Summary
Work History
Overview
Education
Skills
Timeline
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Lora Nelson

Columbus,OH

Summary

Skilled Claims Specialist with a proven track record in claims analysis, policy interpretation, and process improvement. Committed to enhancing operational efficiency and delivering exceptional service.

Results-driven Claims Specialist II with over 14 years of experience in claims processing and compliance. Expertise in mentoring staff and collaborating across teams to resolve discrepancies, leading to streamlined processes and improved service delivery.

Detail-oriented Claims Specialist with extensive experience in claims analysis and risk mitigation. Known for strong communication skills and a commitment to process enhancements that drive efficiency and accuracy in claims handling.

Work History

Claims Specialist II

Ohio Department of Job and Family Services
Columbus
06.2011 - Current
  • Analyzed claims to determine eligibility and compliance with state regulations.
  • Processed complex claims efficiently, ensuring accuracy and adherence to guidelines.
  • Collaborated with cross-functional teams to resolve discrepancies in claim submissions.
  • Mentored junior staff on best practices for claims processing and customer service.
  • Implemented process improvements that increased workflow efficiency within the department.
  • Conducted audits of processed claims, identifying areas for potential risk mitigation.
  • Led initiatives to streamline claim resolution processes, resulting in enhanced service delivery.
  • Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.

Unemployment Insurance Examiner

Ohio Department of Job and Family Services
Columbus, OH
03.2000 - 06.2011
  • Analyzed unemployment claims to ensure compliance with federal and state regulations.
  • Evaluated eligibility criteria to determine claimants' benefits accurately.
  • Collaborated with stakeholders to resolve disputes and clarify policy guidelines.
  • Mentored junior examiners on best practices and regulatory updates.
  • Implemented process improvements that enhanced claim processing efficiency.
  • Conducted training sessions for new staff on examination protocols and systems.
  • Reviewed case files for accuracy, ensuring timely adjudication of claims.
  • Reviewed newly filed claims promptly, minimizing delays for those seeking benefits while unemployed.

Customer Service Representative

Ohio Department of Job and Family Services
Columbus, OH
03.1999 - 03.2000
  • Provided accurate information on services and programs to clients seeking assistance.
  • Assisted clients in completing applications for unemployment benefits and social services.
  • Resolved customer inquiries and issues through effective communication and problem-solving skills.
  • Maintained up-to-date knowledge of policies and procedures to ensure compliance and accuracy.

Computer Data Entry Operator

Ohio Department of Job and Family Services
Columbus, OH
03.1998 - 03.1999
  • Entered and maintained accurate client data in state systems.
  • Processed applications and documentation for timely case resolution.
  • Reviewed and verified information for compliance with regulations.
  • Assisted colleagues in resolving data discrepancies efficiently.

Data Entry Operator

Sears Operations Center
Columbus
08.1989 - 02.1995
  • Entered and maintained accurate data in internal databases to ensure information integrity.
  • Validated and verified data entries to identify discrepancies and improve accuracy.
  • Processed high volumes of data efficiently while adhering to established deadlines.
  • Assisted in developing streamlined processes for data entry tasks to enhance workflow efficiency.
  • Collaborated with cross-functional teams to ensure alignment on data-related projects and objectives.

Overview

36
36
years of professional experience

Education

Bachelor of Science - Psychology

Franklin University
Columbus, Ohio, OH
05-2029

Associate of Applied Science - Business Administration

Bliss College
Columbus, OH
05-1990

Skills

  • Claims
  • Claims processing
  • Claims investigation
  • Verbal communication
  • Policy interpretation
  • Claims analysis
  • Documentation review

Timeline

Claims Specialist II

Ohio Department of Job and Family Services
06.2011 - Current

Unemployment Insurance Examiner

Ohio Department of Job and Family Services
03.2000 - 06.2011

Customer Service Representative

Ohio Department of Job and Family Services
03.1999 - 03.2000

Computer Data Entry Operator

Ohio Department of Job and Family Services
03.1998 - 03.1999

Data Entry Operator

Sears Operations Center
08.1989 - 02.1995

Bachelor of Science - Psychology

Franklin University

Associate of Applied Science - Business Administration

Bliss College

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Lora Nelson