Nuche Xiong
Spartanburg,SC
Summary
Dedicated and experienced Claims Specialist with a proven track record of efficiently managing and adjudicating disability and retirement claims. Possesses in-depth knowledge of policies with SSA. Expertise in reviewing and analyzing records to make accurate claim determinations. Strong communication skills with the ability to explain complex policies to claimants in a clear and empathetic manner. Adept at managing a high caseload, prioritizing tasks, and meeting deadlines. Collaborative team player with a commitment to providing exceptional customer service. Continuously stays updated on evolving policies with the agency. Seeking to contribute comprehensive skills and compassion to a dynamic organization focused on helping individuals navigate the disability and retirement claims process successfully.
Overview
10
10
years of professional experience
Work History
Claims Specialist
Social Security Administration
05.2014 - Current
- Resolve complex issues through communication with various agency components via electronic control systems and direct phone calls.
- Adapt to changing workloads and priorities readily by transitioning from the original position as a Claims Specialist in the concurrent Disability (Title II) and Supplemental Security Income (Title XVI/SSI) unit to Retirement Survivors Insurance (RSI) unit.
- Follow strict guidelines to reduce Field Office (FO) processing time. Manage changing assignments by prioritizing and processing according to precedence, using systems including Workload Action Center (WAC), Workload Management Information (WMI), and EDCS action item list in order to more efficiently process both routine and complex assignments.
- Maintain a rolling list of approximately 300 pending claims and track listings to ensure proper handling and development. Monitor and manage WAC listings, EDCS action items, WorkTrack, tickle lists, and office lead box.
- Resolve problems involving Title II / Title XVI post-entitlement claims for attorneys by contacting Payment Centers regarding underpayment awards for claimants and attorney fees that were not paid.
- Interview claimants for all T2 and T16 programs including Retirement, Survivor’s, Medicare, Disability, and SSI. Communicate orally with claimants from diverse socioeconomic backgrounds about complicated and highly sensitive matters relating to laws, regulations, and procedures on entitlement issues.
- Use interviewing skills to gather appropriate information and cover benefits in a timely fashion while remaining courteous and attentive to the situation. Conduct extensive interviews to obtain as much information from the claimant in the beginning, thus preventing further time-consuming contact.
- Prepare written responses to Congressional Inquiries regarding filing procedures, status, and eligibility for benefits to claimants, other SSA components, attorney offices, and outside agencies. Explain in writing which evidence is necessary to process the claims from the beginning to final adjudication. All claims are prepared with a high level of documentation to assist any other individuals and agency components who work with the claim to prevent confusion and secondary contact. described in SSA Policy (PolicyNet).
- Read, interpret, and apply multiple technical procedures, recognize solutions, and make appropriate final decisions based on law. Understand and utilize the Programs Operation Manual System (POMS) through PolicyNet, referring to it daily to document recommendations and complex decisions.
- Research and analyze complex legal and technical issues using area intranet sites, POMS, and other resources. Assist other Claims Specialists in researching policies and procedures to locate and reference precedents, exceptions, and processing methods to ensure that claims are processed correctly and efficiently.
- Provide system and technical support to employees, as well as advice and guidance on policies, regulations, and procedures.
- Copy encrypted electronic disability files to CD for attorneys and track all requests on an Excel spreadsheet.
- Process and adjudicate Title II Retirement, Survivor and Medicare applications. Utilize SSA systems to ensure applicants are insured, explained work limits if the number holder is under full retirement age and query for any other entitlement from other records if the number holder is entitle to a higher benefit amount. Request needed documents to show entitlement for application.
- Process paper and internet appeals for Request for Reconsiderations, Hearings and Appeals Council Reviews for both Title II and Title XVI cases from Worktrack. Complete EDCS, fax or upload all relevant documents to their electronic folder and/or incorporate documents to their paper folder, transfer appeal to DDS, OHO and Appeals Council. Complete all Update after Transfer to keep records and contact information correct.
- Help initiate and process medical redeterminations, record status and send out letters to claimants. Establish Initial medical determination segments in EDCS and faxed all necessary documents into EF.
- Assist other offices with workload sharing taking claims. Initiate and process Title XVI allowances. Request, input and verify any income and resources claimants and/or SSIDC parents have from protective filing date to present. Go over reporting responsibilities with changes in living arrangement, any income or resources.
- Followed up with customers on unresolved issues.
Emergency Room Social Worker
Greenville Health System
08.2013 - 05.2015
- Updated client documentation for accurate, compliant and current records.
- Interviewed clients and families to assess situations, limitations and issues and implement services to address needs.
- Supported clients and families with empathy and compassion during difficult times.
- Advocated for clients to assure respected rights and wishes.
- Assisted clients with navigating and accessing social services such as housing and medical care.
- Formulated treatment plan strategies with multidisciplinary teams to provide comprehensive and continuous care plan.
- De-escalated stressful situations through individual and family crisis interventions.
- Helped clients develop new coping mechanisms and techniques to drive behavior modification.
- Helped clients with recognizing and managing mental health concerns through evidence-based interventions.
- Facilitated group therapy sessions to build supportive, communicative client networks.
- Documented client progress and activities in accordance with agency policies and procedures.
Education
Master of Science - Social Work
University of South Carolina
Columbia, SC05.2015
Bachelor of Arts - Psychology
USC Upstate
Spartanburg, SC12.2012
Skills
- Expertise in processing disability claims efficiently and accurately
- In-depth knowledge of SSA policy and regulation
- Strong written and verbal communication skills to interact with clients, medical professionals, and other stakeholders
- Ability to explain complex disability policies and procedures to claimants in a clear and understandable manner
Timeline
Claims Specialist
Social Security Administration
05.2014 - Current
Emergency Room Social Worker
Greenville Health System
08.2013 - 05.2015
Master of Science - Social Work
University of South Carolina
Bachelor of Arts - Psychology
USC Upstate
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