Kitonya Green

• Developed and implemented standard operating procedures to ensure efficient workflow.
• Identified areas of improvement and developed strategies to increase efficiency.
• Monitored staff performance and provided feedback for improvement.
• Managed daily operations, including scheduling personnel, assigning tasks, and monitoring progress.
• Maintained accurate records of employee attendance and performance reviews.
• Resolved customer complaints in a timely manner to maintain customer satisfaction.
• Ensured compliance with all safety regulations in the workplace.
• Provided support to other departments as needed to meet organizational goals.
• Conducted regular meetings with staff members to discuss any issues or concerns they may have had.
• Assisted in the hiring process by conducting interviews and making recommendations for new hires.
• Trained new employees on proper job functions and company policies and procedures.

· Mentored all incoming TXVI Claims Representative Trainees. This included preparing training, assigning appointments, and other workloads for trainees to meet agency proficiency level. Met with members of management to discuss trainee progress, goals, and performance.

· Conducted desk and interview audits to assess trainee work and recommend best practices to ensure agency alignment.

· Provided ongoing reviews of journeyman Claims Representatives' workloads to provide feedback on needed corrections to ensure policy compliance.

· Regularly monitored all Virtual RO website listings and assign unworked cases to claims representatives. Work closely with the unit supervisor to implement ongoing refresher training sessions to keep up with agency policy changes.

· Participated in conference calls with the Area Director's Office on new or special projects, such as Mississippi Foster Care.

· Processed all Windfall Offset Diaries and E4345 cases for the Jackson District Office.

· Monitored and updated Jackson's Atlanta Region Virtual Web System Windfall Offset Diary MI Information site.

· Prepared training topics for the SSI unit.

· Processed Pre-Release claims for which we had an agreement with MS State Hospital for Jackson District office until our area was realigned.

· Inherited any SSI claims involving two or more multifaceted issues, such as start date and couple's records, in addition to manual computations and claims involving unresolved attorney fees, in addition to processing a regular claim representative workload.

· Lead TE responsible for researching and processing all special projects, including the recent Martinez Redeterminations, Blind Work Expense Project, Mississippi Foster Care Project, and Clark Court Cases.

· Processed Immediate Disability Pilot Claims to ensure swift payment to TERI, QDD, and CAL beneficiaries.

· Conduct unit meetings in the absence of the Operations Supervisor and served as a liaison to address unit concerns, including training needs, and to communicate general personnel announcements, as well as policy changes.

· Monitored and updated ePad 2.0 for all Title XVI Claims Representative Trainees.

· Created a database to track the progress and adjudication of all appeal reversals, and to be able to provide statistical analysis to management.

· Assisted office wide on complex TII work issues, including SGA Determinations and Ticket to Work issues, from my experience as a generalist Claims Representative.

· Sole authority for SSI Aged Alien claims, Authorized Representative Issues, Goldberg Kelly & Low Birth Weight Claims.

· Sole adjudicator for Federal Court remand cases.

· Consulted with OIG staff on investigations in developing fraud cases.

· Analyzed and processed claim rejects, edits, and alerts.

· Resolved unpaid start date claims.

· Evaluated and reviewed all claims prior to termination or start date.

· Created and developed workflow guides.

• Reviewed and analyzed insurance claims to determine validity, completeness, accuracy, and eligibility for payment.
• Investigated complex or high-value claims to identify discrepancies and fraud indicators.
• Researched medical records to evaluate claim validity and verify the existence of pre-existing conditions.
• Processed payments for valid claims according to established procedures.
• Facilitated communication between claimants, providers, attorneys, adjusters, employers, and other parties involved in a claim.
• Assisted with filing appeals on denied claims with insurance companies.
• Compiled data from multiple sources for reporting purposes.
• Interpreted legal documents related to claims processing such as contracts and policy language.
• Provided customer service by responding promptly to inquiries from claimants regarding their benefits or coverage.
• Advised management on potential changes needed in policies or procedures based on findings from investigations.