Doris Smalls
Rockland
Summary
Dynamic individual with hands-on experience effectively utilizing interpersonal and communication skills assisting diverse population and talent for navigating challenges. Brings strong problem-solving skills and proactive approach to new tasks. Known for adaptability, creativity, and results-oriented mindset. Committed to making meaningful contributions and advancing organizational goals.
Overview
22
22
years of professional experience
Work History
Claims Specialist
Social Security Adminstration
09.2015 - Current
- Follow-up with claimants' on unresolved issues. such as suspended benefits, due to un-reported income, living arrangements, and various un-reported resources .
- Review /request documentation submitted to support various claims filled for non-rep and attorney representative.
- Evaluated and settled complex claims in a timely manner. such as change in disability onset date and workmen's comp entitlement.
- Worked with disability examiners to expedite processing in alignment with procedures.
- Establish various claims face to face or over the phone for initial filing, reconsideration and hearings.
- Conduct personal conferences and make determinations regarding overpaying and suspended benefits.
- Work closely with Medicare and Medicaid eligibility candidates regarding timely enrollment. Including Medicare Part D Extra Help program.
- Review/adjudicate claims for payment and initiate underpayments , overpayments and attorney fees' and approve temporary continue payment of benefits , for timely filed medical reconsideration claims with notices to stop benefits.
- Determine and review documentation when needed if claimants need representative payee to help with their financial affairs. Also, determine if claimants' can handle their own finance.
- Review and expedite immediate payment regarding missing payments or early release of underpayments.
- Contact third party such as attorneys, non-attorneys and disability establishments for clarity on submission of evidence and proper representative filing.
- Establish missing earnings within data base scope, child support, and student entitlement .
- I always try to volunteer for offsite initiatives that will provide professional development and deliver information about agency programs. Example, assist the Metropolitan Public Affairs Specialist on various outreaches.
- I establish and refer cases to Office of Inspector General (OIG) for misuse of SSA benefits, and any fraud action on direct deposits, addresses, or online accounts.
- Utilize Social Security policy and procedures to conduct agency business, and demonstrate confidentiality.
Lead Customer Service Representative
Social Security Administration
01.2004 - 01.2015
- Assist co-workers and resolve all Medicare discrepancies.
- Evaluate and process authentic Immigration documents.
- Oversee system generated alerts involving deceased individuals.
- Review and obtain proofs for established claims with discrepancies.
- Show extensive knowledge and usage of Social Security Automation tools.
- Initiate online access to Social Security website and block online access due to fraud.
- Communicate with the general public face-to-face, by correspondence and telephone.
- Utilize Social Security policies and produces to research and resolve complex issues.
- Investigate and reconcile discrepancies causing interruption in monthly benefit checks.
- Conduct peer-to-peer training, to administer accurate service and system inputs for the public.
- Establish in office / phone appointments regarding benefits and other routine questions/concerns.
- Determine when to provide critical in office payments regarding sensitive or dire need situations.
- Liaison between various Social Security payment centers and field offices regarding high priority issues.
- Review missing payment history and determine if payment was mailed, electronic deposit or given in office.
- Update missing wages, pensions, and work earnings to reflect on IRS data base, Social Security statements or records.
- Establish and refer cases to Office of Inspector General (OIG) for misuse of benefits, direct deposit and internet fraud.
- Continually monitor and terminate all Social Security and non- Social Security deceased individuals with stubborn cases.
- Update and address; phone numbers/direct deposit for Social Security and Social Security Supplemental Income recipients.
- Provide extensive knowledge and forms to the public regarding appeal rights, disability, survivors, supplement income, retirement claims and online services.
- Determine capability on case by case basis, the ability of beneficiaries who need assistance with handling their monthly benefit checks and representative payee accounting forms.
- Assist individuals who are seeking assistance from outside agencies involving Medicare, Servicing Health Insurance needs of Elders (S.H.I.N.E.) and Medicaid.
- Process non-programmatic fee for services utilizing Feebay Net Voucher and Accounting System.
Education
Masters Business Administration - Human Resource Management
Colorado Technical University
Colorado Springs, CO09.2008
Bachelor of Science - Project Management
Colorado Technical University
Colorado Springs, CO06.2006
Associate of Science - Computer Science
Newbury College
Boston, MA05.2005
Paralegal Certificate - Legal Studies
Northeastern University
Boston, MA12.1998
Skills
- Personnel Management, Time Management, Budget and Financial Management, Statistics, Client Relations, Review and Analysis, Mentoring trainees, Team Development, Negotiations, Special Projects, Experience Tele Service Center representative ICAN refresher training
- Microsoft Office: Excel, Word, Outlook, & Power Point Internet Research
- Operating systems: Windows 2003, 2007 and XP
Timeline
Claims Specialist
Social Security Adminstration
09.2015 - Current
Lead Customer Service Representative
Social Security Administration
01.2004 - 01.2015
Bachelor of Science - Project Management
Colorado Technical University
Associate of Science - Computer Science
Newbury College
Paralegal Certificate - Legal Studies
Northeastern University
Masters Business Administration - Human Resource Management
Colorado Technical University
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