Senior Veteran Benefits & Claims Leader
Resume:
WENDY M. EARL-JONES
Leander, TX
*************@*****.***
Senior Veteran Services & Claims Operations Professional with 30+ Years of Experience Delivering High-Accuracy Benefits Adjudication, Patient Advocacy, and Financial Operations Excellence within Federal and Healthcare Environments. Recognized for resolving complex, high-volume cases with 98% accuracy, improving workflow efficiency by up to 80%, managing $1M+ in veteran accounts, and consistently improving veteran satisfaction, compliance, and operational outcomes through meticulous case management and process improvement.
SUMMARY OF ACCOMPLISHMENTS
●Processed and adjudicated 200+ veteran claims per month with a 98% accuracy rate, ensuring timely and compliant benefit delivery.
●Resolved 100+ complex patient complaints monthly, achieving fair, compliant, and timely outcomes.
●Reduced recurring patient and claims issues by up to 80% through proactive problem-solving initiatives.
●Managed and reconciled $1M+ in first- and third-party veteran financial accounts.
●Improved claims turnaround times through streamlined evidence collection and workflow optimization.
●Supported favorable outcomes in 500+ legal and administrative cases through research, documentation, and compliance oversight.
●Increased veteran engagement and utilization of services through outreach coordination and education.
●Improved reporting accuracy and efficiency through disciplined case documentation practices.
●Recognized multiple times for team collaboration and process improvement excellence.
●Maintained consistent compliance with federal, VA, and legal regulatory standards throughout career.
AREAS OF EXPERTISE
●Veteran & Patient Advocacy
●Claims Adjudication & Benefits Counseling
●Case Management & Documentation
●Federal & VA Regulatory Compliance
●Financial Analysis & Revenue Operations
●Legal Documentation & Case Support
●Customer Service & Conflict Resolution
●Process Improvement & Workflow Optimization
●Cross-Functional Collaboration
●Stakeholder & Client Engagement
PROFESSIONAL EXPERIENCE
Department of Veterans Affairs, Louisville, KY
Patient Advocate November 2022 – September 2023
●Resolved 100+ complex patient complaints monthly, ensuring compliant, timely, and equitable outcomes.
●Collaborated with clinical teams, leadership, and veteran service organizations to improve patient experience.
●Identified systemic issues and implemented corrective actions that reduced recurring complaints by 80%.
●Maintained detailed, compliant case documentation to support reporting and audit readiness.
●Served as a trusted liaison between veterans, families, and healthcare providers.
Department of Veterans Affairs, Jackson, MS
Veteran Service Representative May 2014 – November 2022
●Processed and adjudicated 200+ claims per month with 98% accuracy, ensuring timely benefit determinations.
●Conducted in-depth interviews and evidence analysis to support veteran and dependent eligibility decisions.
●Streamlined claims evidence collection processes, reducing processing delays and backlogs.
●Partnered with outreach teams to increase veteran awareness and engagement in benefits programs.
●Ensured strict compliance with VA regulations and federal guidelines.
North Central Consolidated Patient Account Center (CPAC), North Chicago, IL
Facility Revenue Technician August 2007 – October 2011
●Managed $1M+ in veteran accounts, including billing, collections, and reconciliation.
●Processed daily financial reports, improving accuracy and departmental efficiency.
●Provided individualized financial counseling to veterans, increasing repayment compliance.
●Resolved billing discrepancies and coordinated with internal departments to ensure timely resolution.
●Maintained compliance with VA financial and auditing standards.
Department of Veterans Affairs & Naval Legal Service Offices, Various Locations
Claims Assistant / Legal Support Roles 1988 – 2007
●Prepared legal documents, case files, and supporting materials in compliance with federal regulations.
●Conducted case research and drafted recommendations supporting favorable outcomes in 500+ cases.
●Coordinated communication among clients, attorneys, and administrative teams.
●Implemented administrative process improvements that reduced case delays and improved throughput.
●Supported legal proceedings through accurate documentation and case tracking.
EDUCATION
High School Diploma
North Chicago Community High School, North Chicago, IL
GPA: 3.5 Major: Business
CERTIFICATIONS, TRAINING & ACCOMPLISHMENTS
●VA Leadership Program – North Chicago VA
●Legal Document Preparation & Case Management – Naval Legal Service Office
●Financial & Billing Procedures – VA Training Programs
●Multiple Team Collaboration and Process Improvement Awards
TECHNICAL SKILLS
●VA Systems: VISTA, VA Claims Systems
●Microsoft Office Suite
●Typing Speed: 45 WPM
●Advanced English Proficiency (Written, Spoken, Reading)
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