Claims Representative Data Entry

CORY BRADLEY

Marietta, GA ***** 404-***-**** *************@*****.***

WWW: https://www.linkedin.com/in/cory-bradley-a05379103 Professional Summary

Senior Claims Representative with 32 years of industry experience. Successful at meeting customer and company needs with fair and equitable approach to claims process. Detail-oriented, systematic and skilled in identifying exposures and proposing actionable solutions. Analytical problem-solver with excellent communication skills. Effective at interviewing claimants, compiling records and documenting findings. Well-versed in Veterans benefits policies, practices and standards. Successful at developing and deepening customer relations and working well with everyone involved in investigating and adjudicating claims. In-depth understanding of procedures and compliance. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Accomplishments

Received Outstanding Ratings Awards for Overall Performance multiple times. Skills

High-Exposure Claims

Documentation Research

Policy Knowledge

Legal Guidelines Knowledge

Customer Satisfaction

Claims Inspections

Quality Assurance Evaluation

Team Goals

Special Projects

Team Meetings

Claim Validity Determination

Prior Authorization Processing

Claims Evaluations

Problem Resolution

Data Quality

Inquiry Requests

Efficient Service

Production Goals

HIPAA Regulations

Microsoft Office

Database Systems

Peer Review

Policy Update Coordination

Data Entry Software

Regulatory Compliance Adherence

Confidential Records Management

Information Assistance

Complex Problem-Solving

Work History

Senior Veterans Claims Representative 11/2016 to Current U.S. Department Of Veterans Affairs – Atlanta, GA

Reviewed average of 250 Veterans cases per week and verified entitlement to benefits as a GS-11 (Achieved highest level )

Conducted investigations into complicated mid- and high-exposure claims. Collaborated with upper management on important claims. Updated field operations staff on status of open claims and current actions. Checked documentation for accuracy and validity on updated systems. Carried out administrative tasks by communicating with clients, distributing mail and scanning documents.

Verified client information by analyzing existing evidence on file. Generated, posted and attached information to claim files. Maintained strong knowledge of medical terminology to better understand services and procedures.

Processed and recorded new policies and claims.

Posted payments to accounts and maintained records. Maintained confidentiality of Veterans records and health statuses. Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.

Modified, updated and processed existing policies. Communicated effectively with staff members of operations. Communicated verification and authorization status updates with Compensation and Pension department to facilitate decision-making for Veterans disability claims. Reviewed outstanding requests and redirected workloads to complete projects on time. Acted as Compensation and Pension subject matter expert, answering internal and external questions and inquiries.

Senior Veterans Claims Examiner 09/1990 to 11/2016 U.S. Department Of Veterans Affairs – Atlanta, GA

Conducted day-to-day administrative tasks to maintain information files and process paperwork.

Delivered exceptional customer service to Veterans by communicating important information and patiently listening to issues.

Researched claims and incident information to deliver solutions and resolve problems. Resolved complex, severe exposure claims using high service oriented file handling. Reviewed and analyzed suspicious and potentially fraudulent education claims. Analyzed information gathered by investigation and reported findings and recommendations. Maintained claims data in Education systems.

Documented information gathered in field and uploaded data to company database for efficient processing using Veterans Benefits Software. Collaborated with claims department and industry anti-fraud organizations to resolve claims. Organized, planned, and documented materials for Education entitlement claims. Collected and tracked evidence in support of legal appellate processes. Handled education entitlement calls from Veterans about claims processes. Prepared Memorandum of Understanding documents for managers or legal personnel. Collected enrollment information from educational institutions to complete claims and legal files.

Monitored 1000+ clients caseload for each quarter. Incorporated VBA objectives to achieve action plans and strategies. Synthesized data into comprehensive quarterly written reports for management. Verified accuracy of education records to maintain accuracy of records database. Reconciled data in direct collection system with accounting system to address discrepancies. Investigated legal issues pertaining to appellant claims. Ordered enrollment information to complete claims. Corrected system codes to properly classify Veterans claims. Estimated quantifiable characteristics of END products. Education

Bachelor of Science: Communications 12/1990

Kennesaw State University - Kennesaw, GA

Honor Graduate Magna Cum Laude

Honoree of Golden Key National Honor Society

Associate of Science: Political Science 06/1988

University of Georgia - Athens, GA

[Fraternity or Sorority Name] Member Tau Kappa Epsilon Eagle Scout Award, Golden Key National Honor Society 1980 Earned Eagle Scout Award.

Eagle Scout Award

1980 Recipient of the Eagle Scout Award.

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