A Disability Claims Examiner is the core pillar for the social security administration and disability insurance firm. The job description entails reviewing the disability claims of people who are dealing with long-term disabilities and to determine if an appropriate settlement amount is provided to them. Other core duties are listed on the Disability Claims Examiner Resume as – reviewing and evaluating disability process claims; examining claims materials to ensure insurance coverage and validity; determining the liability amount after assessing police reports, medical bills, and medical treatment property; and making an accurate determination of the claim.
The most sought-after skills include the following – strong skills for gathering and analysis; a good understanding of disability laws and regulations governing health information; speaking and report writing skills; interviewing skills; and the ability to draft clear reports. Typically requires a bachelor’s degree or its equivalent.
Objective : To secure a Disability Claims Examiner position with a well-established organization or company with a stable environment that will lead to a lasting relationship. Seeking a position that will enhance and offer growth and personal development.
Skills : Microsoft Office, Inventory Management, SAP, Kaizen - Lean Manufacturing, Customer Service, Business Development.
Description :
Managed a caseload of 175 disability applicants, supervising the adjudicative process for disability determination.
Interviewed applicants to gain a detailed description of alleged disabilities.
Worked with healthcare facilities, doctors, and lawyers to gain applicants' medical history.
Reviewed applicant's medical records to determine the severity of impairments to assess clients' ability to obtain gainful employment.
Provided exceptional customer service keeping the applicant informed of any claimant obligations as well as the status of the claim while answering any questions the client might have.
Ensured all confidential applicant information was secure.
Obtained past/present employment information for applicants including salary information, start dates, and termination dates.
Experience
2-5 Years
Level
Junior
Education
GED
Disability Claims Examiner Resume
Objective : Strong reputation as a team player and passion for helping others with the ability to attain new concepts and skills quickly and efficiently.
Skills : Computer Skills, Information Technology, Data Entry, MS Office.
Description :
Able to investigate and research claims and perform benefit calculations.
Reviewed medical records to determine the extent of disability and to make recommendations concerning the application of pre-existing condition language.
Verified and audit claims before and after processing claims for payment.
Approved members for temporary disability benefits and make recommendations concerning member's eligibility for Total and Permanent Disability.
Experienced in telephonic counseling or customer service skills.
Conducted service audits.
Established follow-up dates and methods for each on-going claim assigned to them.
Experience
2-5 Years
Level
Executive
Education
GED
Disability Claims Examiner Resume
Objective : Seeking a Disability Claims Examiner position with an outstanding career opportunity that will offer a rewarding work environment along with a winning team that will fully utilize management skills.
Skills : Microsoft Office, Writing, Teamwork, Task Management, Leadership, Communication, Customer Satisfaction and Recovery, Fast-Pace Efficiency.
Description :
Swifted review of claims after submission for completeness and accuracy.
Organized and indexed claims into Easyclient System.
Managed claim within the AS400 system including the issuance of disability benefits according to proper policy language.
Determined if the insured will be set up on a monthly-annually request for disability claim form while taking into account the nature of the disability and type of employment.
Issued disability checks based on a four-cycle system with an indication to the insured of set deadlines.
Managed and distributed check reports weekly prior to check run.
Proficient and organized upkeep of daily production log.
Experience
2-5 Years
Level
Executive
Education
G.E.D
Disability Claims Examiner Resume
Objective : As a Disability Claims Examiner, responsible for Preparing written communication for claim notifications in two or more divisions. Responsible for Serving as backup to claims examiners on telephones.
Skills : MS Office, Administrative Skills, Managing Skills.
Description :
Received and effectively developed, managed, and adjudicated initial Social Security/Disability claims.
Conducted phone interviews to gather information.
Obtained medical evidence from sources.
Evaluated all medical information received for consistency and completeness.
Wrote case determinations and summaries based on Medical Evidence Received.
Made professional decisions regarding claims as it relates to the program eligibility.
Prioritized workload and time management.
Experience
0-2 Years
Level
Entry Level
Education
Bachelor Degree
Disability Claims Examiner Resume
Objective : Disability Claims Examiner with 2 years of experience in Utilizing various databases containing waiver of premium, individual disability income accelerated benefits claims.
Skills : Computer Skills, Interpersonal Skills, Communication Skills.
Description :
Assumed responsibility for all assigned large accounts and sensitive groups to review and resolve customer problems and complaints concerning claims matters and personally handles the claim through resolution.
Relieved and completed work assignments for other Claim Representatives during absences, etc.
Investigated, researched, verified, and obtained medical information on all claim types to determine eligibility and interpret information relating to the severity of the stated disability.
Adjudicated claims in accordance with established policies and procedures.
Obtained complete and accurate information from groups, agencies, physicians, claimants, etc., to verify and ensure claim eligibility and/or disability.
Maintained thorough knowledge of all policies, statutes, and regulations, medical conditions, and departmental procedures to ensure proper dispositions of claims.
Provided professional, prompt, and accurate customer service via telephone and in writing to members, groups, doctors, etc., in handling disability and EIB claims.
Experience
2-5 Years
Level
Executive
Education
Bachelor Degree
Disability Claims Examiner Resume
Objective : Self-motivated Disability Claims Examiner professional highly proficient in developing creative solutions and implementing objective decision making. To maintain positive attitude and work hard to build team relationships.
Skills : Microsoft Word, Documenting Skills, Legal.
Description :
Managed workload to ensure completion within established timeframes to meet performance standards.
Communicated with medical sources to request records, evidence, and any clarifications.
Conducted telephone interviews with claimants to clarify application information.
Documented accounts and entered decisions into claim records per policy and procedures.
Analyzed and examined disability decisions for Social Security and/or Supplemental Security Income, based on federal and state laws.
Scheduled appointment evaluations for claimants.
Evaluated all legal documentation, medical records, and occupational aspects of the case necessary to support disability determination.
Experience
2-5 Years
Level
Executive
Education
Master Of Degree
Disability Claims Examiner Resume
Objective : As a Disability Claims Examiner with 2 years Investigating and analyzing insurance claims to determine extent of Insurer's obligations. Responsible for Settling claims with first and third party claimants in accordance with policy provisions and applicable law.
Skills : Professional Counseling, Project Management, Special Events Coordination, Self-Starter, Non-Profit Development and Management.
Description :
Actively participated in training and demonstrated a steady increase in program knowledge.
Achieved federal single decision-maker rank and clearance approximately 2 years before the national average of adjudicators.
Adjudicated higher level Social Security disability claims, involving analysis of complex medical, psychological, and vocational material.
Responsible for conducting proper and timely investigations of short-term disability claims.
Managed claims according to contract guidelines and referred claims for medical review.
Researched and verified DDS jurisdiction to process incoming cases; returned to SSA any cases DDS is proscribed from processing.
Utilized a computer terminal to generate correspondences and other work-related documents.
Experience
2-5 Years
Level
Executive
Education
Master Of Degree
Disability Claims Examiner Resume
Objective : As a Disability Claims Examiner, responsible for Evaluating each claim in light of facts. and also responsible for Investigating to establish proper reserves. Experience in Settling or denies claims in a fair expeditious manner.
Reviewed and managed short term disability claims, interacting with physicians, claimants, and policyholders.
Compiled and collected the necessary documents from the claimants, employers, and physicians to process disability claims for payments.
Interpreted policies, applied legal and contractual provisions for appropriate claim determination.
Responsible for meeting critical deadlines and able to prioritize responsibilities accordingly.
Utilized the ability of discretion, professionalism, and confidentiality in regard to sensitive information overall.
Provided exceptional written, verbal, and interpersonal communication skills to ensure the proper processing of the disability claims.
Provided problem-solving and professional decision-making skills while working independently and taking part in a team-driven environment to ensure the best outcome for our clients overall.
Experience
2-5 Years
Level
Executive
Education
High School Diploma
Disability Claims Examiner Resume
Objective : Disability Claims Examiner with 6 years of experience in Assisting or servicng as back-up for monthly DMF review, Deferred and Life products. Responsible for Researching and confirming deaths and instituting set up process.
Skills : MS Office, Communication, Healthcare, Government Employment, Property Management, Data Entry, Administering programs.
Description :
Gathered and collected data. Performed interviews.
Provided excellent customer services.
Coordinated the issuance of appropriate letters and notifications to the insured as necessary.
Examined technical medical records on a daily basis, and met with nursing staff and doctors on weekly basis to discuss claimants' disabilities in.
Corresponded with the claimant and reviewed medical.
Determined coverage and issued payments based on policy coverage.
Worked a caseload of 1000 to 1500 claims.
Handled incoming calls from claimants by responding to case inquiries, resolving problems, and any complaints.
Experience
2-5 Years
Level
Executive
Education
High School Diploma
Disability Claims Examiner Resume
Objective : To obtain a Disability Claims Examiner with 5 years of experience in Processing short term and long term disability claims Made determinations for eligibility of disability benefits Collected.
Skills : MS Office, Managing Skills, Multitasking, Analyzing Skills.
Description :
Analyzed claimant information to determine medical conditions, impairments, and eligibility.
Assessed records of evidence to ensure accuracy and credibility.
Evaluated claimant vocational status, work history, and earnings by the Social Security Administration.
Managed varying caseloads and files.
Responsible for handling sensitive data including medical records and mental & medical examinations findings.
Requested and handled medical updates on all claims Processed Health Care Reform Act (HCRA) surcharges for assigned Worker's Compensation Accounts.
Adjudicated disability insurance claims following a comprehensive review of individual records.
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