Devora Person Email & Phone Number

Investigates and maintains simple LTC complexity claims, including but not limited to: Reviews and evaluates coverage and or liability.Analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, records, or other documents) to determine eligibility claim decisions.Create or update Plan of Care and accurately document claim.

United States

• Investigated damaged State highway infrastructure for the purpose of third-party reimbursement.
• Data entry and validated costs of repaired assets.
• Researched and validated property damage via Project Personnel, Department of Motor Vehicle
• DMV) and the Virginia Department of Transportation (VDOT).
• Prepared and submitted subrogation recovery packages to insurance companies.
• Followed-up with insurance companies for payment status on previously submitted demands.

Glen Allen, Virginia, United States

• . Managed, investigated and resolved member and practitioner medical and service grievances for Medicare and Medicaid members.
• Received written and verbal quality service grievances and referred timely to appropriate personnel.
• Communicated with various internal and external customers for complaint resolution.
• Resolved and processed denied claims for payment.
• Participated in quality review of all correspondence for accuracy and quality reviews.
• Reviewed and prepared files for internal quality checks in preparation for quarterly audits for The Centers for Medicare & Medicaid Services (CMS).

Glen Allen, Virginia, United States

• Began in 2018 as Claims Adjuster II, promoted to Grievance Coordinator in 2020.
• In a production environment, accurately and timely processed moderate to complexed Medicare, and Medicaid claims.
• Organized and adjudicated daily assigned claims via electronic generated reports.
• Reviewed claims error reports for reprocessing of non-paid claims.
• Subject Matter Expert (SME) for Home Health and Hospice Claims.
• Managed specialized Home Health and Hospice Claims.

Henrico County, Virginia, United States

• Full-time care attendant for family member during their illness.
• Transported to and from doctor’s appointments.
• Grocery shopping and food preparation.
• Assisted with ADLs and IADLs
• Bill review/payments
• Coordination of Home Health Care and Hospice Care

United States

• Identified, investigated, and evaluated, critical information required to adjudicate complex LongTerm Care claims.
• Determined eligibility based on the claimant's contract and investigative facts.
• Developed and implemented claimant’s Plans of Action.
• Managed and prioritized a work queue in a demanding environment.
• Managed incoming and outgoing calls and claimant correspondence.
• Assisted with updating Claims Standard Operation Procedures (SOPs).

• Investigated and managed assigned homeowner losses for various covered states.
• Determine coverage based on insured’s policy coverages.
• Explained coverage and claims processes, and or denials to insureds.
• Established reserves, settled claims, and authorized payments within reserve authority.
• Reviewed claims for liability and potential subrogation recovery.
• Managed high volume case load in a fast past environment.

United States

• Started as a Workers Compensation Investigative Case Manager in 2004 and was offered another position at Travelers Insurance in the Property Department in December 2006.
• Investigated and managed questionable Virginia Workers Compensation Claims.
• Took recorded statements on all claims.
• Determined coverage validity and compensability per Virginia Statutory Laws.
• Filed required documentation with State Workers Compensation agencies.
• Established reserves and authorized payments.

Family And Consumer Sciences/Human Sciences

Coursework towards a degree in Human Services Management.

Associate Of Arts And Sciences - Aas, Business, Management, Marketing, And Related Support Services

Received an Associate of Arts & Sciences Degree for Business Administration, Management and Operations.