Gloreniece Edwards
Chandler
Summary
Detail-oriented professional driven to resolve claims fairly while representing interests of employer. Conducts thorough and informed investigations, precisely evaluates losses and negotiates settlements that satisfy diverse parties. Builds and maintains professional and productive relationships and works to understand potentially conflicting points of view.
Overview
9
9
years of professional experience
Work History
Claims Specialist
Social Security Administration
Phoenix
07.2021 - Current
- Adjudicates and authorizes entitlement or disallowance actions at all levels of difficulty and complexity under programs administered by SSA.
- Develops, investigates, and resolves claims and post-entitlement actions that may involve suspension, resumption, adjustment, or termination of eligibility, or payments.
- Conducts inquiries and/or interviews to obtain, clarify, and verify information about individual applicants' initial and continuing eligibility for programs administered by SSA.
- Examines evidence to evaluate its validity and acceptability in establishing entitlement to benefits, and, when necessary, takes the required developmental actions to obtain all available relevant evidence.
- Assists the applicant in securing evidence, electronically records the evidence required, and when applicable, prepares and records special determinations of fact.
- Determines issues in any claim or referred post-adjudicative action, prepares formal or informal determinations relating the facts, evidence and issues to the requirements of the law, regulations, policies and precedents.
- Responds to contacts from beneficiaries, recipients, the public or other SSA staff by researching inquiries or initiating action to make changes to the claims or beneficiary record.
- Develops facts through direct, mail, electronic, or telephone contacts with Field Office, Payment Centers PSCs,beneficiaries, or third parties to resolve discrepancies and to obtain complete information.
- Performs representational and information activities to secure cooperation of the public; to disseminate facts and advise on program coverage; and to enlist the understanding and cooperation of local organizations.
- Provides technical guidance and mentoring (informal and formal) to other employees.
- Analyzes and prepares detailed reports of trainee's progress to management, orally or through the appropriate system.
- Participates in training sessions both as a student and/or as an instructor, as required.
- Protects the rights of individuals by assuring claimants and/or their personal representative understand the claimant's legal rights and obligations under the Act and its relationship to other social welfare and benefit programs.
- Assists individuals in filing administrative appeals in the programs administered.
- Protects the integrity of SSA programs through identification, investigation, and resolution of potential program abuse/fraud.
- When appropriate, determines the need for and makes referrals to the appropriate component.
- Properly safeguards personally identifiable information (PII) from loss, theft, or improper disclosure, including inadvertent disclosure, and immediately notifies management of any breach, loss, or potential loss of PII in any form.
- Works as an integral part of the unit, office, module, component, team or center, taking all actions necessary to improve overall processing time and quality.
- Performs special projects and duties required to achieve the immediate organization's goals.
- Participates in studies, projects, etc. initiated by the unit, module, component, section, office, program service center, area, or SSA Headquarters; analyzes data and prepares reports of study results as required.
Lead Contact Representative
Social Security Administration
Chicago
02.2017 - 07.2021
- Communicated orally with other agencies and claimants from diverse backgrounds both within and outside of SSA.
- Interviewed beneficiaries and the public about their rights under the Social Security laws and regulations.
- Clarified and conveyed information through other means (i.e. TDD, relay operator, interpreter, etc.).
- Enforced the privacy act preventing access and disclosure errors.
- Recommended and made referrals to other agencies and provided community resources.
- Gathered facts and evidence to establish eligibility for benefits such as Retirement, Survivors, Disability Insurance, Medicare Insurance and/or Supplemental Security Income for the aged, blind and disabled.
- Provided information and advice about specific options for Retirement and/or Medicare including making sure the public understands the application process (i.e. iClaims, in-office/phone appointments).
- Requested pertinent documents/proofs and made determination on what to develop for in accordance with SSA policies and procedures.
- Resolved benefit eligibility and payment problems (i.e. overpayments, underpayments, one-time payments).
- Made determinations if individuals were at or without fault in causing an overpayment.
- Explained appeal rights, waiver request and/or payment recovery procedures.
- Prepared written request for assistance to solicit pertinent information or receive detailed explanations, clearly describing information requested by the claimant.
- Used state-of-the-art computer technology to access and update information about claims.
- Used all the standard software programs and internet to process and/or verify changes of address, direct deposit, Medicare enrollment/termination, voluntary tax withholding request, student data, representative payee accounting, death reports and payment status, in which CHIP propagates.
- Constantly received on the job training on new policy and procedures.
- Always updated and informed the callers of changes that affect SSA and their benefits.
- Utilized online resources to answer questions and explain the use of online services to the customers.
- Mentored a trainee one-on-one for four months before and after graduating from Teleservice Representative Basic training.
- Provided constructive feedback when necessary.
- Provided assistance to others when requested by callers, co-workers and management.
Education
High School Graduate -
English, Science, Sociology and Math
Southern Illinois
EdwardsvilleEnglish, Comm, Math, Science, Criminal Justice, Music, Art, History, Psych
St. Xavier University of Chicago
ChicagoSkills
- Communication
- Adaptability
- Problem Resolution
- Detail Oriented
- Interpersonal
- Analytical
Timeline
Claims Specialist
Social Security Administration
07.2021 - Current
Lead Contact Representative
Social Security Administration
02.2017 - 07.2021
High School Graduate -
English, Science, Sociology and Math
Southern Illinois
English, Comm, Math, Science, Criminal Justice, Music, Art, History, Psych
St. Xavier University of Chicago