Lauren Hori
Mililani
Summary
Experienced professional with a background in customer service seeking a senior position in the public or private sector. Skilled in interviewing individuals for benefits eligibility under various programs. Recognized as a self-starter, highly dependable, and focused on expeditiously processing work with accuracy. Proven track record of supporting agency or business operations through dedicated performance and extensive experience in customer service and management roles. Committed, reliable, and ready to leverage 28 years of valuable experience gained at the Social Security Administration in Kapolei, Hawaii. Recently retired and prepared to add significant value to a new opportunity. Equipped with strong problem-solving abilities, willingness to learn, and excellent communication skills to contribute to team success and achieve positive results. Eager to tackle new challenges and advance organizational objectives with dedication and enthusiasm. Bring a positive attitude and commitment to continuous learning and growth as a professional claims specialist with a strong record in handling and resolving complex claims efficiently.
Overview
28
28
years of professional experience
1
1
Certification
Work History
Technical Expert Claims Specialist
Social Security Administration
01.2018 - 04.2025
- Processed the most technical and difficult claims to resolution by using manual actions when the electronic processing system do not work.
- Trained new employees on SSA/SSI claims taking process and how to find and read SSA/SSI/ Medicare, and Social Security number workloads while using SSA processing procedures and regulations processing claims expeditiously and prompt.
- Responsible for interviewing, reviewing disability documentation to decide disability, maintaining and current cases providing support and problem-solving.
- Provided formal training to new employees on SSA/SSI systems and to interview the public for eligibility or entitlement of SSA/SSI, Medicare programs.
- Did monthly reviews for Supplement Security Income (SSI) claims specialists making sure claims are processed prompt and according to SSA policy.
- Provided refresher training as needed.
- Resolved customer complaints in person and over the telephone.
- Was the 'go to' person on technical claims issues.
- Implemented automation tools to optimize workflows, saving time and resources for the team.
- Enhanced system performance by identifying and resolving complex technical issues.
- Presented complex technical information in an accessible manner during meetings with my unit.
- Conducted training sessions and refresher trainings on new claims processing policies.
- Developed easy to understand workflow for my peers following governmental policy.
- Delivered high-quality technical documentation that facilitated better understanding of complex systems among team members.
- Mentored junior team members in technical skills development, fostering growth within SSA.
- Responded to customer inquiries and provided technical assistance over phone and in person.
- Researched and identified solutions to technical problems.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Developed strong working relationships with State Disability Examiners, attorneys, and State of Hawaii Dept of Human Services.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes.
- Followed up with customers on unresolved issues.
- Provided expert advice on complex claim issues, aiding in resolution of high-stakes disputes.
- Verified client information by analyzing existing evidence on file.
- Resubmitted claims after editing or denial and assist people with disabilities through the appeals process.
- Calculated payments. overpayments, underpayments and offsets.
- Modified, updated and processed existing policies.
- Carried out administrative tasks by communicating with the public, distributing mail, and scanning documents.
- Maintained confidentiality of claimant records, and health statuses.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Generated, posted and attached information to claim files.
Operations Supervisor
Social Security Administration
11.2009 - 01.2018
- My primary responsibility incuded overseeing daily operations, managing staff, ensuring compliance with Social Security regulations, and providing exceptional public service.
- I handled analyzing disability, retirement, Medicare, public welfare claims data, finding trends, and developing strategies to improve timeliness of payments to claimants and recipients.
- Completed monthly progress reports for employees to check employee performance and workloads.
- Timekeeping
- Approved/denied leave
- Resolved customer complaints
- Held monthly meetings with my unit to discuss 'what's new' and how we can collaborate.
- Conducted Employees Annual performance reviews and Appraisals.
- Managed employees ensuring efficiency, enforcing safety protocols, and meeting operational goals.
- Assigned work
- Implemented SSA/SSI operational policies and procedures.
Assistant District Manager
Social Security Administration
05.2012 - 11.2012
- My role as an Assistant District Manager, my primary goal is to support the functioning of business operations by managing supervisors, coordinating operations, and ensuring exceptional public service.
- I aim to create a positive and productive work environment by communicating with team members, setting clear goals, and checking performance.
- Weekly follow-up with offices within Kapolei’s district to ensure workloads processed promptly.
- Served as a liaison between the State and local governments such as the Department of Human Services.
Technical Expert Claims Specialist
Social Security Administration
01.2010 - 05.2012
- Process the most technical claims using manual actions when electronic processing was not available.
- Train new employees on how to interview the public for eligibility or entitlement of SSA/SSI, Medicare programs.
- Trained new employees on SSA/SSI claims taking process and how to find and read SSA/SSI/ Medicare, and Social Security number workloads while using SSA processing procedures and regulations while processing claims timely.
- Implemented automation tools to optimize workflows, saving time and resources for the team.
Claims Specialist
Social Security Administration
09.1997 - 01.2010
- Interview, Process and document disability claims for the public seeking Disability, Retirement, SSI, Medicare benefits from the Social Security Administration.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
- Posted payments to accounts and maintained records.
- Determined appropriateness of payers to protect organization and minimize risk.
Education
Bachelor's - Science Degree, College of Tropical Agriculture, And Human Resources /Family Resources
University of Hawaii
Honolulu, HI03.1998
Associate in Arts Degree - Early Childhood Education
Honolulu Community College
01.1995
Skills
- Interpersonal Skills
- Flexible
- Leadership
- Independent
- Analytical Skills
- Public Service
- Problem-solving
- Takes initiative
- Bilingual in Chinese
- Windows 11 & Mac Sequoia 1541
- Microsoft PowerPoint
- 10-key by touch
- Data Entry
- Customer service
- Time management
- Reliability
- Effective communication
- Adaptability and flexibility
- Decision-making
- Written communication
- Professional demeanor
- Training and mentoring
- Teamwork
- Organizational skills
- Active listening
- Verbal and written communication
- Customer communication and empathy
Certification
November 2024 Regional Commissioner’s Citation in recognition for providing excellent training to new employees.
September 2017 in recognition of twenty years of service in the Government of the United States of America.
Regional Commissioner’s Citation in September 2016 in recognition of leadership, strength, positive attitude, and commitment to quality customer service.
Commissioner’s Team Award in September 2010 'in recognition for outstanding performance and dedication with providing support in the recovery efforts following the America Samoa Tsunami Natural Disaster'.
Languages
Chinese (Cantonese)
Timeline
Technical Expert Claims Specialist
Social Security Administration
01.2018 - 04.2025
Assistant District Manager
Social Security Administration
05.2012 - 11.2012
Technical Expert Claims Specialist
Social Security Administration
01.2010 - 05.2012
Operations Supervisor
Social Security Administration
11.2009 - 01.2018
Claims Specialist
Social Security Administration
09.1997 - 01.2010
Associate in Arts Degree - Early Childhood Education
Honolulu Community College
Bachelor's - Science Degree, College of Tropical Agriculture, And Human Resources /Family Resources
University of Hawaii
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