Disability Claims Quality Assurance
Resume:
J Y
Jamie Yarbrough-Griffin
Professional Summary
Confident, analytical professional with strong attention to detail and problem-solving abilities. Possesses solid understanding of claims processing and regulatory compliance, coupled with proficiency in data analysis and documentation review. Committed to driving efficient claims resolution and maintaining high standards of customer satisfaction. Brings positive attitude and commitment to continuous learning and growth. Work History
Symetra - Short Term Disability Claims Manager
Bellevue, WA
11/2022 - 11/2024
New York Life - Short Term Disability Claims Manager Plano
03/2019 - 11/2022
Collaborated with other departments to improve overall organizational effectiveness in addressing client needs.
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Enhanced customer satisfaction with timely and accurate claims resolutions.
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Streamlined communication between adjusters and clients, expediting claim resolution times.
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Implemented quality assurance measures, monitoring staff performance and providing constructive feedback for continuous improvement efforts.
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Handled claims consistent with client and corporate policies, procedures, best practices and regulations.
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Documented and communicated timely claims information while supporting accurate outcomes.
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Mentored new hires on company policies/procedures enabling them to quickly become proficient in managing claims.
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Manage up to 20 calls and up to 7 scheduled appointments daily to gather information to initiate claims process.
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Serves customers by providing product and service information and resolving product and service issues and complaints
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Building rapport with potential customers by answering product and service questions as well as suggesting information about other
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*****.********************@*****.**
m
Forney, TX 75126
Skills
● Problem Solving Skills
● Claims investigation and research
● Investigation techniques
● Clear Communication
● Writing Skills
● Creativity & Resourcefulness
● Time management
● Ability To Use Positive Language
● Ability to Gain Product Knowledge
Microsoft: Excel; Office; PowerPoint;
Word
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● Claims analysis
● Policy interpretation
● Disability claims process
Education
05/2004
Dr. John D. Horn High School
Mesquite, TX
Diploma
New York Life - Customer Service Representative
04/2012 - 03/2019
products and services
Using data entry methods to open customer accounts and recording account information
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● Maintains customer records by updating account information Resolves product or service by determining the cause of the problem, selecting and explaining the best solution to solve the problem, expediting correction or adjustment when necessary, and following up to ensure resolution
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Recommends potential products or services to management by collecting customer information and analyzing customer needs
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Maintains current desk load of 125 to 200 claims and collaborates with management to incorporate new trends and developments in current and future strategies
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Responsible for appropriate management of caseload to deliver high quality and timely decisions
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Consistently deliver correct benefit decision, duration, benefit amount, communication and (phone calls, letter, action plan, next steps, etc.) under minimal supervision
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Ensures early intervention of claims and medical case management and appropriately returns or transitions employee back to work
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● Acts as the liaison between patients, protocols and providers Conducted thorough investigations of complex claims, gathering evidence to support decision-making processes.
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Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
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Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
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Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
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Maintained detailed records of customer interactions, ensuring proper follow-up and resolution of issues.
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Provided coaching and mentoring to new hires, contributing to their successful integration into the team.
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Responded to customer requests, offering excellent support and tailored recommendations to address needs.
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Met customer call guidelines for service levels, handle time and productivity.
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References
[Available upon request.]
COMMUNICATION
Analytical Skills: Possessing the ability to collect and analyze information, problem solving, and making decisions.
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Communication Skills: Possessing the ability to observe and give critical feedback with the patience for active listening in order to give an accurate presentation.
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Intrapersonal Skills: Self-Confidence; Strong Work Ethic; Relationship Management; Receptive to Feedback; Body Language; Listening; Collaborating with others
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Complex Problem Solving: Identifying complex problems and reviewing related information to develop and evaluate options and implement solutions.
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Critical Thinking: Using logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
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Reading Comprehension: Understanding written sentences and paragraphs in work related documents.
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LEADERSHIP
● Analytical Decision Making
● Delegation
● Teamwork
● Adaptability
● Trustworthiness
● Tech Savviness
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