Tory Davis
Deland,FL
Summary
Analytical and customer-centric professional with a strong foundation in problem-solving, medical documentation review, and regulatory compliance. Eager to leverage strong communication and decision-making skills to accurately adjudicate disabilities claims and support plan members effectively."
Overview
4
4
years of professional experience
Work History
Integrated Claim Specialist
Tential
DeLand, FL
04.2026 - Current
- Reviewed incoming claims, verified benefit eligibility, and determined exact coverage provided under policy.
- Reviewed supporting medical, cross-checked diagnosis and procedure codes, and documented all claim decisions in company claims systems.
- Calculated benefit amounts due, approved or denied claims, and processed overpayments and underpayments.
- Responded to inquiries and resolved discrepancies through direct coordination with policyholders, healthcare providers, and internal teams.
- Ensured all actions complied with state and federal insurance regulations and internal company standards.
Short term disability claims specialist
The Hartford
DeLand, Florida
03.2024 - 02.2026
- Review medical documentation and policy provisions to determine eligibility and benefit approval.
- Communicate with claimants, employers, and healthcare providers to gather required information.
- Explain benefit decisions, claim status, and next steps clearly and professionally.
- Ensure timely processing of payments in accordance with policy guidelines
- Maintain accurate documentation of claim activity while meeting productivity and quality standards.
Sales Activation Specialist
Spectrum
Maitland, Florida
07.2022 - 03.2024
- Work closely with internal employees to fix fall out issues on orders.
- Take inbound calls from new and existing customers to assist with placing orders.
- Upsell Spectrum Mobile and TV service to new and existing customers.
- Pull tasks to resolve open issues.
- Place outbound calls to process customer orders.
Education
Associate In Medical Assistance - Medical Assistance
FCC
Orlando, FL10.2019
Mount Pleasant High School
Wilmington, DE02.2013
Skills
- Attention to Detail: Spot inconsistencies or missing information in medical files and employment records
- Critical Thinking: Synthesize data, assess situations, and make fair judgments on claim approvals
- Empathy & Communication: Listen actively and speak compassionately to claimants who are going through stressful health events
- Time Management: Prioritize high volumes of active cases and meet strict processing deadlines
- Claims Software: Proficiency in specialized claims management systems, case tracking databases, and Microsoft Office Suite (Excel, Word)
- Medical Terminology: Reading and interpreting medical records, treatment plans, and physician statements
- Regulatory Compliance: Adhering to state and federal guidelines, company policies, and regulations like ERISA
Timeline
Integrated Claim Specialist
Tential
04.2026 - Current
Short term disability claims specialist
The Hartford
03.2024 - 02.2026
Sales Activation Specialist
Spectrum
07.2022 - 03.2024
Mount Pleasant High School
Associate In Medical Assistance - Medical Assistance
FCC