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Click here or scroll down to respond to this candidateCandidate's Name
EMAIL AVAILABLEStreet Address Kimberly AveColumbus, Ohio Street Address
PHONE NUMBER AVAILABLELTD Claims ExaminerSeeking change of positionHighly professional examiner with diverse knowledge in the customer service and medical field. Over Twenty years of combined military and civilian experience. Possess excellent interpersonal communication, client service, and organizational skills. Experienced in working in office, field, clinical, and hospital environments. Strong attention to detail with ability to precisely follow procedures and maintain the highest standards of quality and integrity. Demonstrated competencies include:Proven ability to motivate a group of people toward achieving a common goalGreat convincing powers developed through complete knowledge of the product and the related fieldsProven aptitude and skills to excel in a results-driven and customer-focused environmentGreat patience and persistence during the conversation with the customerAbility to handle multiple tasks and work under pressureExtensive work experience in the service industry with absolute customer orientationExcellent computer proficiency with ease in using MS Word, MS Excel and MS PowerPointAbility to work independently and meet deadlines Pleasantandclearvoicewith neutral accentsPROFESSIONAL EXPERIENCESedgwick May 2017 to present Hilllard, OHLTDAnalyzes assigned claims and determines benefits due.Informs claimants of documentation required to process their claim and timeframes.Manages claim to ensure compliance with plan provisions.Provides appropriate documentation to LTD Manager for reporting purposes.Determines need for outside vendors, surveillance and/or independent medical evaluations as required and seeks advice from management, as necessary.Refers cases to LTD Supervisor, LTD Manager, or Project Manager.Negotiates settlement of appropriate claims within designated authority level.Makes claim payments and revisions to benefit amounts.Communicates status on decisions to client, claimant and supervisor.Calculates and collects overpayments.Aetna May 2017 to February 2019 New Albany, OHCSRTook Inbound calls from Medicare / Medicare Advantage members while taking ownership of the members concerns all the way through to resolution no matter where that might take us.Use problem solving skills by solving member issues, while effectively making the right decisions for our members.Focus of one call resolution to insure the best customer service experience.IGS Energy September 2013 to February 2017 Dublin, OHWorkforce SpecialistProduced Inbound and Verification intraday reporting for supervisors and managers on the call center performance as far as service levels, abandon rate, trends and general observations.Monitored agent schedule adherence to ensure that our resources are where they need to be at the time that they are scheduled to be to ensure that service levels are met.Maintained and distributed attendance tracking excel spread sheet for the call center.Run and distribute error reporting to managers and supervisors to ensure the best customer service that we can provide is happening in a consistent fashion.Managed and distributed a weekly data spread sheet to highlight any negative or positive trends that maybe happening in the call center to the managers in a timely manner.IGS EnergyCustomer Service Specialist January 2011 to September 2013 Dublin, OHEnrolled customers and assisted them with various service plansAssisted training department to help with new hire training and help to implement new strategies for the call centerTrained in Outbound to retain customers who initially wanted to cancel by showcasing valuable IGS plans suitable to them.JP Morgan Chase January 2000 to June 2005 Columbus, OHCoordinatorSupervised a team of 12 post-foreclosure analysts in varying capacities, assisted in launching the ACD program.Resolve customer complaints and answer customers' questions regarding policies and procedures.Supervised the work of office, administrative, or customer service employees to ensure adherence to quality standards, deadlines, and proper procedures, correcting errors or problems.Provided employees with guidance in handling difficult or complex problems and in resolving escalated complaints or disputes.Implemented corporate and departmental policies, procedures, and service standards in conjunction with management.Discussed job performance problems with employees to identify causes and issues and to work on resolving problems.Trained and instructed employees in job duties and company policies or arrange for training to be provided.Evaluated employee job performance and conformance to regulations and recommend appropriate personnel action.MILITARY EXPERIENCEArmy National Guard July 2005 to June 2010 Columbus, OHMedicProvided basic emergency treatment for a team of 12.Supervised 6-member trauma-treatment team and established field-trauma areaCoordinated evacuation of critically ill/injured patients by air or land.Supported emergency-room operations while following directions of professional staff..Provided care to 12 soldiers. Performed daily sick call assessed patients and provided treatments including minor surgical procedures.US Navy June 1988 to July 1996 San Diego, CAHospital CorpsmanAssisted in the prevention and treatment of disease and injuries; prepared/administered medications including injections.Instructed sailors and marines in first aid training.Conducted preliminary physical examinations.Maintained treatment records and reports.Conduct blood tests for transfusion purposes and perform blood counts. Examine cells stained with dye to locate abnormalities.Phlebotomy trainingEDUCATION & CERTIFICATIONSSan Diego Mesa JC, San Diego, CaliforniaLiberal Arts AA Degree 1996 |
