Deborah Riddle
Poteau,OK
Summary
Experienced Claims Specialist with 20+ years in claims processing, policy interpretation, and compliance management. Known for accuracy, customer service, and resolving complex claims efficiently.
Overview
21
21
years of professional experience
Work History
Claims Specialist
Social Security Administration Office
02.2005 - 02.2026
- Processed disability claims using agency case management systems.
- Evaluated supporting evidence to determine eligibility and identify missing documentation.
- Communicated with claimants to clarify requirements and explain benefit procedures.
- Resolved discrepancies in records by coordinating with internal staff and external sources.
- Documented case actions and maintained confidential records in accordance with federal guidelines.
- Applied policy guidance to support consistent claims decisions and timely case progress.
- Assisted with claim development by gathering information and tracking follow-up actions.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Developed strong working relationships with external partners such as authorized legal representatives and medical review professionals to facilitate efficient claim resolution processes.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Followed up with customers on unresolved issues.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Reduced claim processing errors by conducting thorough reviews and accurately interpreting policy details.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Achieved performance targets consistently through attention to detail, effective time management, and strong decision-making abilities.
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Streamlined documentation workflow, enabling quicker claim resolution and enhancing customer satisfaction.
- Enhanced accuracy of claim assessments by adopting advanced analytical tools, leading to more informed decision-making.
- Facilitated smooth communication between claimants and ensuring transparent and a positive experience.
- Provided expert advice on complex claim issues, aiding in the successful and timely processing of concurrent disability claims.
- Enhanced data integrity and security in claim management systems, protecting sensitive information from potential breaches.
- Analyzed claim documents to ensure accuracy and compliance, mitigating risk of financial loss.
- Reduced fraudulent claims by implementing stringent verification processes, safeguarding the agency's funds.
- Verified client information by analyzing existing evidence on file.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Checked documentation for accuracy and validity on updated systems.
- Posted payments to accounts and maintained records.
- Calculated adjustments to payments, underpayments as well as overpayments and processed applicable refunds.
- Determined appropriateness of payers to protect the organization and minimize risk.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Generated, posted and attached information to claim files.
- Maintained confidentiality of patient finances, records, and health statuses as well as all personal identifiable information.
- Processed appeals on denied disability claims, both on Supplemental Security Income (SSI) claims as well as Social Security Disability Insurance (SSDI) claims.
- Adjudicated SSI favorable allowance determinations along with appeal reversal determinations.
- Processed post-entitlement changes and updates on all records (retirement, SSDI and SSI).
Education
Bachelor of Science - Business Education
Northeastern State University
Tahlequah, OK05-2009
Skills
- Claims
- Claims management
- Claims analysis
- Claims assessment
- Document review
- Coverage assessments
- Policy interpretation
- Eligibility determination
- Compliance management
- Regulatory compliance adherence
- Information verification
- Denied claims identification
- Claim amount calculations
- Coverage determination
- Claims forms review
- Work prioritization
- Data entry
- Data management
- Data integrity
- Document control
- Records management
- Paperwork processing
- Reporting skills
- Organizing and prioritizing work
- Task prioritization
- Multitasking
- Analytical thinking
- Critical thinking
- Claim follow-up
- Problem-solving
- Attention to detail
- Customer service
- Customer rapport
- Claimant consultations
- Financial transactions
- Forms validation
- Microsoft software proficiency
- Patient contact
- Collaborative relationships
- Teamwork
- Team collaboration
- Communication skills
- Written communication
- Claimant engagement
- Claims payment processing
- Excellent communication
- Claims communication
- Cloud document management
- Complex claims calculations
- Organizational skills
- Microsoft Office Suite
- Data entry accuracy
- Claimant interactions
- Claimant assessments
- Composing business correspondence
- Time-saving strategies
- Payment escalations
- High-pressure situation management
- Streamlining workflows
- Analytical skills
- Multitasking
- Reliability
- Excellent communication
- Organizational skills
- Team collaboration
- Adaptability and flexibility
- Communication skills
- Collaborative skills
- Computer proficiency
- Interpersonal skills
- Relationship building
Timeline
Claims Specialist
Social Security Administration Office
02.2005 - 02.2026
Bachelor of Science - Business Education
Northeastern State University