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Claims Representative

Location:
Valrico, Florida, United States
Salary:
12.00
Posted:
November 27, 2017

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Rosemarie Navarro

**** ****** ****

Valrico, FL *3596

(340)***-****(813)539-7404

ac3h2u@r.postjobfree.com

PROFESSIONAL SUMMARY

An efficient, accurate and detailed professional who takes initiatives and has an intake drive to succeed. A dedicated worker with a strong client and satisfaction history accomplished in the many years as a federal employee. SKILLS

• Bilingual English/Spanish

• Skills in communicating effectively, verbally and in writing

• Skills in community relations, labor relations and labor negotiations

• Skills in organizing records and handling multiple tasks

• Skills in Microsoft office, outlook, excel, and operating office equipment such as a personal computer, multi-line telephone, copy machine, fax printer, scanner and other equipment

• Ability to prepare and maintain various reports and statistical data

• Knowledge in timekeeping, records and file management

• Proficient in collecting information/data and reviewing for accuracy and completeness.

• Ability to research inconsistencies in data and develop logical solutions or recommendations

• Ability to establish and maintain effective working relationships with others/ team player

EXPERIENCE

Technical Expert/Claims Representative 11/1982 - 03/2015 Social Security Administration

• Gathered and analyzed data for studies and reports to make recommendations based on findings.

• Developed and adjudicated claims and post entitlement workloads.

• Interviewed and informed the public of benefits payable or other issues related in a prompt and professional manner.

• Responded to all inquiries from the general public in a prompt and professional manner.

• Developed and adjudicated the most complex, non-routine claims and fully prepared the disability claims for forwarding to the disability determination services.

• Assessed the case characteristics to delineate the evidence and supporting records needed, furnished advice and assisted the public in securing the documentation required.

• Assisted the non-English speaking community in conducting necessary agency business and translated the documents.

• Conducted case reviews, process reconsideration, conferences to reconsider initial post eligibility decisions and determination on initial claims affecting eligibility, payment amount and overpayments.

• Computed monthly benefit amounts, reviewed earn records and made corrections to the records when necessary.

• Provided a lead role in technical training, coaching and mentored other employees while providing the most effective use of software and systems to process complex cases. Served as liaison with employers, payee organizations and other state and local entities to resolve complex cases.

• Served as a technical expert on public fraud issues, identity theft on specific cases and developed potential criminal, civil and monetary penalty cases for the Office of Inspector.

• Developed and implemented administrative sanctions decisions.

• Authorized cases for payments or denial without subsequent review or action by management.

• Performed health and safety inspections at the work place and served as the local Union Representative.

• Supervised four other employees in the office and was the officer in charge regularly. Trained staff as needed.

• Made final decisions on jurisdiction reconsiderations including disability insured status and res judicata and continuing disability review determination, substantial gainful activity decisions, and representative payee as capability and Medicare state buy in issues.

• Routinely monitored office workloads looking for trends and areas needing improvement or changes.

EDUCATION

Jones College 9/2002 – 8/2005

Miami, FL

• Associate of Science: Paralegal

References available upon request.



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