Utilize customer service proficiency to assist members to navigate the health care system, educate members and answer questions about eligibility, benefits, and claims, as well as locate in-network providers. Communicate with members clearly and accurately while explaining concepts such as deductibles, coinsurance, and or copayments and how they may affect the cost of care. Explain how non-covered and out-of-network services factor into the out-of-pocket cost. Use a custom-designed… Show more Utilize customer service proficiency to assist members to navigate the health care system, educate members and answer questions about eligibility, benefits, and claims, as well as locate in-network providers. Communicate with members clearly and accurately while explaining concepts such as deductibles, coinsurance, and or copayments and how they may affect the cost of care. Explain how non-covered and out-of-network services factor into the out-of-pocket cost. Use a custom-designed member-support system, consult with members who require help with regard to their employer-sponsored benefit program(s), tailoring resolutions to meet their unique needs and requests Show less

Maximized technical claims expertise processing the most complex claims and post-entitlement actions, developed and adjudicated Supplemental Security Income (SSI) cases and public fraud issues to completion, expertly led and mentored Claims Specialists and Customer Service Representatives. Processed the most critical and complex claims cases requiring immediate attention to avoid public relations and fraud allegations.Demonstrated training skills to develop SSI program knowledge while… Show more Maximized technical claims expertise processing the most complex claims and post-entitlement actions, developed and adjudicated Supplemental Security Income (SSI) cases and public fraud issues to completion, expertly led and mentored Claims Specialists and Customer Service Representatives. Processed the most critical and complex claims cases requiring immediate attention to avoid public relations and fraud allegations.Demonstrated training skills to develop SSI program knowledge while coaching three claims specialists, one being promoted to current supervisor. Served as a liaison between the Regional Office and field offices across Orange County, San Diego County, and Hawaii while being a member of the South Coast Area Trust Cadre, reviewing trust funds and their applicability to the SSI program. Formulated remedies in taking the lead on administrative sanctions for fraud cases and took necessary actions. Successfully worked remotely for two years. Show less

Supervised a unit consisting of approximately ten Claims Specialists and two Claims Technical Experts in meeting agency goals for redeterminations, initial claims, and post-entitlement workloads while developing staff performance to monitor progress, motivations, and career goals. Exhibited strategic thinking ability in support of the management to assist the critical agency goal of reviewing approximately four thousand cases per year, including successfully achieving the priority agency… Show more Supervised a unit consisting of approximately ten Claims Specialists and two Claims Technical Experts in meeting agency goals for redeterminations, initial claims, and post-entitlement workloads while developing staff performance to monitor progress, motivations, and career goals. Exhibited strategic thinking ability in support of the management to assist the critical agency goal of reviewing approximately four thousand cases per year, including successfully achieving the priority agency objective of 100% redeterminations completed for seven consecutive years. Continuously improved case and agency actions while liaising between the Oceanside district office and Department of Disability Service. Cultivated a positive workplace culture in collaborating with other staff members on inter-office communication and engagement. Acted as key decision-maker on the unit's direction while balancing both the agency's needs and the subordinates' skills. Ensured quality and accurate work on time through meticulously performing case reviews, presentations, interviews, and desk audits. Delivered administrative, logistical and technical support, coordinating with other management members on department administrative support operations and programs, such as organizing spreadsheets and providing documentation to schedule appointments. Concisely addressed broad and complex congressional inquiries while actively engaging in management and leadership training. Showcased administrative support and calendar management skills in coordinating staff meetings, office training, and special events. Identified office and unit trends through extensive research documents to assist and streamline workflows with accuracy. Show less

Executed eligibility decisions by interviewing recipients and payees to determine admissibility for disability, aged, and blindness benefits. Successfully earned two promotions in the organization to Temporary Technical Expert and Temporary Operations Supervisor. Competently screened recipients for potential eligibility by acquiring vital information on living arrangements, income (such as Workers Compensation, State Disability, or wages), and resources (such as bank accounts, savings bonds… Show more Executed eligibility decisions by interviewing recipients and payees to determine admissibility for disability, aged, and blindness benefits. Successfully earned two promotions in the organization to Temporary Technical Expert and Temporary Operations Supervisor. Competently screened recipients for potential eligibility by acquiring vital information on living arrangements, income (such as Workers Compensation, State Disability, or wages), and resources (such as bank accounts, savings bonds, or real property). Prioritized and resolved tasks requiring immediate attention, like program fraud, abuse allegations, and homeless situations. Organized the admission and discharge of recipients from facilities by establishing contacts with local care centers to adjust benefits. Administered all prisoner and incarceration alerts for the Chatsworth district office, including contacting various law enforcement agencies for verification, updating multiple systems, and processing all manual and automated notices with accuracy. Processed all SSI Fugitive Felon cases for the district office, reviewing transmittals, indicating proper suspensions and reinstatements to maintain comprehensive case databases for equipment, materials, reports, data, future references, and proper restoration procedures. Identified the correct benefits and communicated with the recipient in processing post entitlement decisions and waiver requests. Utilized the SSI Monthly Wage Verification program and conducted office-wide training regarding the program and other enhancements. Coordinated and facilitated training to four district offices after attending the Area-level Train-the-Trainer Course on the e4641 software. Displayed analytical and problem-solving capacities as the Site LAN Coordinator, resolving software and hardware issues in coordination and cooperation with Area Systems Coordinators and Regional Officer Call Center, including maintaining the office laptop computer. Show less

I interviewed the public in person and over the phone to determine how to best assist them and help determine what they may be eligible to apply for. I maintained paper files with pertinent information, and requested additional documentation when necessary. I also interacted with processing centers and Medicare when additional actions were necessary to solve challenges.