Kilo Lucas
Culloden,WV
Summary
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
03.2005 - 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
Education
Master of Arts - Organizational Leadership
Mountain State University
Beckley, WV05.2007
Master of Arts - Graphic Design And Business
West Virginia Wesleyan College
Buckhannon, WV05.2004
Skills
- Team Meetings
- Production Goals
- Fraud Detection
- Critical Thinking
- Database Updates
- Project Requirements
- Insurance Terminology
- Reading Comprehension
- Strategic Initiatives
- Information Updates
- Complex Problem-Solving
- Claims Preparation and Processing
- Time Management
Timeline
Claims Specialist and Adjudicator
Social Security Administration Office
03.2005 - Current
Master of Arts - Organizational Leadership
Mountain State University
Master of Arts - Graphic Design And Business
West Virginia Wesleyan College
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