Mareshia Jones
Irmo
Summary
Results-driven insurance claims professional with over 15 years in disability and voluntary benefits. Expertise in managing high-volume claims, ensuring compliance, and delivering exceptional customer service across remote and onsite environments. Accomplished claims manager with a track record of optimizing claims processes and enhancing customer satisfaction. Skilled in analyzing complex claims and collaborating cross-functionally to ensure accurate benefit determinations and compliance.
Overview
18
18
years of professional experience
Work History
Voluntary Benefits Claim Manager – Claims
New York Life Insurance Company
07.2025 - Current
- Manage voluntary benefits claims throughout the full claim lifecycle while ensuring accurate and timely claim determinations.
- Conducted multi-policy eligibility reviews to uncover additional benefit opportunities for claimants with active voluntary benefit policies.
- Review claim documentation and communicate claim decisions clearly and professionally to claimants, employers, medical providers, and internal stakeholders.
- Maintained compliant claim records while adhering to company policies and regulatory requirements to ensure accuracy.
- Collaborated cross-functionally to deliver accurate benefit administration and enhance customer service.
Senior Long-Term Disability Benefits Claims Specialist
Mutual of Omaha Insurance Company
04.2024 - 06.2025
- Managed long-term disability claims, integrating medical, vocational, financial, and contractual information to ensure thorough evaluations.
- Analyzed claim documentation to determine ongoing liability and benefit eligibility, facilitating informed decision-making.
- Interpreted policy language and applied regulatory guidelines to ensure accurate claim outcomes.
- Partnered with leadership to make informed claim decisions and resolve complex claim issues.
- Ensured quality, productivity, and compliance standards while effectively managing a complex caseload of claims.
Short-Term Disability & Accident/Health Voluntary Benefits Specialist
Colonial Life & Accident Insurance Company
02.2022 - 04.2024
- Processed short-term disability, accident, health, and illness claims in accordance with policy provisions, legal regulations, and departmental guidelines.
- Managed a high-volume claims workload averaging approximately 580 claims monthly while consistently exceeding productivity and quality metrics.
- Conducted detailed claim research and analysis to ensure accurate benefit determinations.
- Communicated effectively with policyholders, providers, and internal departments to resolve claim issues promptly.
- Maintained compliance with state regulations and company policies throughout claim adjudication processes.
Paid Leave Specialist (Short-Term Disability)
Unum Life Insurance Company / Colonial Life & Accident Insurance Company
02.2020 - 02.2022
- Administered paid medical leave and short-term disability claims associated with serious health conditions under Paid Medical Leave programs.
- Managed claims and leave cases from intake through resolution while maintaining compliance with statutory guidelines.
- Partnered with HR administrators and employer contacts to coordinate leave administration and claim management.
- Reviewed medical documentation and determined eligibility based on applicable policies and regulations.
- Delivered high-quality customer service and case management support throughout the claims process.
Customer Service Representative IV
Colonial Life & Accident Insurance Company
06.2019 - 02.2020
- Responded to complex customer inquiries related to voluntary benefits, claims status, life insurance, billing, and tax-related questions.
- Handled an average of 50–80 calls daily while consistently exceeding customer satisfaction and quality assurance metrics.
- Resolved customer concerns efficiently while maintaining professionalism and accuracy.
- Achieved and maintained departmental production goals in a fast-paced contact center environment.
Medical Records Specialist / Executive Administrative Assistant
Lutheran Hospice
Chapin
06.2017 - 03.2019
- Managed electronic medical records and physical patient charts while ensuring accuracy and HIPAA compliance.
- Coordinated patient visit scheduling and communicated updates regarding admissions, staffing changes, and care coordination.
- Supported clinical and administrative staff through detailed documentation and operational assistance.
- Maintained effective communication across departments to ensure continuity of patient care services.
Voluntary Benefits Specialist II
Colonial Life & Accident Insurance Company
Columbia
08.2012 - 06.2017
- Processed accident, wellness, cancer, pregnancy, and health claims while ensuring compliance with policy language and legal regulations.
- Managed high-volume production workloads averaging 500–800 claims monthly while exceeding quality standards.
- Conducted claim investigations and reviewed documentation to support accurate benefit determinations.
- Maintained strong productivity and performance metrics in a fast-paced claims environment.
Catalyst Production Clerk
Kraft Foods
Newberry
06.2011 - 04.2012
- Performed production reporting transactions and monitored operational data in a fast-paced manufacturing environment.
- Reconciled production transactions using Microsoft Excel and SAP systems.
- Supported operational efficiency through accurate reporting and data management.
Medicare Claims Processor
Palmetto GBA
Columbia
07.2008 - 06.2011
- Processed Medicare claims and verified procedural coding and diagnosis information.
- Reviewed electronic claims for accuracy and resolved pending claim issues.
- Collaborated with internal departments to resolve claim edits, deferrals, and insurance verification issues.
- Maintained data integrity while meeting production and quality expectations.
Education
Master of Science - Human Resource Development
Strayer University
Columbia, South Carolina01-2021
Bachelor of Business Administration -
Strayer University
Columbia, South Carolina01-2018
Associate of Arts -
Strayer University
Columbia, South Carolina01-2012
Skills
- Disability Claims Management
- Time management
- Conflict resolution
- Attention to detail
- Effective communication
- Decision-making
- Clear communication
- Operations management
- Change management
- Key performance indicators
- Staff training and development
- Verbal and written communication
- Coaching and mentoring
- Cross-functional teamwork
- Long-Term Disability (LTD) Claims
- Short-Term Disability (STD) Claims
- Voluntary Benefits Administration
- Accident & Health Claims Processing
- Leave Administration
- Claims Adjudication
- Policy & Contract Interpretation
- Medical Documentation Review
- Regulatory Compliance
- Customer Service Excellence
- Case Management
- Claims Investigation
- Financial Liability Determination
- Production & Quality Metrics
- Employer & Provider Communication
- Data Analysis & Reporting
- Process Improvement
- Microsoft Office Suite
- Workday
- SAP
- PeopleSoft HCM
- Fineos
- SharePoint
- Workflow Systems
- Mainframe Applications
- Client View
- Content Navigator
- Compass
- Mobius
- Document Direct
- HealthMedx Vision
- DeVero Electronic Medical Records
Websites
Additional Qualifications
- Extensive experience working in remote, hybrid, and onsite environments.
- Strong analytical, organizational, and problem-solving skills.
- Proven ability to manage confidential information with professionalism and discretion.
- Demonstrated success meeting productivity, quality, and compliance standards.
- Experienced in cross-functional collaboration with employers, providers, HR teams, and customers.
Timeline
Voluntary Benefits Claim Manager – Claims
New York Life Insurance Company
07.2025 - Current
Senior Long-Term Disability Benefits Claims Specialist
Mutual of Omaha Insurance Company
04.2024 - 06.2025
Short-Term Disability & Accident/Health Voluntary Benefits Specialist
Colonial Life & Accident Insurance Company
02.2022 - 04.2024
Paid Leave Specialist (Short-Term Disability)
Unum Life Insurance Company / Colonial Life & Accident Insurance Company
02.2020 - 02.2022
Customer Service Representative IV
Colonial Life & Accident Insurance Company
06.2019 - 02.2020
Medical Records Specialist / Executive Administrative Assistant
Lutheran Hospice
06.2017 - 03.2019
Voluntary Benefits Specialist II
Colonial Life & Accident Insurance Company
08.2012 - 06.2017
Catalyst Production Clerk
Kraft Foods
06.2011 - 04.2012
Medicare Claims Processor
Palmetto GBA
07.2008 - 06.2011
Master of Science - Human Resource Development
Strayer University
Bachelor of Business Administration -
Strayer University
Associate of Arts -
Strayer University