Shanise Crawley

• Review, research, and adjudicate over 25 short term disability, FMLA, integrated, and ADA claims
• Ability to learn and use multiple claim system's at once and knowledge of software applications
• Obtain additional information by written correspondence, email and telephone contact for file documentation
• Analyzed complexes caseloads of disability claims, medical records, policies and risk management claims in order to make decisions on initial approval or denial of benefits
• Ability to find solutions to improve workflow efficiency and speed up claims process that met or exceeded team goals
• Trained and mentor inexperienced disability claims specialist to perform among top members of service
• Ability to work independently on own initiative and in team environment
• Checked documentation for accuracy and validity on updated systems.
• Verified client information by analyzing existing evidence on file.
• Used critical thinking to break down problems, evaluate solutions and make decisions
• Exceeded goals through effective task prioritization and great work ethic

Plan and conduct investigation of claims which includes interviewing claimants.

• Analyzed large amounts of data to find patterns of fraud and anomalies.
• Contacted over 50 customers directly to notify of fraudulent activity and minimize impacts.
• Collaborated with team members to discuss fraud trends and brainstorm methods to combat this type of crime.
• Summarized all key information regarding investigation into detailed report for delivery to client.
• Interviewed witnesses thoroughly, asking appropriate questions to ascertain critical details about each case.
• Quickly learned new skills and applied to daily tasks, improving efficiency and productivity.
• Used critical thinking to break down problems, evaluate solutions and make decisions.
• Document investigative findings and escalate unusual or potentially suspicious activity to our Partners
• Collected, analyzed and interpreted information, documentation and physical evidence associated with investigations.

• Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
• Answered over 30 constant flow of customer calls with minimal wait times.
• Offered advice and assistance to customers, paying attention to special needs or wants.
• Followed through on all critical inter-departmental escalations to increase customer retention rates.
• Responded to customer requests for products, services and company information.
• Used company troubleshooting resolution tree to evaluate technical problems and find appropriate solutions.
• Investigated and resolved customer inquiries and complaints quickly.
• Met customer call guidelines for service levels, handle time and productivity.
• Educated customers about billing, payment processing and support policies and procedures.
• Promoted superior experience by addressing customer concerns, demonstrating empathy and resolving problems swiftly.

• Checked patient vitals such as temperature, blood pressure and blood sugar levels.
• Helped patients effectively manage routine bathing, grooming and other hygiene needs.
• Reported unusual or urgent circumstances in patients' condition or environment immediately to nurse supervisor.
• Answered over 20 call lights and supported patient comfort and safety by adjusting bed rails and equipment.
• Utilized nursing knowledge to identify patient needs and offer appropriate remedies.
• Assisted with feeding and monitored intake to help patients achieve nutritional objectives.
• Promoted good oral and personal hygiene by aiding patients with shaving, bathing and teeth brushing.
• Monitored, tracked and conveyed important patient information to healthcare staff to help optimize treatment planning and care delivery.
• Evaluated patients' progress in treatment, communicating observations to physician on duty to maintain or adjust prescribed care.

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