Gloreniece Edwards

• Adjudicates and authorizes entitlement or disallowance actions at all levels of difficulty and complexity under programs administered by SSA.
• Develops, investigates, and resolves claims and post-entitlement actions that may involve suspension, resumption, adjustment, or termination of eligibility, or payments.
• Determines issues in any claim or referred post-adjudicative action, prepares formal or informal determinations relating the facts, evidence and issues to the requirements of the law, regulations, policies and precedents.
• Examined evidence to evaluate its validity and acceptability in establishing entitlement to benefits and took developmental actions to obtain all available relevant evidence.
• Completes development and evaluation of all facts and evidence.
• Maintained accurate records in claims management system, ensuring compliance and facilitating audits.
• Maintains knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
• Responds to contacts from beneficiaries, recipients, the public or other SSA staff by researching inquiries or initiating action to make changes to the claims or beneficiary record.
• Develops facts through direct, mail, electronic, or telephone contacts with FOS, PSCs, WSCS/WSUS, FSPs, beneficiaries, or third parties to resolve discrepancies and to obtain complete information.
• Assists the public by explaining the options for conducting business with SSA, including online services.
• Informs claimants and/or their representatives about their legal rights and reporting responsibilities.
• Assisted applicants in securing and electronically recording required evidence to support claims processing.
• Collaborated with medical professionals to verify information and resolve discrepancies.
• Analyzed trends in claims to identify potential fraud or abuse cases.
• Resolved claims by approving or denying documentation, calculating benefits due and determining compensation settlement.
• Provided support during appeals processes by preparing documentation and responses.
• Maintained detailed records of all claim activities including notes about conversations with claimants or representatives.
• Takes related actions to update or establish SSA records.
• Responded promptly to inquiries from claimants regarding benefits or coverage, enhancing customer satisfaction.
• Performs representational and information activities to secure cooperation of the public; to disseminate facts and advise on program coverage; and to enlist the understanding and cooperation of local organizations.
• Assisted colleagues by providing training on claims processing procedures and best practices. in training on claims processing procedures and best practices.
• Responded promptly to inquiries from claimants regarding benefits or coverage, enhancing customer satisfaction.

provide Technical Assistance (Lead Customer Service Rep) and guidance to Customer Service Representatives (CSR) face-to-face, via instant messaging, Skype or by telephone. I offer support and answer questions pertaining to very unusual/difficult/sensitive cases. I answer all questions verbally and in writing giving the CSR a resource as a reference or tool when needed. I monitor calls and assist management in conducting service observations for CSR calls, providing quality feedback on their accuracy and proficiency. I am responsible for monitoring a unit of 17 CSRs and am available as a backup to other units when the LCSR (Lead Customer Service Rep) is unavailable. I prepared shining star letters for CSRs who receive compliment calls from the public. I review and comment on new procedures and develop reminder items for unit personnel on important issues and actions for the month. I hold one-on-one mentoring sessions with CSRs that need additional help. I Lead with the assist of a Supervisor for the Medicare Cadre that we currently process in our department. I make sure the CRSs process the Medicare enrollment correctly and on time. This is done by checking different programs such as the MBR, PE and NDRed screen.

My goal and objective as a LCSR is to ensure that the CSR provides quality and efficient service to the public by becoming proficient Customer Help and Information Program (CHIP) users. I create desk help guides (i.e. CPS, TCIS, RCS) specifically catered to the CSR job description to ensure proper usage of all SSA programs. With the constant change in policy and procedures, I advise supervisors of training needs and, as assigned, develop appropriate training materials, schedules and plans to meet their needs. I instructed a training class on Chip updates and Benefit Screening, Medicare and SSI. I assist supervisors in developing office work plans and assist in coordinating TSC activities. I am the officer in charge to assist the CSRs when the supervisors or managers are absent or unavailable and they require help from management.

• Guided team in resolving complex customer inquiries effectively.
• Trained new representatives on procedures and best practices.
• Assisted in developing training materials for staff onboarding.