Erica Jones
Springboro,OH
Summary
Experienced Senior Claims Specialist skilled in claims management and insurance policies. Expert in reviewing complex claims, assessing coverage, and negotiating settlements. Strengths include analytical abilities, attention to detail, and risk management knowledge. Enhanced claims processing efficiency and client satisfaction through effective communication and service delivery.
Overview
2
2
years of post-secondary education
15
15
years of professional experience
Work History
Senior Claims Specialist/Social Services Coordinator
Woodglen Alzheimer’s Community
Miamisburg, Ohio
05.2021 - Current
- Reviewed resident insurance claims for Woodglen Alzheimer's Community billing records.
- Processed claim submissions with payers and long-term care carriers.
- Resolved claim discrepancies through records review and policy verification.
- Independently evaluate, process, and manage a caseload of complex or moderately complex individual disability income (IDI) and long-term disability (LTD) claims
- Tracked claim status, denials, and appeals in claims systems.
- Updated claim files with accurate notes, authorizations, and documentation.
- Resolved customer inquiries in a timely manner, while maintaining high levels of customer service.
- Determined liability, compensability, and benefits due on each claim.
Social Services Director
Laurels of Kettering
Kettering, Ohio
02.2014 - 05.2021
- Provided leadership in developing policies, procedures, and protocols for social service programs.
- Ensured compliance with all state regulations concerning social service programs.
- Coordinated resident admissions, transfers, and placement arrangements.
- Developed discharge plans with nursing, therapy, and family teams.
- Conducted psychosocial assessments for Laurels of Kettering residents.
- Supported families through care conferences and service updates.
- Connected residents with community resources and benefit assistance.
- Managed resident grievances and resolved care-related concerns.
- Documented social service notes, resident concerns, and care plans.
- Reviewed resident insurance claims billing records.
- Processed claim submissions with payers and long-term care carriers.
- Resolved claim discrepancies through records review and policy verification.
Social Services Director
Heartland of Miamisburg
Miamisburg
11.2011 - 07.2014
- Developed discharge plans with nursing, therapy, and family teams.
- Coordinated resident admissions, transfers, and placement arrangements.
- Supported families through care conferences and service updates.
- Documented social service notes, resident concerns, and care plans.
- Connected residents with community resources and benefit assistance.
- Managed resident grievances and resolved care-related concerns.
- Collaborated with interdisciplinary teams on resident wellbeing and support needs.
- Coordinated with other departments to ensure efficient delivery of services.
- Ensured compliance with all state regulations concerning social service programs.
Education
MBA -
Purdue University
West Lafayette, IN 08.2026 - 11.2026
Bachelor of Science - Healthcare Administration
Indiana University, Purdue University Indianapolis
Indianapolis, IN 08.2024 - 11.2025
Skills
Experienced Senior Claims Specialist skilled in claims management and insurance policies Expert in reviewing complex claims, assessing coverage, and negotiating settlements Strengths include analytical abilities, attention to detail, and risk management knowledge Enhanced claims processing efficiency and client satisfaction through effective communication and service delivery
Experienced Senior Claims Specialist skilled in claims management and insurance policies Expert in reviewing complex claims, assessing coverage, and negotiating settlements Strengths include analytical abilities, attention to detail, and risk management knowledge Enhanced claims processing efficiency and client satisfaction through effective communication and service delivery
Accomplishments
- Alpha
- 3.98 GPA
References
References available upon request.
Timeline
MBA -
Purdue University
08.2026 - 11.2026
Bachelor of Science - Healthcare Administration
Indiana University, Purdue University Indianapolis
08.2024 - 11.2025
Senior Claims Specialist/Social Services Coordinator
Woodglen Alzheimer’s Community
05.2021 - Current
Social Services Director
Laurels of Kettering
02.2014 - 05.2021
Social Services Director
Heartland of Miamisburg
11.2011 - 07.2014