Totoria McBride
Stockbridge,GA
Summary
Experience Federal healthcare and benefits professional with over 15 years in and analyzing and implementing laws and regulations within complex federal benefits programs under Social Security and Medicare. As a GS-11 Claims Specialist, led the analysis of complex programs requirements and developed recommendations for Congressional inquiries and claimant processes, addressing complex program issues effectively.
Overview
18
18
years of professional experience
Work History
Claims Specialist
Social Security Administration
Morrow, Georgia
12.2019 - Current
- Grade: GS-11, Full Time, 40 hours/week
- Analyzed complex federal benefits and health-care related program issues by interpreting applicable laws, regulations, policies, procedures, program guidance and operational requirements to determine appropriate program actions and support consistent program administration.
- Served as a technical resource on complex program requirements and guidance
- Investigated disputes referred by U.S. Senators and Congressional offices by analyzing case records, federal policies, regulations, procedures and program guidance; developed findings and recommendations and communicate evidence-based resolutions back to Congress.
- Conducted detailed research and analysis of program requirements, case information, records, and operational processes; identify issues, evaluate alternatives and develop recommendations that support accurate, compliant and efficient program delivery.
- Educated clients on their rights and responsibilities regarding Social Security and Medicare benefits.
- Served as a member of the office workflow team responsible for monitoring customer service and claims processing activities; evaluated workload trends and processing issues, coordinates assignments and workflow adjustments and recommends improvements to improve compliance and time delivery of services.
- Developed training materials for staff members on best practices for handling different types of claims.
Claims Specialist
Social Security Administration
Durham, North Carolina
10.2017 - 12.2019
- GS-11, Full-Time, 40 hours/week
- Served as Claims Specialist in the Internet Claims Unit, processing and adjudicating claims submitted through Social Security online claims systems.
- Analyzed complex electronic claims, beneficiary information and supporting documentation.
- Conducted quality reviews of claims and supporting documentation to identify errors and discrepant material and initiated corrective action.
- Provided technical assistance on special workflows that were not processable in the Internet Claims unit due to my processing center experience.
Benefit Authorizer
Social Security Administration, SSA
Birmingham , AL
03.2009 - 10.2017
- GS5/7/9, Full Time, 40 hours per week
- Researched beneficiary records, federal benefit policies and program requirements to resolve complex benefit estimates and payment issues.
- Processed post-adjudicative determinations to ensure claimants receive correct benefit amounts
- Prepared written correspondence explaining eligibility requirements and case determinations to claimants.
- Served as a mentor and technical resource to employees by explaining benefit authorization procedures, systems functionality, documentation requirements and processing compliance and quality expectations.
Education
Master of Public Administration - Public Health And Government Contracting
Troy University
Troy, AL05-2017
Bachelor of Science - Marketing
University of Alabama
Tuscaloosa, AL12-2008
Skills
- Claims processing
- Policy interpretation
- Regulatory compliance
- Program administration
- Case analysis
- Attention to detail
- Decision-making
- Conflict resolution
- Customer service
Affiliations
- Volunteer, United Way of Greater Atlanta, The Scholarship Academy
- Volunteer, Atlanta Community Food Bank
- Member, Women's Advisory Council, Atlanta Region
- Board Member, Travel Aid Society Junior Advisory Board
Timeline
Claims Specialist
Social Security Administration
12.2019 - Current
Claims Specialist
Social Security Administration
10.2017 - 12.2019
Benefit Authorizer
Social Security Administration, SSA
03.2009 - 10.2017
Master of Public Administration - Public Health And Government Contracting
Troy University
Bachelor of Science - Marketing
University of Alabama