Sylvia Annette Lee
West Jordan,Utah
Summary
I consistently demonstrates the ICARE values during the commission of her duties.
Integrity: I adhere to ethical principles ensure each priority claim (Nehmer Survivor, Blue Water Navy)were processed accurately and no corners were cut in serving this group of Veterans. My integrity is beyond reproach and she leads by example every single day in all that she does. I have been recommended for a special contribution award for her outstanding support and effort in several areas including rating Nehmer Survivor claims, Blue Water Navy claims and quickly achieving Nehmer Subject Matter Expert (SME) status which allowed her to mentor, review, and second sign Nehmer Survivor rating decisions. I have embraced her Nehmer SME duties and has provided valuable and relevant guidance to her co-workers.
Respect: I bring a positive attitude to work every day. My disposition and positive attitude has earned me the respect of many co-workers and supervisors alike. I enthusiastically takes on any assignment or task and once assigned there is never a concern about the task being completed timely. In addition I always demonstrates respect to my peers and management ensuring I don't step on any toes when expediting any task thrown her direction. I always communicates in a respectful manner to every person she encounters.
Excellence: I diligently work very hard to improve my outstanding efforts by requesting every opportunity to develop and enhance her skills as a mentor and communicator through training (ELITE) and mentoring (Nehmer SME, new RVSR mentor duties). I have maintained outstanding production and quality while completing her Nehmer SME duties and I have worked very hard in the past several months to develop VBA leadership skills to enhance her career direction. My actions demonstrate the ICARE attitude to it's fullest. My dedication in assisting the VSC has played a significant role in the overall success of the the VA mission. My dedication and passion in serving Veterans provides the SLC VSC immeasurable benefits in helping meet timeliness goals and taking care of the Veterans who have waiting the longest for their benefits.
Overview
12
12
years of professional experience
Work History
Rating Veterans Service Representative GS-12-5
Veterans Benefit Administration
Salt Lake City, UT
04.2015 - Current
- Hours per week: 40
- Duties, Accomplishments and Related Skills:
- Expertise
- Conduct individual quality reviews: Instruct and Provide Mentoring to new mentees
- In-Process Reviews are conducted on a randomonly to help facilitate error-trends
- Personnel Training: Personnel training is provided on a daily basis per QMS reviews for correction
- Claims Management Processes and Procedures Expertise: Denova Review of claims to ensure accurate and proficient decisions
- Quantitative/ Qualitative Analysis, Statistical analysis, trends analysis: Weekly reporting on new transitional employees on progress.
- Expertise (VBA Claims Management System , QMS, STAR): Review of VBMS claims for intial, suplement claims
- After extensive research I am able to review all the evidence and make a sound decision of a claim file from the beginning of the Veterans submission to completed of claims
- Quality /assurance Processes and Procedures Policy & Legislative analysis:
- Communications/ Reporting:Delivering clear and concise that conveys procedures on laws and regulations
- Work and communicate within my team environment
- I work with Coach and co workers on interpretation of the laws
- Conducting reviews to analyze the quality of completed rated cases; Subject Matter Expert for Nehmer adjudicated claims
- Conducting evaluations and reviews on a quantitative or qualitative basis of claims development programs and operations to determine the effectiveness in meeting established goals and objectives;
- Preparing or conducting training activities; Identifying knowledge/skill gaps and plan training strategies;
- Providing and implementing data for one or more information management systems accurately and timely; and
- Providing technical guidance and direction to staff in the daily operation and maintenance of claims management systems
- Serves as a decision maker for claims involving difficult Nehmer, Blue Water Navy, Benefits Delivery at Discharge rating decisions
- Review claims for second signature
- Responsible for developing viewpoints and reconciling differences of opinions and assists with the training of new members
- Incumbent is responsible for analyzing claims to make determinations regarding service-connection, percentage of disability, permanent and total disability and entitlement to compensation, pension and vocational training, medical and dental treatment, adaptive equipment for, automobiles or other conveyances, insurance, specialty adapted housing, dependent education allowances, and other ancillary benefits
- Assures proper application of laws, regulations and procedures and is accountable for proper analysis, appropriate development and final rating determinations
- I contact the Veteran directly to clarify claimed conditions in which are in question
- When the Veteran representative or advocate has contact me directly I will respond respectively and concisely on the status of the claim
- Mentor Reviews for new employees in training for the Rating Veteran Service Representative
- Analyzing claims; Interpreting and applying benefits-related laws, regulations, and procedures;
- Reviewing and examining evidence and making determinations as to the entitlement and/or eligibility of claimants for benefits and services involving compensation and pensions.
- Checked documentation for accuracy and validity on updated systems.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
Veteran Service Representative
Veterans Administration
Salt Lake City, UT
09.2012 - 04.2015
- The Veterans Service Representative explains benefit programs and entitlement criteria, conducts interviews, identifies issues, gathers relevant evidence, adjudicates claims, and inputs data necessary to generate the award and notification letter to the Veteran describing the decision and the reason for it
- Specific duties are the following: Analyzing claims, interpret and applying benefits-related laws, regulations and procedures
- Review and examine evidence for full range of VA benefits and all related programs
- Makes determinations as to eligibility for the type of benefit sought by fully analyzes, develops, with claim processing, and requests required evidence for certain compensation and claims requiring a rating decision
- Decides the necessity for and type of examinations, reexamination or opinions to determine the existence of or to evaluate disabilities resulting from diseases or injuries
- Develops comprehensive requests for these examinations/opinions to ensure appropriate evidence is received from which to adjudicate the claim
- Prepares correspondence to members of Congress and special interest groups on case assignments and other “controlled” correspondence
- Reviews all correspondence to private attorneys; acknowledges and revokes designations for private attorneys
- Utilizes various electronic data processing (EDP) systems for inputting data related to claims adjudication, processing, monitoring, and correspondence preparation
- Context: I was tasked with working the express team year old claims and older
- The claims that were involved was deferred due to incorrect development
- Additional claims added to the claim in the claim processing after the initial development was completed
- Awaiting on additional government and private treatment records
- Challenge: The challenge was to have the claims turned around and completed in 60 days
- Actions: First task was to identify the claims and group them on a worksheet to identify the necessary action to complete the claim in the most expeditious manner
- Then review the claim to identify if the last action was completed correctly
- Then use telephone development to contact the Veteran
- Then contacted the Medical facilities for a time frame on the completion of exams
- Bird dog claim and exam and evidence to make the claim ready for decision
- Then the claim was sent to the rating board and rating was completed and then returned for promulgation and sent to the authorizer
- Worked on the claims every day and reported to Coach on the progression of the workload
- Results: The claims was completed in a record time frame
- Even the claims that was due to roll over after the time was completed before the end of the fiscal year
- This action made it possible for the Veteran that has been waiting for a resolution to there claim
- Ability to read, understands, interpret and apply pertinent laws, regulations and procedures
- This includes the ability to read, understand and interpret legal and medical terminology.
Education
Master of Arts - Business Administration
Everest University - Tampa
Tampa, FLBachelor of Arts - General Studies, Psychology
Indiana University At Purdue University Indianaplis
06.2006
Associate's degree - Early Childhood
IVY Tech College
Skills
- Attention to detail
- Communications
- Extensive Research
- Technical competence
- Training
- Analyze highly complex information
- Daily operation and maintenance of claims
- Analyze the quality of completed rated cases
- Prepare documentation to support unfavorable findingg
Additional Information
- BWN Subject Matter Expert April 2022
- Individual Cash Award for April 2022
- Nehmer Subject Matter Expert 2021
- STAR Quality Certificate April 2021
- Individual Cash Award for August 2017
- Individual Cash Award for May 2016
- Individual Cash Award for February 2015
- 2 year review project for old claims
- Employee of the Quarter for 2014
- Exceptional Performance Standards meet for FY 2013-2014
- Individual Cash Award for November 2014
- Individual Cash Award for August 2014
- Individual Cash Award for May 2014
- Individual Cash Award for April 2014
- Individual Cash Award for March 2014
- Individual Cash Award for August 2013
Job Related Training:
- Speed of Trust2009/2010 Mandatory OGC Ethics
- Privacy and HIPPAA Training
- VA Privacy and Information Security Awareness and Rules
- Prevention of Workplace Harassment/No Fear
- VBA Continuity of Operations Awareness
- SME Nehmer Expert
- Telework
- IConet Pilot Program
- COVID/ max telework
Timeline
Rating Veterans Service Representative GS-12-5
Veterans Benefit Administration
04.2015 - Current
Veteran Service Representative
Veterans Administration
09.2012 - 04.2015
Master of Arts - Business Administration
Everest University - Tampa
Bachelor of Arts - General Studies, Psychology
Indiana University At Purdue University Indianaplis
Associate's degree - Early Childhood
IVY Tech College
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