Matthew Waldron
Summary
Dynamic Claims Specialist with over a decade of experience in customer service, benefits and health expedited claims analysis, significantly enhancing organizational processes and customer satisfaction. Expertise in insurance claim processing, problem-solving, and effective communication empowers the ability to develop innovative solutions for complex requirements. A proven track record in fostering positive relationships and collaboration across diverse teams demonstrates a commitment to excellence. Ready to leverage extensive analytical skills and leadership capabilities in a senior integrated claims specialist role to drive continuous improvement and organizational success.
Overview
11
11
years of professional experience
Work History
Sr Intergrated Claims Specialist
Lincoln Financial Group
04.2024 - 10.2025
- Reviewing insurance policies to determine the coverage of a claim.
- Communicating with policyholders, medical professionals, legal counsel, and others to obtain information necessary to process a claim.
- Ensuring compliance with company policies and procedures, as well as regulatory requirements
HR Benefits Specialist
ADP
Tempe
11.2022 - 04.2024
- Track and manage employee leave records.
- Handle intake of leave requests, send required notices, forms and letters, determine employee eligibility.
- Coordinate with agency HR Business Partners to evaluate the need for potential accommodations.
Senior Expedited Appeals and Grievances Specialist
UnitedHealth Group
Phoenix
01.2021 - 11.2022
- Responsible for reviewing, analyzing and processing claims regarding customer concerns as a grievance or appeal.
- Responsible for documenting, maintaining and processing claims in a timely manner.
Documentation Team Lead
OptumRx
Phoenix
12.2017 - 01.2021
- Maintained up-to-date knowledge of procedure documents.
- Responsible for annual procedure documents check-ups.
- Produced and provided Customer Advocates with up-to-date Job Aides, Work Instructions, Work flows, etc.
- Policy Tech trained.
Senior Customer Advocate Representative
OptumRx
Phoenix
12.2015 - 12.2017
- Acting as a primary point of contact for customers, answering their questions and addressing their concerns.
- Building and maintaining positive relationships with customers through regular communication and engagement.
- Providing customer service and support, including troubleshooting and problem-solving.
- Documenting customer interactions and providing regular reports on customer satisfaction and feedback.
- Continuously looking for ways to improve the customer experience.
Customer Advocate Representative
OptumRx
Phoenix
12.2014 - 12.2015
- Acting as a primary point of contact for customers, answering their questions and addressing their concerns.
- Building and maintaining positive relationships with customers through regular communication and engagement.
- Providing customer service and support, including troubleshooting and problem-solving.
- Documenting customer interactions and providing regular reports on customer satisfaction and feedback.
Education
High School Diploma -
Maricopa High School
Maricopa01.2009
Skills
- Insurance claim processing
- STD, LTD, and WC expertise
- FMLA administration
- Problem solving
- Customer service and satisfaction
- Effective communication
- Networking skills
- Customer experience management
- Human resources management
- Innovation strategy
- Quality assurance
- Multitasking proficiency
Timeline
Sr Intergrated Claims Specialist
Lincoln Financial Group
04.2024 - 10.2025
HR Benefits Specialist
ADP
11.2022 - 04.2024
Senior Expedited Appeals and Grievances Specialist
UnitedHealth Group
01.2021 - 11.2022
Documentation Team Lead
OptumRx
12.2017 - 01.2021
Senior Customer Advocate Representative
OptumRx
12.2015 - 12.2017
Customer Advocate Representative
OptumRx
12.2014 - 12.2015
High School Diploma -
Maricopa High School