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 : Dedicated professional with 2 years of experience in disability claims examination, adept at evaluating medical evidence and determining eligibility for benefits. Proven ability to collaborate with healthcare providers and maintain compliance with regulatory standards. Committed to delivering exceptional service while managing a high caseload effectively.
Skills : Data Analysis Tools, Claims Processing, Regulatory Compliance, Medical Record Review
Description :
Evaluated disability claims to determine eligibility based on medical evidence and policy guidelines.
Reviewed medical records and documentation to assess claim validity and compliance with regulations.
Collaborated with healthcare facilities, doctors, and legal representatives to gather comprehensive medical histories.
Communicated with claimants to gather necessary information and clarify details regarding their claims.
Provided exceptional customer service, keeping applicants informed of their claim status and addressing inquiries promptly.
Ensured the security and confidentiality of all applicant information throughout the claims process.
Obtained employment history details for applicants, including salary and termination dates, to support claims evaluations.
Experience
0-2 Years
Level
Entry Level
Education
B.S. Health Admin.
Junior Disability Claims Examiner Resume
Objective : With two years of focused experience in disability claims examination, I specialize in assessing medical documentation and determining eligibility for benefits. I excel in communication with healthcare providers and ensuring compliance with regulations. My commitment to accuracy and efficiency has enabled me to manage complex caseloads while delivering exceptional service.
Skills : Data Analysis, Documentation Skills, Analytical Skills, Customer Service, Attention To Detail
Description :
Investigated and researched claims to perform accurate benefit calculations.
Reviewed medical records to assess disability claims and recommended eligibility outcomes.
Verified and audited claims pre- and post-processing to ensure compliance.
Maintained accurate and detailed records of claim evaluations and decisions for audit purposes.
Utilized strong communication skills for effective telephonic counseling and customer service.
Conducted service audits to maintain quality assurance standards.
Established follow-up protocols for ongoing claims management.
Experience
0-2 Years
Level
Junior
Education
B.S. in H.A.
Disability Claims Examiner Resume
Headline : Experienced Disability Claims Examiner with 7 years in evaluating complex claims and determining benefit eligibility. Skilled in analyzing medical records and collaborating with healthcare professionals to ensure compliance with regulations. Proven track record of managing high caseloads while delivering timely and accurate claim resolutions.
Skills : Claims Processing Software, Collaboration With Healthcare Providers, Case Management, Decision-making Skills, Client Advocacy, Statistical Analysis
Description :
Conducted thorough reviews of submitted claims for accuracy and completeness.
Utilized Easyclient System for efficient organization and indexing of claims.
Managed claims within the AS400 system, ensuring compliance with policy language during benefit issuance.
Assessed insured's eligibility for monthly or annual disability claims based on their specific circumstances.
Processed disability checks on a four-cycle system, adhering to set deadlines for claimants.
Maintained and distributed weekly check reports prior to payroll runs.
Kept a detailed daily production log for tracking claim processing activities.
Experience
5-7 Years
Level
Senior
Education
B.S. in BA
Consultant Disability Claims Examiner Resume
Objective : Results-oriented professional with 5 years of experience in disability claims examination, specializing in the analysis of medical documentation to determine eligibility for benefits. Proven expertise in collaborating with healthcare providers and ensuring compliance with regulatory standards. Dedicated to delivering accurate and timely claim resolutions while effectively managing high volumes of cases.
Skills : Proficient In Ms Office Suite, Administrative Management, Claims Analysis, Medical Terminology, Critical Thinking, Data Interpretation
Description :
Managed and adjudicated initial Social Security Disability claims, ensuring compliance with all regulatory standards.
Conducted comprehensive interviews to gather detailed claimant information.
Secured medical evidence from various sources to support claim evaluations.
Reviewed and assessed medical documentation for accuracy and completeness.
Drafted thorough case determinations based on medical evidence received.
Made informed decisions regarding claims in accordance with program eligibility guidelines.
Effectively prioritized workload to manage high caseloads efficiently.
Experience
2-5 Years
Level
Consultant
Education
B.S. Health Admin.
Disability Claims Examiner Resume
Summary : Accomplished Disability Claims Examiner with 10 years of extensive experience in evaluating complex claims and determining benefit eligibility. Expert in analyzing medical documentation, collaborating with healthcare providers, and ensuring compliance with regulations. Proven ability to manage high-volume caseloads while delivering timely and accurate resolutions for claimants.
Managed a portfolio of large accounts, addressing and resolving complex claims-related issues through effective problem-solving.
Provided support to colleagues by taking over claims during absences, ensuring continuity of service.
Conducted thorough investigations, verifying medical information to assess eligibility and severity of disabilities.
Adjudicated claims in compliance with established policies and procedures to ensure accurate determinations.
Collaborated with various stakeholders to gather complete information necessary for claim eligibility verification.
Maintained an in-depth understanding of policies, regulations, and medical conditions to enhance claims processing accuracy.
Delivered professional customer service, addressing inquiries from members, healthcare providers, and claimants regarding disability claims.
Experience
7-10 Years
Level
Management
Education
B.S. in HSA
Freelance Disability Claims Examiner Resume
Objective : Dynamic Disability Claims Examiner with 5 years of comprehensive experience in assessing and processing disability claims. Expertise in analyzing medical documentation and collaborating effectively with healthcare professionals to ensure compliance with legal standards. Passionate about delivering accurate claim resolutions while managing high workloads efficiently.
Skills : Medical Documentation Analysis, Report Writing, Problem Solving, Process Improvement
Description :
Managed a diverse caseload of disability claims, ensuring timely completion within established deadlines.
Collaborated with medical professionals to obtain necessary documentation and evidence.
Conducted interviews with claimants to verify application details and clarify discrepancies.
Documented findings and entered decisions into claim management systems in accordance with policies.
Reviewed and analyzed disability claims under Social Security and Supplemental Security Income regulations.
Coordinated evaluations and assessments for claimants requiring further medical review.
Evaluated legal and medical documentation to support comprehensive disability determinations.
Experience
2-5 Years
Level
Freelancer
Education
B.S. in Health Admin.
Disability Claims Examiner Resume
Summary : With a decade of experience as a Disability Claims Examiner, I excel in evaluating complex claims while ensuring compliance with regulations. My expertise includes analyzing medical documentation and collaborating with healthcare providers to determine eligibility for benefits. I am dedicated to delivering accurate and timely claim resolutions while effectively managing high caseloads and maintaining exceptional service.
Skills : Medical Evidence Evaluation, Claims Management, Regulatory Compliance Coordination, Analytical Problem Solving, Communication Skills, Confidentiality
Description :
Evaluated complex disability claims, analyzing medical documentation to determine eligibility for benefits.
Conducted thorough investigations of short-term and long-term disability claims, ensuring compliance with established policies.
Collaborated with healthcare providers to obtain necessary medical evidence, enhancing claim accuracy.
Managed a high-volume caseload, processing over 150 claims monthly while maintaining compliance with regulations.
Utilized advanced software systems to document findings and generate correspondence for claimants.
Provided timely resolutions for claims, ensuring adherence to departmental procedures and regulatory standards.
Participated in training programs, leading to enhanced knowledge and efficiency in claims examination.
Experience
10+ Years
Level
Executive
Education
B.S. in Health Admin.
Senior Disability Claims Examiner Resume
Headline : Detail-oriented Disability Claims Examiner with over 5 years of experience in evaluating claims for accuracy and compliance. Proven ability to analyze medical records and documentation to determine eligibility for benefits. Strong communication skills to liaise with claimants and healthcare providers, ensuring a thorough understanding of policies and procedures. Committed to delivering fair and timely decisions.
Evaluated and processed short-term and long-term disability claims, collaborating with physicians and claimants for accurate outcomes.
Collected and verified necessary documentation from claimants, employers, and medical professionals to ensure efficient claim processing.
Interpreted insurance policies and applied legal guidelines for accurate claim determinations.
Consistently met critical deadlines while prioritizing tasks to manage a high volume of claims.
Maintained confidentiality and professionalism while handling sensitive information.
Utilized strong communication skills to facilitate effective interactions with stakeholders, ensuring clarity in the claims process.
Demonstrated problem-solving abilities and sound judgment in decision-making to achieve optimal outcomes for clients.
Experience
5-7 Years
Level
Senior
Education
B.S. in HA
Disability Claims Examiner Resume
Objective : Compassionate professional with 2 years of experience in disability claims examination, skilled in evaluating medical records to assess benefit eligibility. Demonstrates strong collaboration with healthcare providers to ensure compliance with regulations. Focused on delivering accurate outcomes while effectively managing a substantial caseload.
Skills : Data Analysis Software, Interpersonal Skills, Empathy, Medical Record Analysis, Conflict Resolution, Technical Proficiency
Description :
Collected and analyzed data to assess claims.
Delivered exceptional customer service to claimants and stakeholders.
Coordinated communication by issuing necessary letters and notifications regarding claims.
Reviewed technical medical records daily and collaborated with healthcare professionals to discuss claimant disabilities.
Corresponded with claimants to clarify medical documentation.
Evaluated coverage and processed payments based on policy terms.
Monitored claim trends and patterns to identify areas for improvement in the claims process.
Experience
0-2 Years
Level
Entry Level
Education
B.S. Health Admin.
Disability Claims Examiner Resume
Summary : Bringing a decade of experience as a Disability Claims Examiner, I specialize in evaluating complex claims and determining benefit eligibility. My skills in analyzing medical documentation and collaborating with healthcare professionals ensure compliance with regulatory standards. I am dedicated to providing accurate and timely claim resolutions while managing substantial caseloads efficiently.
Skills : Data Management Software, Training Skills, Prioritization Skills, Cultural Competence, Organizational Skills
Description :
Evaluated complex claimant information to determine medical conditions, impairments, and eligibility for benefits.
Conducted thorough assessments of medical evidence to ensure accuracy and compliance with regulations.
Analyzed vocational history and earnings reports from the Social Security Administration.
Managed diverse caseloads, ensuring timely updates and resolutions.
Handled sensitive medical data, adhering strictly to confidentiality protocols.
Requested and processed medical updates for ongoing claims, ensuring completeness.
Adjudicated disability insurance claims after comprehensive reviews of individual records.
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