federal, state, and local agencies to complete claim file investigation
- (Indiana office closed due to corporate reorganization)
Education
Bachelor of Science - Public Health Administration
Indiana University at Indianapolis
Indianapolis, Indiana05.1989
Skills
Strong analytical skills
Professionalism and integrity
Documentation proficiency
Time management capabilities
Self-motivation and initiative
Workflow management
Relationship management
Verbal and written communication
Professional Highlights
- Recognized for exceeding customer service goals based on the number of complimentary letters received from customers.
- Achieved distinction as one of top 3 collectors in the office for collecting over $140,000 in 1 year.
- Recognized for meeting quarterly subrogation goals.
- Maintained 100% closing ratio of files each month.
- Saved over $20,000 for company by referring files to medical services department in which the client seemed to be over-treated or the provider over-charged for services.
- Organized and planned fundraiser for company sponsored golf outing. Collected over $10,000 which was donated to support youth activities at Indianapolis’ Douglas Park.
- United employees to form the companies first chorale ensemble during Black History Month to go sing in hospitals, nursing homes and in the office. Fame spread to HQ and others formed throughout the company.
- Served as Company Representative on the United Way Committee Fundraising Campaign.
Certification
- Resident Producer- Individual License for Life, Accident & Health Insurance, Indiana. Expires 2027
ACTIVITIES
Community Volunteer Event Coordinator Implemented and organized an annual community-wide event for inner-city youth, successfully raising funds and securing volunteers.
· Coordinated logistics and obtained a venue for the event.
· Engaged diverse cultural groups to ensure that the needs of all attendees were met.
· Collaborated with various organizations to guarantee the event's success.
Timeline
Life and Disability Claims Examiner II
Renaissance Life and Health Insurance Co.
11.2019 - Current
Program Coordinator (TANF, PCBHI)
Indiana Family and Social Services Administration
03.2019 - 11.2019
Claims Analyst
Seven Corners, Inc.
06.2014 - 01.2019
Retirement Plan Specialist
Indiana Public Retirement System
03.2013 - 05.2014
Senior Casualty Claims Adjuster
American Family Insurance Company
01.1998 - 08.2012
Bachelor of Science - Public Health Administration
Indiana University at Indianapolis