NILAM PATEL
Summary
Tactful Claims Specialist with expertise in claim preparation, claims processing and appeal filing. Diplomatic and personable professional accustomed to handling sensitive, confidential information and investigating complex liability claims. Committed to maintaining customer satisfaction and contributing to company success. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Hardworking and passionate job seeker with strong organizational skills. Ready to help team achieve company goals. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills. Experienced Claims Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 3+ years of experience and willingness to take on any challenge.
Overview
10
10
years of professional experience
Work History
SOCIAL CLAIMS SPECIALIST
Social Security Administration
10.2018 - Current
- Developed strong working relationships with external partners such as state adjudicators, legal counsel to facilitate efficient claim resolution processes.
- Performed administrative duties by verifying documentation, researching facts and contacting other parties involved to determine fault percentages and minimize potential losses.
- Conducted full claim investigations and reported updates and legal actions.
- Understood requirements for disputes, gathered evidence to support claims and prepared cases to handle appeals, and overpayment disputes.
- Reviewed outstanding requests and redirected workloads to complete projects on time.
- Optimized work processes within the team by sharing best practices for evaluating evidence, validating coverage eligibility, and determining loss values.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Processed and recorded new policies and claims.
- Identified fraudulent claims through diligent investigation through agency policy when necessary.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Improved claim processing efficiency by streamlining workflows and implementing time-saving strategies.
- Collaborated with cross-functional teams to optimize claims handling procedures, resulting in improved productivity.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Reduced claim processing errors by conducting thorough investigations and accurately interpreting policy details.
- Responded to inquiries by answering questions, providing information and directing customers to appropriate resources.
- Followed up with customers on unresolved issues.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of agency policies.
- Monitored compliance with regulations and industry best practices to promote fair and proper treatment for insured customers.
- Streamlined the claims process for clients with proactive case management, regular updates, and prompt resolution.
- Passionate about learning and committed to continual improvement.
- Self-motivated, with a strong sense of personal responsibility.
- Proven ability to develop and implement creative solutions to complex problems.
- Adaptable and proficient in learning new concepts quickly and efficiently.
- Demonstrated creativity and resourcefulness through the development of innovative solutions.
- Participated in team projects, demonstrating an ability to work collaboratively and effectively.
- Excellent communication skills, both verbal and written.
- Worked effectively in fast-paced environments.
- Developed and maintained courteous and effective working relationships.
- Skilled at working independently and collaboratively in a team environment.
- Identified issues, analyzed information and provided solutions to problems.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Cultivated interpersonal skills by building positive relationships with others.
- Proven ability to learn quickly and adapt to new situations.
- Organized and detail-oriented with a strong work ethic.
- Used strong analytical and problem-solving skills to develop effective solutions for challenging situations.
- Provided advice to customers regarding claims, rights and appeal process to prevent disputes.
- Provided exceptional customer service during stressful situations by offering empathy and support while resolving issues efficiently.
- Maintained accurate records by diligently updating claim files and ensuring all required documentation was submitted in a timely manner.
Human Services Specialist
Hudson County Department Of Family Services
08.2014 - 04.2015
- Completes the necessary forms for applicants program eligibility and acceptance.
- Performs work involved in eligibility determinations, including rates, fees, refunds, credits, benefits, cash values,
payments, collections or other amounts consistent with schedules,formulas or other established procedures. - Collects, reviews and records data and information to evaluate the client's need for support services.
Consults with the supervisor to discuss issues relating to a client's eligibility. - Advises supervisor of client complaints and responds as instructed.
- Conveys information to the general public; informs clients of
available public assistance and other related programs.
Maintains records and files. - Provided crisis intervention services, deescalating tense situations and connecting individuals to appropriate support systems.
- Assessed barriers, strengths and needs of each family and worked quickly to remediate.
- Described procedures, requirements, and benefits to clients and interested parties.
- Established positive relationships with aid recipients and assessed goals, working hard to address individual needs and tailor services to suit them.
- Maintained accurate case documentation, ensuring compliance with regulatory requirements and agency policies.
- Processed applications and followed strict procedures to keep sensitive data confidential.
- Interviewed applicants for services and supported application completion as necessary.
- Answered high volume of calls and provided assistance through effective listening and question response skills.
- Prepared documents for review and completion by service applicants, supporting completion and responding to questions.
- Increased client engagement by developing culturally competent materials and tailoring communication styles to individual needs.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Applied effective time management techniques to meet tight deadlines.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Proven ability to develop and implement creative solutions to complex problems.
- Gained strong leadership skills by managing cases from start to finish.
- Developed and maintained courteous and effective working relationships.
Human Services Specialist
Hudson County Department Of Family Services
04.2015 - 10.2018
- Completes the necessary forms for applicants program eligibility and acceptance.
- Performs work involved in eligibility determinations, including rates, fees, refunds, credits, benefits, cash values,
payments, collections or other amounts consistent with schedules,formulas or other established procedures. - Collects, reviews and records data and information to evaluate the client's need for support services.
Consults with the supervisor to discuss issues relating to a client's eligibility. - Advises supervisor of client complaints and responds as instructed.
- Conveys information to the general public; informs clients of
available public assistance and other related programs.
Maintains records and files. - Provided crisis intervention services, deescalating tense situations and connecting individuals to appropriate support systems.
- Assessed barriers, strengths and needs of each family and worked quickly to remediate.
- Described procedures, requirements, and benefits to clients and interested parties.
- Established positive relationships with aid recipients and assessed goals, working hard to address individual needs and tailor services to suit them.
- Maintained accurate case documentation, ensuring compliance with regulatory requirements and agency policies.
- Processed applications and followed strict procedures to keep sensitive data confidential.
- Interviewed applicants for services and supported application completion as necessary.
- Answered high volume of calls and provided assistance through effective listening and question response skills.
- Prepared documents for review and completion by service applicants, supporting completion and responding to questions.
- Increased client engagement by developing culturally competent materials and tailoring communication styles to individual needs.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Applied effective time management techniques to meet tight deadlines.
- Used critical thinking to break down problems, evaluate solutions and make decisions.
- Proven ability to develop and implement creative solutions to complex problems.
- Gained strong leadership skills by managing cases from start to finish.
- Developed and maintained courteous and effective working relationships.
Education
Bachelor of Science - BUSINESS MANAGEMENT
NEW JERSEY CITY UNIVERSITY
Jersey City, NJ05.2019
Associate of Science - Business Management
Hudson County Community College
Jersey City, NJ12.2017
Skills
- Account Management
- Claims expeditor
- Verbal Communication
- Number-savvy
- Application Review
- Decision-Making
- Client Interviews
- Claims Processing
- Problem-Solving
- Teamwork and Collaboration
- Eligibility Determination
- Attention to Detail
- Policy Interpretation
- Customer Relations
Languages
Gujarati
Native or Bilingual
Hindi
Professional Working
Timeline
SOCIAL CLAIMS SPECIALIST
Social Security Administration
10.2018 - Current
Human Services Specialist
Hudson County Department Of Family Services
04.2015 - 10.2018
Human Services Specialist
Hudson County Department Of Family Services
08.2014 - 04.2015
Bachelor of Science - BUSINESS MANAGEMENT
NEW JERSEY CITY UNIVERSITY
Associate of Science - Business Management
Hudson County Community College
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