Summary
Overview
Work History
Education
Skills
EDUCATION/ACHIEVEMENTS
References
Timeline
Generic

TYLER RAYMOND

Aubrey ,TX

Summary

Results-driven Claims Examiner II at Reliance Matrix with expertise in regulatory compliance and claims processing. Demonstrated analytical skills and attention to detail while managing a caseload of complex cases. Proven ability to deliver exceptional customer service and ensure accurate benefit payments, contributing to operational efficiency and client satisfaction. Team Work Makes The Dream Work!

Overview

12
12
years of professional experience

Work History

Absence Specialist

AbsencePlus
Novi, MI
07.2024 - Current
  • Company Overview: Managing FMLA, Short Term Disability, and ADA for multiple companies
  • Managed project workflows to enhance team efficiency and collaboration.
  • Review medical documentation to support strategic planning and decision-making processes.
  • Analyzed data trends to inform operational improvements and resource allocation.
  • Ensured compliance with company policies through regular audits and assessments.
  • Created plans to propose solutions to problems related to efficiency
  • Key Skills: Strong attention to detail, Ability to meet deadlines, Problem-solving and conflict resolution, Preparing for audits and legal inquiries, Identifying red flags or inconsistencies in claims

Claims Examiner II

Reliance Matrix
Phoenix, AZ
12.2017 - 10.2024
  • Company Overview: Reliance Matrix delivers employee benefits, absence management, and workforce productivity solutions through the financial stability of a top-rated insurance carrier.
  • Coordinated benefit payments between employer payroll and state disability insurance programs (e.g., CA SDI, NY PFL), ensuring accurate offset calculations to prevent overpayments.
  • Provides payment or denials promptly, and in full compliance with department procedures and regulations.
  • Involves technical resources (Social Security specialist, medical resources, and vocational resources) at appropriate claim junctures.
  • Utilizes appropriate mediation for the characteristics of each claim.
  • Manages an assigned caseload of 110-120 simple and some complex cases with oversight from an independent source.
  • Provide customer service that is respectful, prompt, concise, and accurate in an environment with competing demands.
  • Key Skills: Knowledge of Leave Laws and Regulations, Attention to Detail, Organizational & Time Management Skills, Problem-Solving Skills, Analytical & Quantitative Skills, Mathematical Skills

Operations Team Lead

CIOX Health
Phoenix, AZ
08.2016 - 11.2017
  • Company Overview: Working with multiple insurance companies to collect medical records for audit and billing purposes.
  • Contact assigned medical providers by phone to collect accurate office information.
  • Comply with HIPAA (Health Insurance Portability and Accountability Act), ensuring the right to privacy for patient records.
  • Ensuring a team of 10-15 individuals to ensure that daily and weekly call volume and quality requirements/standards are being met while maintaining accuracy and professionalism.
  • Comply with HIPAA (Health Insurance Portability and Accountability Act), ensuring the right to privacy for patient records.
  • Key Skills: Time and Shift Management, Problem Solving and Decision-Making, Attention to Detail, Technical Proficiency, Compliance, and Confidentiality.

Shift Manager

McDonald's
Surprise, AZ
04.2013 - 07.2016
  • Supervised food safety and cleanliness procedures to uphold McDonald's standards.
  • Ensured effective communication with crew and shift managers for optimal shift preparation.
  • Achieved performance targets, supporting departments in meeting operational goals.
  • Monitored safety, security, inventory, and profitability metrics actively.
  • Delivered exceptional customer service alongside high-quality food production.
  • Key Skills: Team Leadership, Staff Scheduling & Labor Management, Inventory & Stock Control, Cash Handling & Financial Accountability, Training & Onboarding

Education

Leadership Program - Future Leadership

Tokio Marine 2100
11.2023

High School -

Shadow Ridge High School
Surprise, AZ
05.2014

Skills

  • Finance/Accounting Focused
  • Analytical & Problem-Solving
  • Claims processing
  • Regulatory compliance
  • Attention to detail
  • Customer service
  • Data analysis

EDUCATION/ACHIEVEMENTS

  • Achieved High Customer Satisfaction Ratings
  • Surveys for both after call experience and overall claim management

References

References available upon request.

Timeline

Absence Specialist

AbsencePlus
07.2024 - Current

Claims Examiner II

Reliance Matrix
12.2017 - 10.2024

Operations Team Lead

CIOX Health
08.2016 - 11.2017

Shift Manager

McDonald's
04.2013 - 07.2016

Leadership Program - Future Leadership

Tokio Marine 2100

High School -

Shadow Ridge High School

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