Peggy Espinosa
Claims Specialist
946 Rayhon Terr Rahway,NJ
Summary
Diligent service oriented professional with 10+ years accustomed to working independently and collaboratively in direct response to claimant care and support requirements. Communicates well with others and maintains accurate records. Decisive problem solver with enthusiastic attitude and desire to help claimants/consumers the best I can.
Overview
12
12
years of professional experience
5
5
years of post-secondary education
2
2
Languages
Work History
Claims Specialist GS-11/5 40hr/wk $87,000/yr
Social Security Administration, SSA
New Brunswick, Union, NJ
04.2014 - Current
- Interviewed and followed up with claimants on unresolved issues.
- Gather, analyze and create/assemble initial applications for many types of social secuirty benefits and to make conclusions and/or devise solutions.
- Develop and adjudicate claims and post-entitlement processes through the usage of modernized software and computer systems.
- Ensure that all required evidence meets the provisions and regulations and thoroughly document evidence as instructed by the program’s operating procedures.
- Direct claimants to local agencies for additional assistance. and help.
- Coordinate with state agencies and other sources of Social Security Administration, like the Disability Determination Services (DDS), Office of the Inspector General (OIG) to investigate entitlement and/or eligibility factors and fraud activity.
- Timely and efficiently manage workloads to ensure good customer service and promote good stewardship of the program's resources.
- Monitor 100+ benefit claims and follow up with status until completion.
- Manage multiple workloads daily.
Administrative Assistant
Warren & Kallianos
Charlotte, NC
07.2012 - 10.2013
- Answered customers' questions, and explain available services; investigated and corrected errors upon customers' request.
- Conferred with customers by telephone or in person to provide information about products or services, take or enter information, and/or obtained details of complaints.
- Kept records of customer interactions or transactions, recorded details of inquiries, complaints, or comments, as well as actions taken.
- Contacted customers to respond to inquiries or to notify them of claim investigation results or any planned adjustments.
- Checked to ensure that appropriate changes were made to resolve customers' problems.
- Interviewed customers to obtain information needed for opening and/or updating claims.
Patient Assistance Specialist
Pharmaceuticals Review
East Hanover, NJ
07.2010 - 08.2012
- Helped uninsured/underinsured cancer patients with processing there patient assistance applications, so they are able to receive life saving cancer drugs.
- Collected and entered patient demographic and insurance data into computer database to establish the patient's medical record.
- Identified and calculated proper amount of dosage to send to medical sources and listed payers in proper sequence to establish chain of payment.
- Worked with multiple hospital pharmacy directors and there staff members all over New Jersey to insure that the PAP medications for each patient gets to them with correct dosage and on time for treatment.
Education
MBA - Healthcare Administration
Saint Peter's University
Jersey City, NJ 09.2010 - 05.2012
Bachelor of Science - Economics
Saint Peter's University
Jersey City, NJ 09.2004 - 05.2008
Study Abroad (Comparative Economic Systems)
Universidad Antonio De Nebrija
Barcelona, Spain 05.2007 - 06.2007
Skills
Bilingual in English and Spanish (Verbal and Written)
undefinedTimeline
Claims Specialist GS-11/5 40hr/wk $87,000/yr
Social Security Administration, SSA
04.2014 - Current
Administrative Assistant
Warren & Kallianos
07.2012 - 10.2013
MBA - Healthcare Administration
Saint Peter's University
09.2010 - 05.2012
Patient Assistance Specialist
Pharmaceuticals Review
07.2010 - 08.2012
Study Abroad (Comparative Economic Systems)
Universidad Antonio De Nebrija
05.2007 - 06.2007
Bachelor of Science - Economics
Saint Peter's University
09.2004 - 05.2008
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