Rosa Coleman
Frisco,TX
Summary
At the Social Security Administration, I excelled as a Claims Representative, streamlining claim workflows and enhancing customer satisfaction through effective communication and timely resolutions. My expertise in claims investigation and dedication to team collaboration led to significant improvements in process efficiency and fraud minimization, showcasing my ability to blend analytical skills with interpersonal strengths.
Experienced with evaluating claims for accuracy and compliance. Utilizes strong organizational skills and attention to detail to process claims efficiently. Track record of effectively communicating with clients and stakeholders to resolve claims disputes.
Overview
19
19
years of professional experience
Work History
Claims Representative
Social Security Adminstration
04.2006 - 10.2024
- Worked productively in fast-moving work environment to process large volumes of claims.
- Followed up with customers on unresolved issues.
- Improved customer satisfaction by providing timely and accurate information on claim status and resolution.
- Maintained compliance with Social Security Adminstraion regulations by adhering to established procedures and guidelines in claims handling.
- Developed strong relationships with clients, facilitating trust and open communication during the claims process.
- Enhanced claim processing efficiency by streamlining workflows and implementing best practices.
- Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
- Minimized financial losses by identifying fraudulent claims through thorough analysis and investigation.
- Negotiated favorable settlements with claimants, resulting in cost savings for the company.
- Conducted detailed assessments of claims documents, ensuring accuracy and completeness before submission for approval.
- Reduced turnaround time for claim settlements by prioritizing tasks and managing deadlines effectively.
- Served as a subject matter expert on specialized claims, providing guidance and support to other team members when needed.
- Trained new Claims Representatives on company policies, procedures, and software systems, improving overall team productivity.
- Developed in-depth understanding of insurance policies and procedures.
- Provided exceptional customer service, addressing concerns and resolving issues promptly.
- Maintained up-to-date knowledge of regulatory changes, ensuring company compliance and minimizing legal risks.
- Delivered personalized customer service, addressing policyholder concerns and clarifying coverage details.
- Enhanced client satisfaction by efficiently processing claims within designated time frames.
- Reviewed and updated claim processing guidelines, ensuring alignment with industry standards.
- Investigated and resolved complex claims, ensuring adherence to policy guidelines and regulatory compliance.
- Verified client information by analyzing existing evidence on file.
- Calculated adjustments, premiums and refunds.
- Coordinated with contracting department to resolve payer issues.
- Processed and recorded new policies and claims.
- Checked documentation for accuracy and validity on updated systems.
- Modified, updated and processed existing policies.
Education
Master of Arts - Education
University of West Florida
Pensacola, FL12-2004
Skills
- Claims investigation
- Documentation review
- Allocating claims
- Team collaboration
Timeline
Claims Representative
Social Security Adminstration
04.2006 - 10.2024
Master of Arts - Education
University of West Florida
Similar Profiles
Bryan SztukowskiBryan Sztukowski
Claims Specialist at Social Security AdminstrationClaims Specialist at Social Security Adminstration
RICHARD CUMMINGSRICHARD CUMMINGS
Customer Service Representative at Social Security AdminstrationCustomer Service Representative at Social Security Adminstration
Corina HuertaCorina Huerta
Lead Bilingual Customer Service Rep. at Social Security AdminstrationLead Bilingual Customer Service Rep. at Social Security Adminstration
Karley DuhonKarley Duhon
Claims Representative at Social Security AdminstrationClaims Representative at Social Security Adminstration
Chandrasekhar NowduriChandrasekhar Nowduri
Architect at HCL America / T-MobileArchitect at HCL America / T-Mobile