Miraz Rasoul
Salt Lake City
Summary
Detail-oriented professional with supervisory experience in disability claims processing. Prior experience in mentoring staff and addressing complex claim inquiries. Committed to achieving team performance goals and metrics.
Overview
11
11
years of professional experience
Work History
Disability Claims Specialist
Disability Determination Services
Salt Lake City, UT
05.2023 - Current
- Assistant supervisor on the unit mentoring staff on adjudicating claims
- Mostly answer difficult claim questions with policy compliant POMS directions
- Complete weekly/monthly stats and weekly reports
- Adjudicate claims for assistant supervisor caseload requirement and sometimes work additional claims for overtime
- Schedule mentor session meetings with staff to assist with medical vocational assessments, FSF, DAA, etc. claims when needed
- Update supervisor on mentee progress and assist with addressing all unit staff questions via email, teams and phone
- Provided new examiner training on the training unit (worked in the training unit for a year as an assistant supervisor prior to moving to the more advanced examiner unit)
- Meet with supervisor weekly to address OQR returns received on the unit and assist with writing IRRs and RPCs
- Assist unit staff with NCPS, DDE, Imagen, eView, and DEDA questions
- Complete QDD/TERI/CAL claims and certified in all other claim types (IN, RC, CDR, PH, EXR)
- Review unit claims needing IQA and OQR corrections prior to closure
- Reset qualified claims for unit staff and complete monthly aged case reports (sometimes full caseload reviews when needed)
Claims Examiner II
Disability Determination Services
Salt Lake City, UT
07.2021 - 05.2023
- Adjudicated all disability claim types (caseload included 100 claims)
- Reached out to claimants to obtain work history for voc, discovered work/sources found and any other needed information on the claim
- Wrote claim FOFAEs and submitted claims to staffing and worked with consultants to correct any changes needed
- Worked with supervisor and mentor on claims and prioritized claims when needed
- Updated claimants on their claim status and sent contact/FTC letters
- Scheduled consultative exams when needed on claims
- Addressed any FSF and DAA found on claims, worked with CDI and consultants to ensure claim adjudicated properly
- Ensured onset was correct on claims (inferred and projected when needed)
- Used POMS to further rationalize issues found in claims
Compliance Officer
Department of Alcoholic Beverage Services
Salt Lake City, UT
08.2019 - 07.2021
- Audited all licensees assigned to me (300 + licensees) at least once every year and follow up audits scheduled as needed
- Collaborated with all licensees, local government, and law enforcement to ensure licensees remained complaint
- Audits conducted would include looking over financial records, purchase receipts, dispensing records, training certificates, etc.
- Processed licensing applications for bars, restaurants, banquets, hotels/resorts, beer only, single events, etc.
- Participated in the regular monthly Commission Meetings and presented on applications processed and licensee issues
- Handled licensee renewals, extended closure requests, manager background checks/fingerprints, and patio extensions
- Worked with local government to resolve licensing issues during Covid-19 pandemic (informed licensees of required closures and rules during the pandemic shutdown)
Customer Success Specialist
Henriksen Butler Design Group
Salt Lake City, UT
05.2018 - 07.2019
- Handled warranty claims submitted to the warranty dept. for repair/resolution, contact was made within the first 24 hours
- Claims submitted daily for approval ranged from 2-8 per day, during the busy season 4-10 per day
- Responsible for all customer contact on the claim; answering questions, updating customers and confirming schedules
- Reached out to different vendors requesting replacement parts and labor reimbursement for repair of product
- Facilitated sending out techs for assessment of products and sending techs to complete repairs when parts are received
- Provided estimates for parts and labor to all customers when product is no longer under warranty
- Responsible for sending out all customer surveys on all orders for the company and tracking customer satisfaction
Claims Adjuster
Progressive Insurance
Midvale, UT
08.2016 - 05.2018
- Obtained recorded statements from claimants on all claims (typically 5-7 claims assigned daily)
- Setup shop repairs and completed total loss tasks on vehicles deemed a total loss
- Investigated coverage issues and obtained documents needed to verify coverage
- Thoroughly investigated facts of loss and determined responsible party in every claim
- Provided genuine customer service to customers involved in a recent traumatic accident
- Setup rentals for customers, followed up on repairs, paid customers for losses
- Drafted reservation of rights letters and denial letters on claims with coverage issues
Claims Examiner
Sedgwick CMS
Salt Lake City, UT
01.2015 - 08.2016
- Processed worker’s compensation claims for Kroger owned stores (Fred Meyer and QFC)
- Provided treatment authorizations and followed up on all treatment plans/requests provided by MDs on claims
- Handled a case load of 90-130 workers compensation claims at a time- including indemnity, litigated, medical, vocational, and permanent disability claims
- Investigated incoming claims for compensability and verified benefits (medical & time-loss) to be paid on each claim
- Filed jurisdictional state forms to LNI to accept, deny or further investigate claims
- Scheduled independent medical exams for second opinions and assigned field investigators on questionable claims
Education
Bachelor of Science - Mass Communications
University of Utah
Salt Lake City, UT05-2013
Skills
- Supervisory experience and managing staff
- Experience in training and mentoring
- Attention to detail and good problem solving skills
- Excellent communication skills; both written and verbal
- Self-motivated and team player
- Claims processing proficiency
Timeline
Disability Claims Specialist
Disability Determination Services
05.2023 - Current
Claims Examiner II
Disability Determination Services
07.2021 - 05.2023
Compliance Officer
Department of Alcoholic Beverage Services
08.2019 - 07.2021
Customer Success Specialist
Henriksen Butler Design Group
05.2018 - 07.2019
Claims Adjuster
Progressive Insurance
08.2016 - 05.2018
Claims Examiner
Sedgwick CMS
01.2015 - 08.2016
Bachelor of Science - Mass Communications
University of Utah