Enthusiastic Social Security specialist who examines claims, negotiates and processes complex cases, and verifies insurance coverage. Attentive team player consistently treats clients fairly and equitably. Motivated to succeed in fast-paced and deadline-driven professional environment.
Overview
18
18
years of professional experience
Work History
Claims Specialist and Adjudicator
Social Security Administration Office
2005.03 - Current
Followed up with customers on unresolved issues.
Conducted full claim investigations and reported updates and actions.
Reviewed new files to determine current status of disability claim and to develop plan of action.
Escalated files with significant indemnity exposure to supervisor for further investigation.
Utilized appropriate techniques to reduce and develop fraud.
Modeled exceptional customer service skills and appropriate diagnostic techniques to team members.
Generated, posted and attached information to claim files.
Maintained confidentiality of patient finances, records and health statuses.
Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.
Checked documentation for accuracy and validity on updated systems.
Verified client information by analyzing existing evidence on file.
Posted payments to accounts and maintained records.
Processed and recorded new policies and claims.
Prepared insurance claim forms or related documents and reviewed for completeness.
Reviewed outstanding requests and redirected workloads to complete projects on time.
Calculated adjustments, premiums, and refunds.
Acted as Retirement, Disability, Medicare and Supplemental Security Income (SSI) subject matter expert, answering internal and external questions and inquiries.
Determined appropriateness of payers to protect organization and minimize risk.
Reviewed client 300+ of client cases per week and verified accurateness and consistency
Conducts interviews in person and by telephone with clients, attorneys, and representatives or advocates.
Adjudicates, develops, and provides notification for the most complex and sensitive cases
Reviews cases to ensure state and federal laws, statutes and procedures, and rulings have been addressed
Serves as authorizer reviewing work of other CSs when a second signature is requires and ensures accurate funds are released to the claimant
Reviews and approves work for technical accuracy, clarity, thoroughness, and sensitivity of notification
Makes determinations on appeal cases as to whether reconsideration of the claim is necessary all policies have been followed
Prepares and conducts training to other employees, attorneys, and area agencies on Social Security topics
VHR Verbalism Hearing Recorder at StratComm, Inc./ Social Security Administration Office of Disability and ReviewVHR Verbalism Hearing Recorder at StratComm, Inc./ Social Security Administration Office of Disability and Review