Project Management Claims Review

Steven M. Burris

Plainfield, NJ 908-***-**** **********@*******.***

Reporting & Analysis Claims Review & Investigation Project Management Ü Ü Ü Self-and High insights Decisive team managing directed degree settings. from self-of starter analyst diverse Conveys claims intellectual who with investigations and complex takes disparate extensive curiosity initiative, information sources. in experience and regulated expertise learns clearly evaluating quickly, environments. in and synthesizing and succinctly multi-works source information in equally written data, well and conducting to independently cull oral actionable, communication. stakeholder or decision-in collaborative interviews, driving Analytical & Decision-Making Skills Multitasking & Prioritization Claims Administration Documentation Process Improvement Fraud Prevention Trend Identification Relationship Building Strong MS Office/Excel Policy Review & Interpretation Medical Terminology Time Management Cross-Functional Collaboration Professional Experience

STATE Disability OF Claims NEW JERSEY, Adjudicator Social Security Administration, Trenton, NJ Dec 1991 – Feb 2022 Managed in-medical status. used depth various Gained diagnoses analysis caseload research, broad of of to medical disability understanding determine database, records, claims, validity and of claims documentation, upwards medical of claims management terminology of 10 and new and extent cases tools third-and of daily, efficiently. conditions, party disability, from references. initial in interpreted line receipt Applied with state procedures to eligibility complex requirements matrices and decision. regulations, for for Performed disability various and Project Management

Top • • Performance Following determination Developed cases at various initial and of maintained stages case disability, review, of claims project and established evaluate lifecycle. management impact case plan on systems and claimants’ timelines to track ability to progress gather to perform and additional follow-duties information, up of status employment. for establish multiple Communication • • • Sustained Seamlessly changes Selected light of additional in for & quality processes Collaboration transitioned transfer metrics information to and claims from directives at or onsite appeals, submitted. above to to goal, meet virtual which consistently deadlines comprised work during for 90% high-inbound COVID, or level higher adapting claims review on all flow. of to randomized previously and evolving adjudicated internal with frequent audits. cases in Investigations • • Authored claimants Communicated rapport and reports of relationships benefit with outlining amounts physicians’ with decision or physicians ineligibility. offices rationale. to request and Developed office additional staff, findings overcoming case review and objections detailed and/or correspondence documentation, to avoid processing to building inform delays.

• • • Utilized established Executed hospital Evaluated state-records, detailed statements criteria approved and and for visit and thorough determining medical records testimony review diagnostic from disability from of diagnostic medical treating matrices eligibility. records, and physicians, to follow-verify including alignment up attorneys, appointments. but of and not medical limited previous claims to employers/prescription documentation colleagues. lists, with Education & Affiliations

UNIVERSITY OMEGA PSI PHI OF FRATERNITY, SOUTH CAROLINA INC. – – Former Bachelor Chaplain of Arts (& BA) Keeper in Economics of Records & Seal (KRS), 1994 – Present