Tanisha Lewis

Mobile 708-***-**** * ad2w2h@r.postjobfree.com

Career Profile

Insurance professional with more than seven years of experience in Claims Operations Advocate/Examiner and Customer Service Associate. Versatile skill set in individual life, group life/ADD, group disability and health claims adjudication. Workers Compensation Certified Skilled decision maker, problem solver and team leader. Effective decision-maker ability, organizational skills, written, and verbal communication skills.

Experience

Sedgwick, Aurora IL

Workers Compensation Claims Rep 2021 to Present

• Processes low level workers compensation claims determining compensability and benefits

• due on long term indemnity claims, monitors reserve accuracy, and files necessary

• documentation with state agency.

• Develops and coordinates low level workers compensation claims' action plans to resolution,

• return-to-work efforts and approves claim payments.

• Approves and processes assigned claims, determines benefits due, and administers action plan

• pursuant to the claim or client contract.

• Administers subrogation of claims and negotiates settlements.

• Communicates claim action with claimant and client.

• Ensures claim files are properly documented and claims coding is correct.

• May process low-level lifetime medical and/or defined period medical claims which include

• state and physician filings and decisions on appropriate treatments recommended by utilization

• review.

Maintains professional client relationships.

.

Dearborn Group, Lombard, IL

Life & Waiver Claims Examiner 2019 to 2021

• Adjudicate, investigate and process life claims from receipt to final decision.

• Communicate decisions to beneficiary & policyholder via approval or denial letter

• Daily diary of claims processing while maintaining financial accuracy

• Adjudicate credit disability claims and other pertinent, approving or denied claims accordingly. Delta Dental of Illinois, Naperville, IL

Client Services Representative 2015 to 2019

• Answer inbound calls regarding dental insurance and document information.

• Review claims and provide accurate processing information to members and providers.

• Complete assigned special projects in a timely manner.

• Process adjustments for claims.

Comcast/Xfinity Corporation, Elmhurst, IL

Comm Ops 2 Fulfillment (Project Management Pre-Call Dispatcher) 2001 to 2013

• Provided pre-setup work to ensure all services are qualified to be installed for all lines of business.

• Pre-call customers to confirm appointments and review services to be installed.

• Provided coaching documentation to cross-functional areas associated with work orders.

• Coordinate appointment reminders and review services to be installed, as needed.

• Call customers for feedback to ensure the problem was resolved.

• Identify and communicate possible outages and confirm service calls.

• Troubleshoot and resolve issues regarding installations and outbound service calls for appointments.

Education

College of DuPage 2013 to 2015

General studies for associate degree

SKILLS

• Microsoft office (Word, Excel, Outlook, and Power Point). CSG, Grand Slam, Watch Tower, Workforce; typing 45 wpm.

• Effective communication skills written/verbal

• Completion of Sedgwick Claims Progression Program (CPP) Certified

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