Ylexis Sizemore

Examine completed claims, adjudication determinations including fraud/overpayments to ensure compliance with established unemployment insurance benefit laws, regulations, policies and procedures; review periodic reports to track quality assurance, timeliness and customer service goal achievement for individual employees and the team/unit; determine
individual and team/unit training requirements; recommend and implement corrective action plans when established quality assurance, timeliness or customer service goals are not met; answer subordinates’ questions and resolve problems with staff and claimants regarding unemployment insurance claims. Supervise subordinate professional and paraprofessional staff; participate in hiring interviews; prepare work performance standards for subordinates; prepare and conduct performance evaluations; recommend and prepare documentation for disciplinary action. Deliver on-the-job training to address areas of deficiency for individual employees or to introduce new procedures; assist the unemployment insurance staff support unit to develop and present classroom training related to unemployment insurance claims examining and processing, monitor and evaluate claim and adjudication calls in progress, evaluate service on each telephone queue line and make ongoing adjustments to staff assignments to ensure adequate coverage, minimize customer wait time, and ensure efficient use of time; investigate and resolve complaints from claimants and employers regarding adjudication times and determinations; ensure staff is adequately equipped and that equipment works properly

Review claims for possible fraud, adjudicate(one touch), conduct interviews/investigations gathering pertinent information from claimant and employer, write investigative reports summarizing findings and supporting evidence, make determination disqualifying claimants for a specific period of time to collect overpayments, in person identity verification, incarceration issues, contact representatives of government agencies, and other witnesses, and attending appeal hearings when needed

• Interview claimants by phone and obtain necessary accurate information; maintain confidentiality of claimant records; interpret and apply complex rules, regulations, polices, and procedures to specific situations; research information from a variety of sources; receive, review, and process a variety of documents according to established guideline, policies, regulations, detect eligibility, fraud, and clearing slots for Adjudication. I also work on many special projects such as Prior Disqualification, First Order Payout, New Hire Hits, Support team, Double Dip, PUA, and Fraud.

• Responsible for managing the overall daily store operations, motivating sales associates to provide friendly and prompt service, resolving customer complaints in a timely professional manner, and developing our team; overseeing ordering and inventory of merchandise and ensuring the store exceeds company standards for cleanliness, organization, and appearance.

• Conduct basic interviews from those applying for social service programs; position requires detailed knowledge of federal, state, and local guidelines with regard for specific program applied. Maintain concise detailed confidential records, process documents from a variety of sources, prepare reports, and communicate effectively with clients, office personnel, management, and other government agencies.