Tiffany Cooper
Social Insurance Specialist (Claims Technical Expert)
Fieldale,VA
Summary
Diligent [Desired Position] with strong background in managing and processing claims efficiently. Successfully resolved numerous complex cases while ensuring compliance with regulations and maintaining high customer satisfaction. Demonstrated proficiency in analytical problem-solving and effective communication.
Experienced with analyzing and processing diverse claims accurately and efficiently. Utilizes strong investigative skills and attention to detail to ensure fair settlements. Track record of maintaining compliance with industry regulations and providing excellent customer service.
Overview
12
12
years of professional experience
Work History
Claims Specialist
Social Security Administration
04.2019 - Current
- In my current position as a Claims Specialist I am the office go to for all things Title XVI. Whether its assisting SRs with PE changes such as living arrangements or assisting seasoned CSs with seeding claims, force pay on manual records or clearing high priority RZs. Voluntarily enrolled in Crossover training and have completed 75%.
- As a Claims rep my daily duties include completing tasks of remittance clerk, screening VIP appointments for potential issues, running automated systems such as WAC and processing any claims, issues or tickets that can be completed before we are open to the public. My workload also includes working on Adhoc lists and pending open applications as well as adjudicating approval and denials of claims.
- Claims Specialist (CS) Grade 11 presented the opportunity to participate in community outreach by visiting the Patrick Henry Correctional Unit. During this visit Social Security Administration (SSA) participated in a panel style presentation with other agencies. I presented the inmates information on the various SSA programs with a focus on the necessity of Social Security replacement cards (SS-5), as well as the online services offered through SSA.gov. The inmates were also given the opportunity to ask questions, which included a variety of topics including acceptable documents for replacement cards, when they could file for retirement, working while disabled and how to get benefits restarted once released.
- This required me to analyze the policy and develop a way to provide them with processes of securing a new card while giving feedback on the process as a whole.
- Within this grade I was also given the opportunity to train the entire office on One Note and also do a separate training about online services available through SSA.gov. This training enabled journeymen CS and CSR’s to be able to understand how to navigate through the One Note program and online services and use it in everyday job responsibilities.
- Microsoft OneNote is a program that the agency suggests that trainees use while going through training. However, seasoned employees may not be as familiar with the program. The entire office received training on the basics of OneNote and was provided step by step examples of how to set up a notebook. This training was conducted in person in the training room.
- I facilitated training with the entire office about Internet Social Security Replacement Cards (iSSRC) and mySSA account online services. With the use of power point presentations and visual aids from the website. The office staff was presented with information and resources to use in the future for number holders wanting to file for a replacement card online or start an application for a card online and complete it in the office. We also reviewed the Toolkit available on Philanet Home page that allows employees to provide assistance to the public when they are stuck on a certain screen in an application. This training was conducted via Microsoft Teams.
- Assist co-workers in all positions with complex questions that require researching policy net and the use of other resources is a daily occurrence.
- Serve as office expert for critical SR workloads.
- Claims Specialists (CS) have inquired and received assistance with new programs or updates to existing programs such as CCE, iClaims, ELAS, WAC, i454, OneNote as well as others.
- The Office Assistant (OA) sometimes requires assistance with SS-5 applications that are not seen in this office that often. Reviews were also conducted on the SS-5 that were processed by the OA. Also, provided assistance and reference to policy on Medicare questions as well as, SSI resource and income questions and various other issues.
- Other duties I performed as a Claims Specialist include, but are not limited to the following.
- Interview customers daily for program eligibility and entitlement for Social Security Administration
- Disability claims, Retirement claims
- Supplemental Security Income (SSI) claims
- Representative payee applications
- Non-receipt of payment and other payment issues
- Develops and processes a wide range of complex SSA entitlement actions – Disability Insurance, SSI for the aged/blind and disabled, rep payee misuse, SSI complex living arrangements
- Review cases to ensure program integrity and consistency
- Suggested (formally or informally), recommended, organized, and/or implemented a work process that improved accuracy, or resulted in cost or time savings
- Delivered formal classroom instruction and continue to provide informal mentoring/on the job training to Customer Service Representative Trainees
- Provide informal leadership and encouragement to others in hopes to complete team projects
- Manage and control peer workloads to ensure cases are processed on a timely basis
- Answering phones – Provide excellent customer service to all members of the public at all times; often able to calm individuals down who are experiencing emotional distress in crucial situations with the use of soft skills while providing technical guidance to others on questions and problems concerning claimants benefit eligibility. During these calls I take/draft notes to ensure accurate updating of the callers records
- Volunteering for additional duties on a regular basis
- Monitor and assist the reception whenever possible
- Handling PR issues ensuring that I identify, examine and integrate the information to resolve problems or questions derived from customers
- Implementing decisions made in the most complex case situations
- Leader in finding effective solutions to challenges while maintaining a positive attitude even in challenging situations
- Maximize the use of my available resources
- Processing ALJ decisions to completion in under 60 days, prior to this workload being covered by another office
- Managing changing workloads and demands of day to day operations, while keeping my workload current
- Go to source for peers in regards to policy and case actions
- Manage changing workloads related to Title 2 and Title 16 programs – Initial claims, appeals, post entitlement actions
- Utilizing automated systems such as EDCS, CCE, EVIEW, SSI, MWI, ERPA, WAC, Debt Management, ERPS, MCS, MSSICS, EPATH, AFI and POS to process inputs appropriately
- Using computers and laptops along with various software programs to complete necessary casework assignments
- Gather information from various sources to evaluate interrelated factors to define issues related to a particular situation or problem – including usage of state systems to verify vehicle ownership and value, wage/employment records; also, usage of public property records to determine real property ownership
- Analyze customer needs and makes routing determinations and referrals based on the information provided – i.e., Finding out that an SSI recipient is insured for T2 benefit program or Medicare Part D plan selection assistance needed or requested, customers are referred to local Senior Services groups to help ensure proper plan selection
- Daily usage of DPS to create and prepare correspondence that explains problems, discrepancies and reasons for actions taken in matters pertaining to laws, regulations and other procedures
- Accessing the MDW section of PCOM to create written requests for assistance to solicit pertinent information
- Regularly requests and evaluates evidence from customers to develop and resolve case issues in accordance with SSA policies and procedures
- Confers with management and offers advice on such matters as major changes in local policies and procedures
- Frequent usage of the SSI MWI program to input wages of working recipients
Claims Service Representative
Danville/Martinsville SSA
09.2017 - 04.2019
- Conduct inquiries during interviewing/screening at reception to obtain, clarify and verify information about applicants’ initial and continuing eligibility for programs administered by SSA.
- Assists the public by explaining the options for conducting business with SSA, including but not limited to telephone, face to face interviews or online services. Explain and assist in setting up MySSA accounts, offer Self Help PC for clients to perform online transactions.
- Trained in the adjudication of payment decision making for prisoners, simple living arrangements and SSI low profile redeterminations.
- Consistently volunteers to work on all workloads available to improve overall processing time.
- Suggested a mail-processing guide to improve accuracy of mail dissemination.
- Regularly seeks self-initiated training to ensure quality and processing time.
- Promote filing Disability and Retirement claims online.
- Inform clients of reporting responsibilities
- Examine evidence to evaluate its validity and acceptability.
- Respond to contacts from beneficiaries, recipients, the public and other SSA staff via phone or in person
- Provide technical guidance and informal mentoring to coworkers as necessary.
- Participate in mandatory training, IVT training as well as the monthly courses.
- Protect the rights of individuals by assuring claimants and/or their personal representative understand the claimant’s legal rights and obligations.
Benefit Program / Intake Specialist
HM Department of Social Services
02.2014 - 09.2017
- Processed SNAP benefits and Medicaid applications.
- Maintained workload of 150 cases monthly.
- Reviewed applications for other referrals or community resources.
- Assisted claimants in navigating the complexities of their benefit options, providing guidance on plan selection based on individual needs and preferences.
- Worked closely with benefits providers to resolve eligibility errors.
Education
Bachelors - Business Administration
Averett University
Danville, VASkills
- Typing 68 WPM
- Language Fluent Passable Good Fair Good Fair
Claims processing
Claims analysis
Claims investigation
Documentation review
Verbal communication
Time management
Data entry
Documentation processing
Multitasking
Reporting skills
Verbal and written communication
Critical thinking
Effective communication
Active listening
Attention to detail
Microsoft office
Accomplishments
- Used Microsoft Excel to develop inventory tracking spreadsheets.
5. AWARDS - LIST ALL JOB RELATED AWARDS
Exemplary Contribution or Service Award 03/2019 GS-6 For overall contributions to the Martinsville FO meeting PSI, Exemplary Contribution or Service Award XX/2020 GS-9 For overall contributions to the Martinsville FO meeting PSI, Exemplary Contribution or Service Award XX/2021 GS-11 For overall contributions to the Martinsville FO meeting PSI
Timeline
Claims Specialist
Social Security Administration
04.2019 - Current
Claims Service Representative
Danville/Martinsville SSA
09.2017 - 04.2019
Benefit Program / Intake Specialist
HM Department of Social Services
02.2014 - 09.2017
Bachelors - Business Administration
Averett University