Responsible for managing a daily caseload of Long-Term Care (LTC) Claims in a fast-paced environment. Utilize claim policies and guidelines to assesses claims to determine if the Insured is benefit qualified and receiving covered services from a qualified provider. Responsible for educating policyholders on Policy coverage, corresponding directly with service providers and physicians to resolve claims. Possess a high degree of empathy and professionalism, possess strong analytical and problem-solving skills, and can work both independently and as a team. Proactive and take initiative.

Maintained strong relationships with brokers, policyholders, agents, and others to foster timely claims resolution.Assisted clients in understanding their insurance coverage by explaining complex terms and conditions clearly and concisely.Handled first level appeals and some second level appeals.Handled first level approvals for foreign and domestic wires.Improved claim processing efficiency by conducting thorough investigations and promptly addressing discrepancies.Enhanced client satisfaction by providing timely updates throughout claims process and effectively resolving claim disputes, achieving high customer satisfaction.Reduced backlogs of pending claims using effective time-management strategies such as prioritizing tasks based on urgency or complexity levels.Reviewed loss reports, medical billing, medical treatment records, accident reports, travel documents and correspondence to determine proper coverage.Contributed to team success by training new staff members and mentoring other staff members on proper handling and evaluation of injury and travel related claims.Assisted in updating training materials for new hiresParticipated in ongoing professional development opportunities to maintain current knowledge of insurance laws, regulations, and best practices within the field of claims adjustment.Currently hold 28 state licenses