William Sours
Winchester,VA
Summary
Skilled Claims Analyst with experience in analyzing and processing complex insurance claims. Possess strong analytical, problem-solving, and communication skills for effective liaison between clients and administrative personnel. Have demonstrated ability to streamline processes, improving efficiency and customer satisfaction in previous roles.
Overview
40
40
years of professional experience
Work History
Claims Analyst
NALC Health Benefit Plan
Ashburn, VA
09.1988 - 08.2024
- Reviewed customer claims, identified discrepancies and determined appropriate course of action.
- Conducted investigations to gather evidence in support of claims resolution.
- Assessed medical records for coverage eligibility and benefit accuracy.
- Developed strategies for resolving complex claims issues.
- Prepared detailed reports on claim status, payment history, and other relevant information.
- Verified documents to ensure accuracy of information provided by customers.
- Provided guidance to customers regarding their rights and obligations under policy terms.
- Maintained accurate records of all claim activities in accordance with company policies.
- Evaluated requests for additional benefits or changes in existing coverage levels.
- Managed escalated cases involving high-value claims or multiple parties involved.
- Advised customers on filing requirements, documentation needed, and other matters pertaining to their claims.
- Ensured compliance with federal and state regulations governing insurance industry operations.
- Collaborated with legal team to resolve any disputes arising from denied or delayed payments.
- Participated in meetings with internal departments or external vendors as necessary to discuss disputed claims or other related matters.
- Investigated and analyzed requirements to improve timeliness of reports to customers.
- Followed all company procedures to keep data confidential.
Operations Specialist
US Navy
Norfolk, VA
09.1984 - 09.1988
- Understood and followed oral and written directions.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Demonstrated leadership by making improvements to work processes and helping to train others.
- Planned and completed group projects, working smoothly with others.
Education
High School Diploma -
Clarke County High School
Berryville, VA06-1984
Skills
- Policy Interpretation
- Data Interpretation
- Claims history analysis
- Interpersonal and written communication
- Insurance knowledge
- Claims review
- Team Collaboration
Timeline
Claims Analyst
NALC Health Benefit Plan
09.1988 - 08.2024
Operations Specialist
US Navy
09.1984 - 09.1988
High School Diploma -
Clarke County High School
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