Latoria Hall
Lincoln Financial Group
Henderson,NC
18
years of professional experience
Seasoned claims specialist with excellent planning and problem solving abilities. Experienced with managing disability cases and providing client support. Utilizes strong organizational skills and regulatory knowledge to ensure compliance and effective service delivery. Track record of building collaborative relationships with clients and multidisciplinary teams, leading to positive outcomes.
Work History
Disability Case Manager
8 Years 5 Months- Analyzed and evaluated disability claims through detailed investigations to confirm comprehensibility and coverage compliance.
- Effectively managed a high-volume caseload of over 100 claims while maintaining and implementing disability action plans
- Conducted comprehensive assessments of insurance claim forms and associated medical documents to ensure compliance with regulatory standards.
- Conducted thorough investigations into clients' work history, determining eligibility for disability benefits in each case.
- Cultivated in-depth understanding of medical terminology to enhance comprehension of procedures.
- Executed calculations for premium refunds, commissions, and adjustments based on insurance rate standards to maintain financial accuracy.
- Actively communicated with clients throughout the claims process, providing updates on status and answering any questions or concerns they may have had.
- Provided empathetic support to clients during their recovery process, fostering a positive environment conducive to healing.
- Mentored junior case managers in best practices for client engagement and support strategies.
- Reduced caseload backlog by efficiently prioritizing cases and developing effective time management strategies.
- Served as a knowledgeable resource in disability-related matters for colleagues, contributing to a well-informed, high-performing team.
- Participated in ongoing professional development courses to stay abreast of industry trends and best practices in disability case management.
Claims Adjuster
1 Year 5 Months- Reviewed and adjudicated medical claims to ensure compliance with policy guidelines.
- Analyzed and adjudicated over 60 claims daily while maintaining accuracy
- Conducted thorough investigations of questionable claims to ensure payment authorization integrity.
- Conducted audits of processed claims to maintain quality assurance and compliance standards.
- Analyzed and resolved referred files through comprehensive investigations, adhering to specified time constraints.
- Coordinated benefits while applying applicable deductibles, co-insurance and out-of-pocket costs.
- Investigated discrepancies in claims, identifying trends to prevent future issues and improve processing accuracy.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Contributed to a positive work environment through active participation in team meetings and collaborating on cross-functional projects.
Benefits And Claims Specialist
1 Year 10 Months- Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
- Provided assistance to plan participants by explaining benefits information to ensure educated selections.
- Checked accuracy and completeness of benefits applications and documents.
- Oversaw enrollment of new employees and company-wide yearly enrollment period.
- Mastered state and Federal benefit laws Including ERISA, FMLA, COBRA, HIPPA and 401k administration.
- Communicated effectively via email, phone and face-to-face with plan participants to resolve issues pertaining to health and welfare benefits.
- Researched employee benefit and health and safety practices, recommending changes or modifications to existing policies.
- Coordinated benefits processing, including enrollments, terminations and claims.
Instructor
2 Years- Utilized syllabi to inform students of course requirements, evaluation procedures and attendance requirements.
- Employed variety of teaching styles to respond to needs of diverse learners.
- Attended meetings, training and activities to enhance skills and credentials.
- Observed and evaluated student performance and development and provided appropriate feedback on work.
- Prepared instruction through lesson plans to address student's assessed needs, goals and objectives.
- Evaluated performance of students and made provisions to meet learning needs.
- Planned instruction to achieve objectives based upon student needs and established curriculum.
- Leveraged technology and provided instructional materials to facilitate active learning.
Credit Analyst
2 Years 8 Months- Managed credit accounts valued between $45,000 - $1 million Included credit analyses and summaries of loan requests and submitted to loan committees for approval.
- Reviewed customer financial data to ascertain level of risk involved for extending credit.
- Prepared basic and preliminary credit analyses to determine creditworthiness and compliance.
- Reconciled customer accounts to identify delinquencies or disputes, documenting root causes.
- Developed comprehensive understanding of financial statements, enhancing opportunities to assess risk.
- Worked closely with both customers and sales team to reconcile accounts and oversee payment negotiation.
- Conducted credit reviews on corporations to assess financial conditions.
- Monitored and maintained compliance with internal controls and government regulations.
- Assessed customer credit files regularly to review receivables.
Education
Master of Science (M.S.) In Continuing Adult Education
Bachelor of Science (B.S.) In Business Administration
Skills
Disability knowledge
Ethical practices
Policy interpretation
Case assessment
Attention to detail
Problem-solving abilities
Multitasking
References
Available upon request.
Timeline
Disability Case Manager
Lincoln Financial Group
01.2018 - CurrentRead More
Claims Adjuster
United Health Group
06.2016 - 11.2017Read More
Benefits And Claims Specialist
Blue Cross Blue Shield
07.2014 - 05.2016Read More
Instructor
Vance Granville Community College
07.2012 - 07.2014Read More
Credit Analyst
American Express
02.2008 - 10.2010Read More
North Carolina A&T State University
Bachelor of Science (B.S.) In Business Administration
Read More
North Carolina A&T State University
Master of Science (M.S.) In Continuing Adult Education
Read More