The main job purpose of a Disability Claims Specialist is to take responsibility for reviewing disability documentation and to determine eligibility, maintain and review the case files, and as well render support and assistance. While the duties vary based on the requirements of the client, the following are certain core tasks mentioned on the Disability Claims Specialist Resume – analyzing and investigating the insurance claims and help in preventing fraud, performing site inspections, providing well-informed court testimonies, reviewing and processing new claim reports and court verdicts, negotiating settlements, and presenting claims review plans.
To help the disability people legally and in terms of receiving claims, the specialist needs the following skills and abilities – strong knowledge of the latest policies and regulations in the insurance industry, the ability to conduct research and gather data from various sources, and a good understanding of negotiation and settlement techniques. To become a Disability Claims Specialist, one must hold a bachelor’s degree in counseling or social work or a related field.
Objective : Using Social Security evaluation forms and considers all medical, psychological, vocational, and/or educational records to establish program eligibility, in consultation with DDS Medical and Psychological.
Skills : Surgical Technician, Medical Assistant.
Description :
Responsible for educating the part-time and full-time members on the out of work benefits offered.
Responsible for taking complete information on the initial claim and sending out proper materials based on the situation (W/C, Third Party, Motorcycle, MVA or Illness and Injury).
Knowledged in filing liens with the Department of Industrial Accidents and Health & Welfare Office.
Maintained liaisons with lawyers, members, doctors and employers throughout disability process to retrieve necessary information.
Responsible for reviewing, approving / denying, processing and maintaining all disability claims.
Assisted with completing benefits enrollment packages and ensure proper documents (birth, marriage and death certificates, divorce decrees and adoption papers) are included to complete application.
Assisted with completion of deposit slips for health insurance premiums.
Experience
2-5 Years
Level
Junior
Education
MS
Disability Claims Specialist Resume
Objective : Training to provide safety, prevention and intervention in a crisis when called upon, Using to stressful situations and can maintain a professional manner as required, ability to keep a perfessional attitude and to keep ones personal life out of the work place is crucial in an environment such as a prison and/or jail.
Skills : Microsoft Office, Medical Terminology, Vital Signs, Combat Life Saving.
Description :
Provided guidance and directions to other disability analysts.
Coordinated back-up activities for caseload of absent analysts.
Assisted branch manager by responding to staff questions and telephone inquiries.
Reviewed and assured that staff correct deficiencies identified by QA.
Reviewed staff caseloads for timeliness and appropriateness of actions.
Maintained and coordinated good public relations with SSA district offices.
Trained new disability analysts on administrative policies, rules, and regulations, and case load management.
Experience
2-5 Years
Level
Junior
Education
B. A.
Disability Claims Specialist Resume
Summary : To establish a long-term career in a company where I may utilize my Disability Claims Specialist professional skills and knowledge to be an effective Associate Program Manager and inspiration to those around me.
Skills : Supervising Skills, Analysing Skills.
Description :
Prepared Social Security Disability forms required for legal proceedings.
Required intensive written and verbal communication.
Scheduled and held lengthy interviews with Social Security Disability claimants.
Utilized impeccable written and verbal communication skills to probe claimants, for information relevant to their claim.
Often communicated with other personnel relevant to disability claims, including attorneys, judges, and SSA personnel.
Coupled a healthy balance of efficiency understanding the SSA deadlines while exercising compassion and patience with claimants' limitations.
Instructed experienced and new staff when program changes were implemented by the SSA, when program requirements were changed by DDS administration, or when a specific training need was identified for one or more employees.
Experience
10+ Years
Level
Senior
Education
Associate Of Arts
Disability Claims Specialist Resume
Summary : Explaining program eligibility and interprets medical and vocational information for claimants, their legal representatives, Social Security Administration officials, and other interested parties.
Skills : Microsoft Office, Customer Relations.
Description :
Managed assigned caseload of FMLA, Short and Long Term Disability claims.
Responsible for administering claims within contractual provisions, internal /external guidelines, and federal laws.
Evaluated claimant eligibility via information received from the claimant, attending physician, and employer.
Established a relationship with claimants in order to understand their perspective on their disability.
Used that perspective and other information identifies the claimant's functional capacity and leverage s that capacity within the context of the contract to support and encourage a return to work as appropriate.
Conducted weekly claim status meetings with clients.
Met timeliness and production metrics on a consistent basis.
Experience
7-10 Years
Level
Management
Education
MS
Disability Claims Specialist Resume
Objective : As a Disability Claims Specialist professional and fun-loving early childhood teacher with over 10 years of experience, strive to provide a positive, loving, and encouraging learning and discovery environment for early learners. Enjoy collaborating with colleagues to share ideas and support in teaching and I enjoy keeping parents up to date on the milestones children are achieving; as well as coordinating with parents and colleagues to help children overcome challenges.
Skills : Training & Development, Training & Development, Customer Service, Curriculum Development, Curriculum Development, Leadership, Technical Writing, Webex.
Description :
Assisted with the filing of census cards, health insurance folders, and any paperwork collected on a daily basis.
Maintained weekly / monthly spreadsheets for Fallon, Blue Cross, and Medco Pharmacy Claims.
Completed appeal paperwork, questionnaires and assisted with questions regarding the disability process.
Assisted the claims representatives with the completion of the disability application.
Requested medical, financial, occupational, and other information to make appropriate claim decisions.
Composed clear and technically correct letters.
Communicated with the Field Service Unit and medical professionals to make claim decisions.
Experience
2-5 Years
Level
Executive
Education
Associate Of Arts
Disability Claims Specialist Resume
Objective : Seeking a Disability Claims Specialist 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 : Ability to multi-task, Complete Deadlines, Excellent written and verbal communication, Excellent work ethic Professional, and friendly rapport.
Description :
Processed worker compensation and medical disability claims for General Motors employees.
Informed claimants of documentation requirements, payment information, and claims status.
Referred cases for appropriate case management.
Investigated and resolved claimants' complaints and concerns.
Prepared written correspondences to claimants and providers.
Entered and updated claim information.
Conducted phone interviews with eligible claimants filing for SSDI benefits.
Experience
2-5 Years
Level
Executive
Education
Associates Of Science
Disability Claims Specialist Resume
Objective : Disability Claims Specialist with 6 years of experience in the public and private sector with proven ability in establishing strong relationships with high levels of customer service and cross-cultural communication and negotiation strategies. I am able to adapt and very flexible to different situations and areas within the company. Passion for International Business and Foreign Trade.
Skills : MS Office, Time Management, Leadership.
Description :
Analyzed complex caseloads of disability claims, medical records, policies, and risk-managed claims, in order to make decisions on initial or approval or denial of benefits.
Clients include Northrop Grumman, Cisco systems, Costco, BFI Waste Management, and Caremark.
Team Development through strong communication, and collaborative skills.
Ability to find solutions to improve workflow efficiency and speed up the claims process that met or exceeded team goals.
Developed a strategic plan for claimants to return to work on certain restrictions and limitations through vocational rehabilitation and ergonomic training.
Consistently had strong employee performance reviews each year 3.5/4.0 Awarded 9 customer service awards from clients, for excellent communication, keep composure under pressure, and meet customer needs.
Determined responsibility for Disability Insurance benefits.
Experience
2-5 Years
Level
Executive
Education
Master's In International Management
Disability Claims Specialist Resume
Objective : Disability Claims Specialist Training Continuous Process Improvement Staff Development & Leadership Data Processing Time Management Public Speaking & Presentations Human Resources Management.
Skills : Proficient In Microsoft Office, Internet Explorer, Proficient In PC And MAC Platforms, Workday, Deltek Time And Expense.
Description :
Scheduled 20 weekly phone appointments with clients to complete Social Security Disability Insurance appeal applications and questionnaires.
Acted as a liaison between the client and client's representative to provide concise information regarding the Social Security Disability Insurance benefits process.
Wrote extensive reports on client's symptoms and limitations based on their conditions, and how these affect the client's daily activities and personal care needs.
Managed daily timetables and provided meticulous client and administrative data reporting.
Trained and mentored inexperienced Disability Claims Specialists to perform among top members of service.
Obtained sensitive personal and confidential information from disabled clients regarding their disability to properly assist clients with their Social Security Disability Insurance claim.
Investigated and processed total and permanent individual disability claims on private policies for physicians and dentists.
Experience
2-5 Years
Level
Executive
Education
GED
Disability Claims Specialist Resume
Headline : Analyzing data including diagnostic and assessment tests for program requirements, Ordering medical and psychological examinations and tests to help determine the severity of applicants' physical or mental impairments.
Skills : Microsoft, Claims Specialist.
Description :
Reviewed and evaluated new and ongoing short-term disability claims to determine liability.
Reviewed contract provisions and medical/vocational evidence to support claims.
Referred claims to appropriate internal and external resources to impact a safe and timely return to work.
Established action plans to bring the claim file to a resolution.
Updated and maintained data records in a clear and concise manner.
Participated in additional pieces of training and competencies to include California State Paid Family Leave and Family Medical Leave Act training and utilization.
Requested and reviewed medical records and Physician Statements, and interviewed claimants regarding disabilities.
Experience
5-7 Years
Level
Junior
Education
BA In Psychology
Disability Claims Specialist Resume
Objective : Disability Claims Specialist with 3 years of experience in Evaluating previous vocational history to evaluate the ability to perform past work or if the claimant has transferrable skills to other work activity, and also Consultanting, Disability Program Specialists (quality assurance) and Disability Program Managers.
Skills : Disability Specialist, MS Office.
Description :
Managed assigned caseload of Short Term Disability claims.
Determined whether to pend, deny or pay claims. Inputs data. Evaluates claimant eligibility via information received from the claimant, attending physician and employer.
Decided payment period, follows up and monitors payment accuracy and timeliness.
Followed and established claim policies and practices to resolve claims and issues.
Reviewed initial and reconsideration claims and applications as well as Continuing Disability Review Reports for both adults and children and determines what medical/vocational/educational information is needed.
Requested information from applicant by telephone or U.S. Mail as necessary to meet disability program requirements.
Contacted doctors, psychologists, other health care professionals, and educational institutions to obtain information regarding claimants' physical and mental conditions.
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