Disability Claims Analyst Resume
Headline : As a Disability Claims Analyst, responsible for adjudicating and managing disability claims in a team-oriented, multi-disciplinary, digital environment.
Skills : Communication, Customer service.
Description :
- Ensured claims were recertified and paid under unit procedures while delivering superior client service.
- Applied appropriate risk management strategies that impact the company’s financial results, reputation and regulatory risks, client relationships, and business retention.
- Adjudicated claims utilizing a multidisciplinary claim management model to ensure objective, fair, and thorough claim adjudication, and comply with practices procedures, and regulatory requirements.
- Provided the highest level of customer service managed reputational risk and, developed and implemented claims management and return-to-work strategies on assigned caseloads where warranted.
- Managed a large caseload of disability claims.
- Documented the appropriate next steps while effectively applying the adjudication process.
- Communicated outcomes to our clients and given the very sensitive nature of the information gathered in the adjudication process, extreme care must be exercised in the handling of a claim to guard against any breach of confidentiality.
Experience
5-7 Years
Level
Consultant
Education
BSW
Disability Claims Analyst Resume
Objective : As a Disability Claims Analyst, responsible for communicating and building rapport with team members, stakeholders, and business partners using a variety of techniques and collaboration from initiation to close.
Skills : Collaboration, MS Office.
Description :
- Reviewed information submitted to identify disability status, benefit eligibility, and benefits.
- Made claims payment and led the claim over the life of the client's disability.
- Maintained relationships by providing clients and advisors with a clear understanding of requirements and status of claims.
- Handled claim documents as they were received and communicated clearly and completely regarding the handling of the claim.
- Adjudicated timely claim payments by settling the type and amount of the claim, verifying the status of the insurance policy and riders, confirm policy provisions.
- Requested and analyzed medical, financial, and occupational claim requirements.
- Coordinated investigative efforts ensuring appropriate referral of claims to internal resources and outside vendors.
Experience
0-2 Years
Level
Entry Level
Education
BSW
Disability Claims Analyst Resume
Objective : As a Disability Claims Analyst, responsible for performing all activities associated with the settlement of claims on Individual Disability insurance policies and riders.
Skills : Data Entry, Documentation.
Description :
- Obtained appropriate claim documents, and interacted with clients, advisors, and outside vendors.
- Provided a thorough review of contestable claims.
- Made detailed claim files with subjective, objective, analysis, and plan information.
- Understood and aligned with Fair Claim Handling requirements, state regulatory requirements, insurance law, and legal/compliance procedures related to contracts and insurance claims in general.
- Identified claim risk and red flags, mitigating such risk during adjudication of the claims.
- Applied referral resources and vendors appropriately to monitor risk and claim costs throughout the life of the claim.
- Investigated the details of claimants’ compensation requests by identifying and requesting relevant information and documents confirming the details of the loss.
Experience
0-2 Years
Level
Fresher
Education
BSW
Disability Claims Analyst Resume
Objective : As a Disability Claims Analyst, responsible for performing secondary review and approval of peer claims within the authorization level. Handling claims referrals from team members and assisting with complex claims as necessary.
Skills : Medicaid, Technical, Understanding of medical terminology.
Description :
- Secured and analyzed claim information to make and approve disability decisions and payments on disability claims.
- Developed, applied, and approved appropriate claim and disability management strategies to ensure prompt and accurate payment and liability management of disability claims.
- Provided responsive and caring customer service to claimants, policyholders, and other internal and external customers.
- Participated actively and effectively in team/department projects and issues.
- Contributed to the company’s success through excellent customer service and meeting or exceeding performance objectives for the following major job functions.
- Investigated, secured, and analyzed information about claimants’ medical conditions, occupational demands, insured status, and other policy provisions to accurately determine eligibility for and entitlement to disability benefits.
- Identified file/fact discrepancies and outstanding issues and secured additional documentation as needed while investigating within prescribed timeframes.
Experience
2-5 Years
Level
Junior
Education
BSW
Disability Claims Analyst Resume
Summary : As a Disability Claims Analyst, responsible for communicating disability decisions and issuing correct benefits for new and continuing claims.
Skills : Analysis, Innovation.
Description :
- Developed and executed a claim and disability management strategy for each claim to appropriately manage claim liability.
- Investigated, applied, pursued, and used to reach timely and appropriate claim resolution.
- Communicated and responded to claim and account inquiries from claimants, policyholders, field personnel, and other interested parties.
- Resolved issues through effective oral and written communication and by involving appropriate people within, or outside, the department or company.
- Acted as the primary client contact within Benefits and liaison with Operations and Sales on the installation, servicing, and renewal of disability clients.
- Worked on analyzing claim/service trends and implementation of responses; creation of customer claim reports and communications to meet client needs.
- Participated in renewal assessments and client visits, effectively and professionally representing the company in all interactions.
Experience
7-10 Years
Level
Senior
Education
BSW
Disability Claims Analyst Resume
Headline : As a Disability Claims Analyst, responsible for approving claim decisions, claim and disability management strategies, and payments recommended by less-experienced staff, and providing training for the department, team, and individuals.
Skills : Liability, Medicare, Conflict Resolution.
Description :
- Ensured the company’s reserve liability was accurately established by identifying all applicable claim offsets and maintaining accurate claim and system data.
- Analyzed and applied medical, technical, contractual, and legal information to manage an increasingly complex range of disability claims and teach and model effective claim practices to others individually and in a classroom setting.
- Managed claim and account trends as well as individual claims.
- Expert in Federal, State, and local laws and regulations affecting claim investigation, disability decisions, and taxation of benefits, such as the Fair Claim Settlement Practices Act, ERISA, and Americans with Disabilities Act.
- Responsible for managing disability and claim management principles and practices including medical, vocational, investigative, financial analysis, legal issues, contract interpretation, and application, company policies, and guidelines.
- Worked closely in group disability claims and their administration, department practices and procedures, department’s automated claim adjudication and management systems and resources.
- Achieved results by effective use of all appropriate resources and model positive teaming behaviors in team and department interactions.
Experience
5-7 Years
Level
Executive
Education
BSW
Disability Claims Analyst Resume
Summary : As a Disability Claims Analyst, responsible for determining medical eligibility on initial, reconsideration, child, continuing disability review, and complex priority claims for the Social Security Administration (SSA) disability program by receiving applications, interviewing claimants, obtaining, and reviewing medical and vocational information, and preparing reports.
Skills : Claims processing, Detail-oriented.
Description :
- Incubated and completed a training and mentorship program to develop knowledge and proficiency to determine medical eligibility for all claim types.
- Able to investigate, analyze, and extract critical information, identify problems, be organized, and manage multiple priorities.
- Communicated clearly and concisely, and made decisions maintaining a high level of production, accuracy, and timeliness.
- Utilized multiple computer software applications and data systems proficiently, coach and mentor coworkers,
- Reviewed medical and other types of records critically analyzed large amounts of information and wrote reports and medical functional assessments.
- Provided exemplary customer service, and worked with others in a manner that shows sensitivity, tact, and professionalism.
- Comprehended information and appropriately applied new information learned to the adjudication process taking direction and constructive criticism.
Experience
7-10 Years
Level
Consultant
Education
BSW
Disability Claims Analyst Resume
Summary : As a Disability Claims Analyst, responsible for working independently and in a team setting to reach common goals and maintain an optimistic demeanor and outlook that reflects agency culture.
Skills : Compliance, Judicial, Time Management.
Description :
- Applied analytical thinking and deductive reasoning to make accurate disability determinations.
- Expert on applicable laws, rules, and regulations of the Social Security disability program, and disability adjudication policies and procedures.
- Obtained and analyzed medical and vocational information to ensure sufficient information was received to determine the medical eligibility of those applying for Social Security disability benefits.
- Requested daily living information from claimants and third parties.
- Requested medical, psychological, vocational, and related information from the claimants’ physician, and treating facility.
- Requested additional information when evidence is discovered that reveals there is a need for further development.
- Interviewed claimants, physicians, employers, claimants’ friends, relatives, legal representatives, institutional staff, and other service agencies to gather necessary information to substantiate claims.
Experience
7-10 Years
Level
Senior
Education
BSW
Disability Claims Analyst Resume
Headline : As a Disability Claims Analyst, responsible for conferring with medical consultants, disability claims specialists, and supervisors to resolve complex problems with claims or medical evidence.
Skills : Scheduling, Analytical Skills, Legal Knowledge.
Description :
- Reviewed and analyzed the evidence to determine whether there is enough information in the file to determine the claim.
- Requested specialized examinations and/or testing if the medical information is not sufficient to make a medical determination.
- Requested essential vocational evidence to ensure the claimant's work issues are accurately addressed in the determination of eligibility.
- Made determinations on eligibility for Social Security disability benefits to ensure claims are handled effectively.
- Reviewed medical information and wrote residual functional capacity assessments based on sufficient evidence.
- Made referrals to medical consultants to sign off on the functional assessments or to assist with problems in interpreting the severity of medical or psychological conditions.
- Reviewed the vocational information and determine the employability factor of the claimant, based on their age, education, and work experience.
Experience
5-7 Years
Level
Executive
Education
BSW
Disability Claims Analyst Resume
Objective : As a Disability Claims Analyst, responsible for interpreting and explaining program criteria and the basis for the determination of claimants, their representatives, and public officials.
Skills : Medical Knowledge, Attention to Detail.
Description :
- Wrote rationales explaining the reasoning for decisions made in processing the claim, based upon an analysis of medical, psychological, and vocational records and federal policies, rules, and regulations.
- Determined the need for future reviews based on knowledge of the impairment and the potential for changes in claimant status and set the review dates.
- Managed and assigned cases to maintain up-to-date information ensuring effective case processing.
- Monitored a computer database program that assists in establishing caseload priorities.
- Took daily action to order records, view exam reports, order or reschedule exams, review records on claims with all records in, process claims when back from the consultants, and take follow-up action to ensure effective claim movement.
- Viewed claim files through a web-based electronic disability collection system to edit, move, flag, and take a specified case action.
- Entered data into the electronic claims analysis tool that guides analysts through the sequential evaluation process of individual claims.
Experience
2-5 Years
Level
Junior
Education
BSW
