SCHELERRIA WHALEN-WILSON

adxg8a@r.postjobfree.com 405-***-**** Edmond, OK 73003

Skills

Customer Support and Assistance

Client Meetings

Assistance Program Knowledge

Well-Trained in [Software]

Patient

Compassionate

Empathetic

Hard-working

Dependable

Reliable

Experience

The Guardian Life New York, NY

Long Term Disability Claims Manager

07/2022 - 01/2023

Input claim information and payments into company database.

Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.

Investigated potentially fraudulent claims with focus on thoroughness, quality and cost control.

Drafted statement of loss to summarize damages, payments and underlying policy coverage.

Analyzed information gathered by investigations and reported findings and recommendations.

Reviewed police reports, medical treatment records, medical bills and physical property damage to determine extent of liability.

Reduced loss ratios through fair and prompt processing of claims.

Norman Regional Hospital Norman, OK

Financial Counselor

01/2022 - 06/2022

Called patients to obtain their out of pocket portion after I ran their insurance for their medical procedure, surgery, or other medical tests Also called insurance companies and various medical providers in order to obtain prior authorizations

OU Health Science Center Edmond, OK

Patient Benefits Advisor

04/2018 - 12/2021

Provided direct service and support by handling referrals for advocacy issues or resolving complaints.

Established and maintained relationships to meet community needs and avoid service duplication.

Ran a daily census to identify uninsured patients to screen them for various government programs

Applied and processed patients according to their medical conditions and maintained individual caseload

Processed their applications for Social Security Disability,Medicaid Insurance, Oklahoma Victim and Crime Compensation, and Indian Health Services

Work closely with Case managers and Social Workers to assist with making sure patients are approved for Long Term Care Placement and Physical Rehabilitation

Saved the Hospital monies by attending High Dollar meetings (patients whose hospital charges exceed $500,000 or more ) assisted with making sure I get these patients approved for Social Security Disability and Medicaid

Disability Determination Services Oklahoma City, OK

Disability Specialist III

01/2010 - 02/2016

Review and analyze complex medical information(i.e. diagnostic tests, office notes, operative reports, etc) to determine service connection and disability entitlement

Attends a comprehensive training program to learn medical terminology, VA regulations, how to critically analyze evidence, and apply the VA schedule if disabilities to render decisions on claims

Assures proper application to federal laws and regulations and other applicable instructions, and he or she is fully accountable for proper analysis, appropriate development, and final rating determinations

Analyzes claims to determine if diseases and/or injuries were incurred or aggravated by military service for purposes of compensation, treatment, or hospitalization

Determines service-connection, percentage of disability, permanent and total disability, and entitlement to compensation, pension, burial, dependency indemnity compensation, special monthly compensation, special monthly compensation and vocational training, medical and dental treatment, automobiles, or other conveyances, insurance, specially adapted housing, dependent education allowances, and other ancillary benefits

Communicates and interacts with Veteran and their representatives/advocates to facilitate timely, proper decisions. As dictated by the circumstances of each case the RVSR may may conduct interviews or hearings in person or by telephone with Veterans, eligible individuals, representatives, and advocates to obtain or clarify information

Works independently as a decision maker on claims following training and a period of mentoring and working reviews to assess comprehention.

Disability Determination Services Madison, Mississippi

Senior Examiner

01/2004 - 12/2009

Duties are the same for Disability Specialist III

Education and Training

Hodges University Naples, FL

Master of Science in Public Administration

08/2010

Mississippi University For Women Columbus, MS

Bachelor of Science in Family And Community Services

08/2002

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