Customer Service Medical
Resume:
Maribel Amor
Miami Gardens, FL **055
786-***-**** (cell)
***********@*****.***
USA Citizen
OBJECTIVE
Major interest is obtaining a job in business management,
public service, administrative careers and professional
level positions with the private sector, state and federal
government. Major emphasis in careers that would enhance
my personal growth
EMPLOYMENT
Senior Claims Analyst
04/06/2006 to 04/11/2014
Aetna Life Insurance Company
1600 SW 80 Terrace
Plantation, FL 33324
Transferred to the Centralized LTD Unit to handle seven (7)
Aetna Insured National Accounts in October 2006. Major
duties: issued timely payment,
approvals/denials/terminations. Administer claims by
following ERISA regulations in the adjudication of new
active and maintenance claims. Handled moderate to complex
Long Term Disability (LTD) claims. Issued survivor and
death benefits. Accomplishments: remained timely on tasks
despite multiple technical issues. Assisted the unit by
providing examples of letter, edit-corrections of letters,
templates, etc. Ability to make accurate and independent
decisions. In charge of the Lumbermens project from 04/2009
to 11/2009. Received a score of 4/5 on my most recent
evaluation. Mentored several members of the unit. Provided
excellent customer service to internal and external
customers.
In September 2011, I audited the Dell Account Long Term
Disability claims for financial errors and the outcome was
that the external audit conducted by Dell in October 2011
resulted in excellent scores.
From 2010 to March 1, 2013, I handled three self-insured
accounts and on March 1, 2013, I began adjudicating
exclusively Long Term Disability claims for Dell. In
November 2013, a new account was added (Boston Scientific).
I was nominated for the silver award in the area of
caring.
Disability Claims Specialist III
11/2003 to 10/08/06
Broadspire Services, Inc.
1601 S.W. 80 Terrace
Plantation, FL 33324
Supervisor's Name: Ruby Hotter, ph. 954-***-****
Main emphasis was to act as a leader in the adjudication of
the BellSouth Long Term Disability claims. Handling and
assignment of complex Long Term Disability Claims. Provide
training, direction, and mentoring to other members of the
BellSouth Long Term Disability Unit. Awarded Silver award
for excellence in Customer Service. Administered
approvals/denials/ termination when necessary. Created
templates for letters, in charge of completing the
production report for the unit, and several monitoring
documents.
Aetna acquired Broadspire Services 04/01/2006 but Business
was handled under the umbrella of Broadspire until
approximately October 2006.
Disability Claims Examiner II
01/2000-11/2003
1601 SW 80 Terrace
Plantation, FL 33324
Supervisor's name, Ruby Hotter, ph#954-***-****
Manage and adjudication of complex Long Term Disability
claims for disabled Employees, assessing disability
pensions, applying ERISA principles and Regulations,
obtaining medical data, analyzing medical and vocational
data, submit correct forms. Above average performance.
Responsible for developing and creating letters to be used
by members of the unit. Often assisting members of my unit
with interpretation of medical records or vocational
issues. Obtained customer service awards in 2004 and 2005.
In charge of the production report, Hewitt report and
other projects.
Medical Disability Quality Control Analyst
07/98-01/2000
Office of Disability Determinations
P.O. Box 839001
Miami, FL 33283
Supervisor's name: Allen Hallas, ph#305-***-**** Ext. 271
Review disability claims for accuracy at the initial,
reconsideration, and continued disability reviews as
outlined by Social Security Administration rulings and
regulations. Provide training to members of the unit; stay
within the approved budget for expenditures involved in the
cost of obtaining consultative exams. Monitor and suggest
strategies in the proper adjudication of disability claims.
Adjudicate claims in both title II and title XVI for both
children and adults by analyzing medical and vocational
data and other pertinent information such as activities of
daily living.
Promoted to the above position July 21, 1998. Awarded
certificate for extraordinary case management on July 24,
1998. Adjudicated a large quantity of cases both
accurately and timely.
Medical Disability Specialist 04/1996-
07/1998
Supervisor's name: Allen Hallas, ph#305-***-**** Ext. 273
Major duties were adjudication of disability claims at the
initial, reconsideration and continuing disability review
claims for both children and adults for both titles XVI and
title II of the Social Security Act. This was accomplished
by gathering medical and vocational evidence, interpreting
of the evidence obtained, contacting medical sources by
letter, phone or fax, setting up consultative exams, rating
impairment severity, and closing up cases using PC. From
07/1994-04/1996, I worked as Medical Disability Examiner at
the same office listed above. Major duties were
adjudication of initial title XVI and title II disability
claims for both children and adults. The work described
above was performed full time, 40 hrs/wk. Supervisors name
Marty Lenkowsky, ph#305-***-**** Ext. 258
Environmental Specialist I
02/1997-06/1997
Florida Dept. of Health, Environmental Waste Unit
1725 NW 167 St.
Miami, FL 33056
Supervisor's name: Candace Moore, ph# 305-***-****
Making inspections of facilities that generate biomedical
waste investigate biomedical waste complaints; use code
enforcement to achieve compliance with Florida Statutes.
Review of biomedical waste protocols in each of the
generating facilities.
Biology Instructor Fall 94-Spring
95
Dade Community College-Kendall Campus
11011 SW 104 St.
Miami, FL 33176-3393
Supervisor's name: Dr. Pope, Part-time Work
Prepare lessons, deliver lectures, grading and giving
exams, maintaining attendance.
Substitute Teacher (K-12) 8/1990-06/1994
Dade County Public Schools
1444 Biscayne Blvd., suite 150
Miami, FL
Planning of lessons, taking attendance, assigning and
correcting homework, maintaining discipline, Employee
#185225. Kenneth Wright (Coordinator),
Ph# 305-***-****
EDUCATION
Associate in Science Degree/Biology
May 1980
Lincoln Land Community College Springfield, IL
Graduated with a GPA of 3.48. Major course was Science
Bachelors in Science Degree/Biology April
1983
Florida International University
Miami, FL
Graduated with a final GPA 3.10
Master's of Science in Teaching Biology December
1991
Florida Atlantic University
Graduated with a GPA of 3.67
SKILLS
Ability to work independently as well as in group. Good
ability to write and analyze reports and interpret data.
Computer skills to include Microsoft office, Windows 95 &
98, WordPerfect 5.1, Lotus 1.2.3, Lotus Notes, Typing 80
w.p.m. (tested) excellent command of the Spanish language.
Ability to handle complex disability claims. Knowledge of
medical terminology and disease processes. Excellent
customer skills.
Contact this candidate