Claims Analyst Life, LTD, and Living Benefits Specialist

Tiffany Hollins

*** ******** ****** **. ********, OH 45030 ******************@*****.*** ***************@*****.***

Cell 513-***-****

Authorized to work in the US for any employ

Objective

Experienced claims analyst specializing in Life and Death claims along with LTD and living benefits such as Chronic and Terminal illnesses. In-depth knowledge of insurance policies and state regulations. Skilled in using ClaimsPro software to efficiently process and resolve complex claims. Proven efficiency in equitable resolutions and high levels of client satisfaction and risk mitigation. Implemented a new quality assurance process through Facets that reduced processing errors by 25%. Proven track record of critical thinking and independent decision making skills with timely completion of projects.

Summary

Experienced Claims Specialist and Testing Analyst specializing in life and death claims along with LTD and Accelerated (living) benefits. In-depth knowledge of insurance policies and state regulations. I am skilled in using ClaimsPro software to efficiently process and resolve complex claims. Proven efficiency in equitable resolutions and high levels of client satisfaction and risk mitigation. Implemented a new quality assurance process that reduced processing errors significantly. Proven track record of critical thinking and independent decision-making skills with timely completion of projects. Proficient IBM iSeries (AS400) professional with hands-on experience in data extraction, entry, and auditing.

Interpersonal Skills

Analytical & Problem-Solving skills:

Interpret complex data and develop effective solutions

Organizational & Planning skills:

Develop and implement efficient plans and manage multiple tasks.

Communication Skills:

Collaborate with diverse stakeholders and present information clearly.

Technical Skills:

Proficiency with various software tools and systems for planning, monitoring, and reporting.

Adaptability:

Adjust plans and strategies as circumstances change.

Managed Care Systems:

Experience with configuring and maintaining managed care plans within core administration systems, such as Eyemed’s claims system.

Configuration and Auditing:

Proficient in plan configuration, product key sheet methods, and performing internal audit

Compliance:

Knowledge of industry audit controls (SSAE 1 8, HIPAA) and corporate compliance procedures.

Database Management:

Experience with database administration, data analysis, and reporting. Including SQL knowledge.

Software Proficiency:

Advanced skills in Microsoft Excel end other MS Office Suite applications Such as but not limited to:

CURA

Facets

Citrix DESKTOP

Citrix Workshop

Avaya 2.0 AWD Platinum

QuickBooks

Excel

Microsoft office Suite

Onenote

Mainframe

Filebound

Reflections

LifePro claim’s software

Benekiva

IBM iSeries (AS400)

Eyemed’s claims Software

Skills:

•Organizational Skills

•Filing

•Data Entry (3 years)

•Invoicing (1 year)

•General Ledger Accounting

•HIPAA (4 years)

•Customer Relations (5 years)

•Medical Billing

•Medical Terminology

•Claims Auditing

•Insurance Claims

•Claims handling

•Data Analysis

•Claims Research

•Claims testing

•Claims Analyzing

•Critical Thinking

•Independent decision-making

•Pivot Tables

•Contract Reconciliations

•Vlookup

•Excel Query

•Excel Reports

•Excel Audits

•SQL programming Language

•SAP data entry

•Claims Resolution

•Conflict Resolution

•Attention to Detail

•Written and Verbal Communication

Work Experience

Logistics Claim Specialist

Integrity Express Logistics LLC

October 23, 2025 – present

•Process Cargo Claims by processing claims IEL experiences from a variety of carrier service issues such as temperature abuse, cargo theft, incorrect or damaged product at delivery

•File claim through carrier insurance and manage claim until completion

•Record claims upon initial notification through the MyEZClaims software, IEL’s claim tracking software

•Work with Accounts Payable team members to process and collect payments

•Collect necessary claim documents needed to process and substantiate each case in an effort to mitigate IEL loss and exposure

•Assist with customer payment and overall satisfaction throughout claim process

•Adhere to Claims Department principles to ensure best practices are communicated through organization

•Develop claims training material and facilitate training sessions for sales team

•Identify trends and trouble areas that IEL can use to mitigate risk and future loss.

•Expand knowledgebase and continuously learn throughout the industry from experts, current events, and case precedent

•Provide reporting to management as requested and maintain accurate claim tracking

•Handle other duties as assigned

Claims Analyst

Unity Financial Life

January 6, 2025- July 9, 2025

•Managed entire claims function

•Acquired proof of death, claim calculation and payments

•Created and completed claim jacket form & Texas reconciliations

•Investigated and formulate recommendations for policy recession

•Knowledge of SQL, pulling data from AS400 into Facets

Claims Testing Analyst

Eyemed / Vertex Global Solutions

April 2024 – January 3, 2025

•Investigated, evaluated and settled claims, applying technical knowledge and human relations skills to effect fair and prompt disposal of cases and to contribute to a reduced loss ratio.

•Adjusted reserves or provide reserve recommendations to ensure that reserve activities are consistent with corporate policies.

•Resolved complex, severe exposure claims, using high service oriented file handling.

•Paid and processed claims within designated authority level.

•Examined claims investigated by insurance adjusters, further investigating questionable claims to determine whether to authorize payments.

•Verified and analyzed data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.

•Entered claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.

•Maintained claim files such as records of settled claims and an inventory of claims requiring detailed analysis.

Claims Specialist

TATA Consultancy Services / Transamerica October 2021 – April 2024

•Analyzed insurance information of deceased

•Performed data entry with average of 45+ wpm

•Investigate, verify and record all life insurance claims

•Cross reference insurance claims with insurance policy, coverage and legal documents to determine validity of claim

•Keep detailed documentation of all correspondence

•Review, prepare, create and/or send letters, reports or forms

•Review all documents for trusts and estates to insure they are compliant with federal and state laws and regulations

•Effectively manage a portfolio of various claims

•Communicate claim action/processing with claimant, client and appropriated medical contact

•Identify notification issues, coordinates resolution and takes corrective action as needed

•Maintain action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution, escalates issues as needed

•Ensure claim payments comply with federal, state and company regulations

Medicaid Health Support Specialist

Teleperformance USA / UnitedHealth Care

November 2020 to August 2021

•Communicate with internal or external sources such as pharmacies and patients

•Make & receive calls to patients, carriers and physicians.

•Handle sensitive client & patient interactions

•Navigate both Citrix workspace and web

•Maintain all compliance and HIPAA regulations

•Handle all areas of behavioral health including mental health, domestic and potential suicide cases providing necessary resources.

•Thorough knowledge of government Medicaid & benefit resources, laws & regulations for Ohio and New York

•Provide mental health support by providing information for community outreach programs with partnered vendors.

•Ensure eligible families are receiving their health services and making/keeping appointments to b receive necessary care that is mandated by the federal government

•Determine clients eligibility for financial assistance by reviewing and calculating income and documenting with accuracy and create files for auditing.

Administrative Associate

Pieczonka's Unlimited

March 2020 to September 2020

•Update all inventory for store and mobile truck

•Accounts Payable, Accounts Receivable, creating invoices

•Customer service / Retail

•Take orders for screen printing and embroidery 5. Build SKU's and barcodes for new inventory

•Processed payments, including sales and refunds

•Maintained inventory according to company procedures

•Maintained exceptional customer service standards

•Performed administrative duties such as Make copies, fax file, communicate through emails, etc.

Assistant Teacher/Teacher

ABC Early Childhood Learning Center - Cincinnati, OH

October 2019 to February 2020

•Helped children develop independent learning skills

•manage their own learning and prioritise their time.

•Provided one-to-one and small group support to children.

•Provide meals as scheduled

•Keep consistent schedules and reports

•Provide daily physical assessments of children

Private Childcare Provider/Owner

In-house childcare - Monroe, OH

September 2015 to February 2018

Education

Associates of Science in Business Administration And Management

University of Phoenix - Phoenix, AZ

June 2012 to August 2014

Certifications and Continued Learning

BLS for Healthcare Providers 2018 to 2020

CPR/First Aid 2018 to 2020

Child Abuse and Neglect 2020 to 2023

Communicable disease 2020 to 2023

Driver's license

iQMS for PLs Training

January 21, 2023

LDP: Organizational Awareness Foundations

October 26 2022

BPS: Environmental Health & Safety Foundation

November 22, 2021

Texas department

Of banking- Reconciliations January 2025

Competencies

Sustained Stability and Business

Jan 16,2023

Process Improvement (PI)

Nov 5, 2022

Coaching

Aug 18, 2022 L1 Proficient

Interpersonal Skills

Oct13,2021 L2 Proficiet

BFSI compliance and Fraud

Six Sigma completed courses

Resource Management – Behavioral

Business Acumen – Behavioral

Customer Focus – Behavioral

Quality management for Delivery – MRC

Health Insurance

CMI- Information Services – Non Finance

Assessments

Knowledge of Early Childhood Development — Highly Proficient February 2020

Knowledge of the development of children ages 0-3 and of ways to foster that development. Full results: Highly Proficient

Data Entry Clerk — Proficient February 2020

Maintaining data integrity by detecting errors. Full results: Proficient

Scheduling — Familiar February 2020

Cross-referencing agendas and itineraries to avoid scheduling conflicts. Full results: Familiar

“Indeed Assessments provides skills tests that are not indicative of a license or certification, or continued development in any professional field.”

Additional Information

Skills

•Accustomed to working under pressure and exhibiting patience

•Excellent talent for using strategies to deescalate tense situations

•Strong interpersonal skills, with the ability to relate and empathize with people of varying personalities and from all walks of life

•Creating and completing Pre-need and At-need contract reconciliations.

•Excellent communication skills in verbal, written, and oral communication.

•Proficiency in numerous computer applications and software, including MS Word, Power Point, Excel, QuickBooks, POS, Ricks and ACH.

•Highly motivated and driven to achieve set goals and targets

•Ability to maintain a calm and composed manner when dealing with complex situations.

•Superb ability to multitask, able to handle multiple duties and responsibilities without sacrificing quality of work

•Experienced in handling confidential matters

•Great team player and excellent independent worker

•Unique talent for handling and resolving conflicts within the team.

•Proficient in analytical, document management, and database query software.

Contact this candidate