Motivated and detail-oriented Insurance and Claims Specialist with over 7 years of experience in the insurance and disability claims industries. Proven ability to handle complex cases, provide empathetic client support, and drive process improvements. Skilled in working independently in remote environments while maintaining high standards of accuracy, professionalism, and service excellence.
Skills
Claims Processing
Microsoft Office
Time management
Quality Assurance
Problem-solving
Microsoft Word
MS office
Analytical thinking
Conflict resolution
Medical Billing
ICD-10
Adaptability and flexibility
Insurance Verification
High-energy attitude
CRM software
Member account management
Relationship building
Microsoft Excel
Problem-solving
Call escalation
Compliance management
Documentation review
Policy interpretation
ERISA
Compass
Fineos
GSAP
Work History
Senior Claims Analyst
Mutual Of Omaha Insurance Company
Madison, MS
04.2019 - Current
Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
Communicates with the claimants’ providers to set expectations regarding return to work.
Makes claim determinations, based on the information received, to approve routine disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.
Provide compassionate and timely service to claimants during sensitivelife events.
Customer Care Representative
Progressive Casulty Insurance
Madison , MS
09.2017 - 04.2019
Educated customers about billing, payment processing and support policies and procedures.
Support customer inquiries and insurance policy needs by answering questions regarding coverage, rates, billing issues, and general policy reviews.
Share expertise of Progressive products and services to ensure appropriate insurance coverage through benefits selling.
Care for customers recently in accidents by demonstrating empathy while setting up new claim reports and offering additional products.