Researched, gathered and analyzed data from multiple sources to identify discrepancies in claims.
Reviewed and processed incoming claim documents for accuracy and completeness.
Monitored the progress of claims to ensure timely resolution.
Initiated contact with customers to gather additional information or documentation needed to process claims.
Provided guidance and support to customers on the status of their claims.
Adhered to state regulations regarding insurance coverage requirements when processing claims.
Resolved customer complaints promptly and professionally.
Short term disability claims specialist
Metlife
Bloomfield, CT
08.2021 - 03.2022
Worked on claims submitted to the company from members
Participated in team meetings to discuss case management issues and provide updates on pending disability claims.
Worked in multiple systems simultaneously to complete short term disability cases
Handled a caseload of 100+ while meeting timing standards for each claim
Achieved 100% on calls reviewed for quality assurance and received an award for the highest customer service score for the quarter.
Conducted interviews with claimants, employers, physicians, witnesses, and other third parties to obtain information relevant to a claimant's disability claim.
Investigated medical records and gathered evidence in support of approved or denied claims.
Customer Service Advocate
Anthem Blue Cross
Albany, NY
12.2019 - 11.2020
Worked on a dedicated team handling grievances & appeals, claims, and benefit questions
Exceeded goals set by management and the company
Achieved an average quality score of 99% and an average survey score of 4.8 out of 5
Recognized by management for the quality of work and placed on a specialized queue handling claims.
Provided accurate, valid, and complete information to customers in a timely manner.
Maintained records of customer interactions and transactions.
Developed relationships with customers through friendly conversations.
Retirement Specialist
Kelly Services
Schenectady, NY
09.2019 - 11.2019
Worked with multiple systems to input retirement selections
Exceeded work goals set by supervisor and received kudos for high work rate
Helped create a new training program for new employees.
Provided comprehensive advice on retirement planning strategies, including Social Security benefits and 401s.
Assisted customers in understanding the tax implications of various retirement savings vehicles.
Maintained accurate records of member interactions and transactions.
Adhered to all applicable policies, procedures, regulations, and laws.
Took calls for Medicare and Medicaid populations
Achieved a 96% quality score from the first month on the floor and worked with the claims department to process claims as needed.
Provided support to members regarding account inquiries, processing transactions, and resolving issues.
Consumer Services Specialist III
MAXIMUS
Albany, NY
12.2017 - 09.2018
Achieved a 98%+ quality score for the first three months
Supported the DSRIP Specialized Queue due to excellent customer service skills
Participated in a focus group for the search engine in Siebel and became eligible for the shadowing program within the first three months
Received a quarterly excellence award for Quarter 2.
Provided customer service support to clients via phone and email.
Researched and resolved customer inquiries, complaints, and requests in a timely manner.
Assistant Manager
My Place and Company
Delmar, NY
09.2017 - 12.2017
Led training of new hires and implemented new processes for ordering supplies and scheduling
Monitored food preparation methods and developed new specials to maximize business profits.
Provided guidance and support to junior staff members on daily tasks, projects, and objectives.
Conducted regular performance reviews for employees to identify areas of improvement.
Ensured compliance with safety regulations and company policies.
Prep Cook Manager
Warehouse Grill and BBQ
Colonie, NY
04.2017 - 09.2017
Managed a staff of 4-6 to prepare food efficiently
Created specials that saved the restaurant an average of $250 a week and developed efficient opening and closing procedures.
Inbound Sales Representative
Time Warner Cable
Colonie, NY
01.2015 - 07.2017
Exceeded sales quota by 35%+ for three years
Answered an average of 40+ calls a day, helped develop sales scripts, led meetings on de-escalating calls, and developed a new system for agents to track their sales.
Responded to customer inquiries via phone, email and chat.
Identified customer needs and recommended products accordingly.
Line Cook
Warehouse Grill and BBQ
Colonie, NY
01.2017 - 04.2017
Set up and stocked stations, followed instructions from chefs, cleaned stations, and ensured high-quality food service.
Nodal Network Systems Operator Sergeant
United States Army
Augusta, GA
05.2012 - 12.2014
Planned and coordinated with soldiers to implement improved security measures
Conducted training on new equipment and supervised 3-4 soldiers in complex tasks
Operated master consoles to monitor computer systems and networks.
Explosive Ordnance Disposal Specialist
United States Army
07.2011 - 05.2012
Researched and identified ordnance, assisted in preparation and use of advanced robotics, explosively disposed of hazardous ordnance, and maintained tools, equipment, and vehicles
Completed advanced leadership course and received Army achievement award.
Education
Honors Regents Diploma -
Clayton A Bouton High School
Voorheesville, NY
06.2011
Skills
Insurance knowledge
Microsoft Office
Claims Investigation
Confidentiality
Policy Interpretation
Eligibility Determination
Quote
Don't be afraid of failure. This is the way to succeed. - LeBron James
Career Experience
Allstate, Northbrook, IL, Claims Service Specialist, 08/22, Present, Assisted callers by answering inquiry calls related to claims procedures, policy requirements, coverages, and scheduling repairs., Maintained proper file documentation to ensure accurate and complete file resolution., Worked with Auto Damage Adjusters to make sure that payment was issued to all necessary parties when reviewing customer losses and subrogation demands from adverse carriers., Acted as a reliable point of contact for customers throughout the claims process, addressing their concerns with empathy and professionalism., Utilized strong negotiation skills to settle disputed liability cases in a fair and reasonable manner, ultimately minimizing company exposure to financial risk.
Metlife, Bloomfield, CT, Short term disability claims specialist, 08/21, 03/22, Work on claims that are submitted to the company from members., Work the claim from intake all the way through the claims process., Work in multiple systems at once to complete a short term disability case., Was handling a case load of a 100+ at the same time and meeting the standards of timing for each claim., Had 100% on the calls that were reviewed for quality assurance., Also received an award for highest customer service score for the quarter.
Anthem Blue Cross, Albany, NY, Customer Service Advocate, 12/19, 11/20, Worked on a dedicated team that handled grievances & appeals, claims, and benefit questions., Always exceeded goals set forth by my manager and the company., Had an average quality score of 99%., Also had an average survey score of 4.8 out of a possible 5., Was recognized by my manager for the quality of my work., Put on a specialized queue handling claims.
Kelly Services, Schenectady, NY, Retirement Specialist, 09/19, 11/19, Worked with multiple systems in order to successfully input retirement selections., Exceeded work goals set by supervisor., Achieved kudos for the high work rate., Helped create a new training program for the job for new employees.
Capital District Physicians Health Plan, Albany, NY, Member Services Representative, 09/18, 01/19, Answered members calls in regard to the members policy information., Handled questions from members about claims that were submitted., Took calls for Medicare and Medicaid population., Worked with Facets and Maces., Achieved a 96% quality score from the first month on the floor., Worked with the claims department to process claims on a as needed basis.
MAXIMUS, Albany, NY, Consumer Services Specialist III, 12/17, 09/18, Achieved a 98%+ quality score for the first three months on the floor., Chosen to support the DSRIP Specialized Queue, specifically for my excellent customer service skills and attention to detail., Participated and contributed in a focus group for the search engine in Siebel., Became eligible to be part of the shadowing program in my first three months on the floor., Received quarterly excellence award for Quarter 2.
Time Warner Cable, Colonie, NY, Inbound Sales Representative, 01/15, 07/17, Exceeded Sales quota by 35% + for three years., Answered on average of 40+ calls a day., Helped develop sales script., Lead meetings in regards to de escalating calls., Developed a new System to help agents individually track their sales., Completed supervisor training course.
United States Army, Augusta, GA, Nodal Network Systems Operator Sergeant, 05/12, 12/14, Planned and coordinate with other soldiers to implement improved security measures to protect data, software and hardware., Conducted training on new equipment and solutions to problems in the field., Supervised 3- 4 soldiers in complex tasks in an efficient and timely manner., Operated master consoles to monitor the performance of computer systems and networks.
Explosive Ordnance Disposal Specialist, Augusta, GA, Explosive Ordnance Disposal Specialist, 07/11, 05/12, Research and identify ordnance., Assist in preparation and use of advance robotics., Explosively disposing of hazardous ordnance., Prepare and maintain tools, equipment and vehicles., Completed advanced leadership course., Was awarded Army achievement award.
My Place and Company, Delmar, NY, Assistant Manager, 09/17, 12/17, Lead training of new hires to the restaurant and closely worked with them to develop their skills in the kitchen., Implemented new processes for ordering supplies and scheduling of employees., Monitored food preparation methods, portion sizes, and garnishing and presentation of food to ensure that the food is being prepared and presented in an acceptable manner., Developed new specials in regards to business needs and excess supplies to maximize business profits.
Warehouse Grill and BBQ, Colonie, NY, Prep Cook Manager, 04/17, 09/17, In Charge of a staff of 4-6 in order to prepare food ready for service in a timely and efficient manner., Created specials that ended up saving the restaurant on average of $250 a week by using ingredients to their fullest capacity., Developed an efficient opening and closing procedure for all employees to follow for the back of the house positions., Negotiated prices from distributors and was able to save the restaurant on average $200 off of each order that we processed.
Warehouse Grill and BBQ, Colonie, NY, Line cook, 01/17, 04/17, Set up and stocking stations with all necessary supplies., Answer, report and follow executive or sous chef's instructions., Clean up station and take care of leftover food., Ensure that food comes out simultaneously, in high quality and in a timely fashion., Maintain a positive and professional approach with coworkers and customers.