NICOLE NORMAN
Newark,DE
Summary
Claims professional with a strong mix of life and disability case management, customer service, and team leadership. Handles claim review, file analysis, return-to-work assessment, benefit accuracy, and escalation support while coordinating with internal and external resources to keep cases moving and decisions well documented.
Overview
19
19
years of professional experience
Work History
Expatriate Benefit Claim Specialist
MetLife
Wilmington
07.2016 - 12.2025
- Manage Life and Long Term Disability cases
- Conducted timely and accurate claim reviews to ensure compliance and support beneficial outcomes for claimants
- Analyze information to make reasonable and logical claim determinations
- Develop detailed action plans for claim management
- Identify return to work potential for Long Term Disability claimants
- Facilitated proactive verbal communication with claimants and representatives to address concerns and enhance claims experience
- Communicate effectively and efficiently with external and internal resources
- Provide timely and detailed written communication during the claim evaluation process
- Process Axa Assistance claim payments timely and accurately
Supervisor Service Operations
Aetna
Newark
05.2012 - 07.2015
- Guiding and driving the development and activities of an organized customer service and claims team
- Oversaw daily operations of team to ensure efficiency and productivity
- Resolved customer concerns, achieving high levels of satisfaction and adherence to service requirements
- Conducted training sessions for new employees, enhancing their skills and ensuring effective service delivery
- Acted as subject matter expert while interfacing directly with internal and external customers
- Planned and established schedules and assignments to effectively meet production goals and optimize team workflow
- Recommend and execute personnel actions, such as interviewing potential candidates and writing and delivering employee evaluations and promotions
Senior Integrated Service Specialist
Aetna
Newark
04.2009 - 05.2012
- Processing highly complex claims/adjustments for all providers and products while exceeding quality and production standards
- Conducted peer claim and call audits, providing coaching to enhance team performance in meeting metrics
- Presented insights and updates to internal and external customers, ensuring clear communication of key information
Integrated Service Specialist
Aetna
Newark
10.2007 - 04.2009
- Processed complex claims and adjustments, handling difficult inquiries to completion while upholding quality and production standards
- Managed activities independently with minimal direction, serving as key contact for internal and external customers
- Handled member calls about Aetna benefits, eligibility, and claim status
- Reviewed service requests using Aetna systems and updated case notes
- Explained plan coverage, copays, and prior authorization steps to members
Associate Service Operations Specialist
Aetna
Newark
08.2006 - 10.2007
- Responded to routine inquiries and resolved concerns related to authorizations, payments, denials, coordination of benefits, and eligibility, ensuring customer understanding and satisfaction
- Investigated, analyzed, and resolved outstanding issues to enhance customer satisfaction while meeting quality and production standards
- Communicated with customers through telephone, written correspondence, fax, and electronic mail to address inquiries and provide support
Education
Master in Science Management - Health Care Administration
Wilmington University
Wilmington08-2011
Bachelor - Human Resources Management
Wilmington University
Wilmington08-2008
Associate - Human Resource Management
Delaware Technical Community College
Wilmington08-2005
Skills
- Claim adjudication
- Claims processing
- Benefit calculation
- Policy interpretation
- Claims investigation
- Claims analysis
- Medical terminology
- Policy eligibility
- Fraud Investigation
- Claim forms review
- Policy execution
- Quality assurance
- Invoice auditing
- Documentation review
- File review
- Time management
- Customer service
- Case management
- Interpersonal communication
- Written communication
- Team collaboration
- Creative Problem Solving
- Creative Problem Solving
- Critical Thinking
- Microsoft office
- Allocating claims
- Claim forms review
- Policy execution
Personal Information
Title: Expatriate Benefit Claim Specialist
Timeline
Expatriate Benefit Claim Specialist
MetLife
07.2016 - 12.2025
Supervisor Service Operations
Aetna
05.2012 - 07.2015
Senior Integrated Service Specialist
Aetna
04.2009 - 05.2012
Integrated Service Specialist
Aetna
10.2007 - 04.2009
Associate Service Operations Specialist
Aetna
08.2006 - 10.2007
Master in Science Management - Health Care Administration
Wilmington University
Bachelor - Human Resources Management
Wilmington University
Associate - Human Resource Management
Delaware Technical Community College