Golf, Music and DIY Projects
Lydia Joye Pressley
High Point
Summary
Claims professional well-versed in intricacies of claim management and resolution. Known for strategic approach to resolving disputes and ensuring compliance with industry standards. Reliable team collaborator with focus on achieving optimal outcomes and adapting to changing requirements. Skilled in negotiation and critical thinking.
Overview
20
20
years of professional experience
Work History
Claims Specialist
Lincoln Financial Group
03.2024 - Current
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Managed a high volume of claims effectively by prioritizing tasks and maintaining excellent organizational skills.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Settled complex claims fairly by applying critical thinking, negotiation skills, and detailed knowledge of insurance policies.
New Business Associate II
Lincoln Financial Group
01.2016 - Current
- Processes insurance applications from receipt to final status in accordance with established procedures and guidelines in a timely manner and meeting departmental quality/production standards
- Reviews documents for completeness, accuracy, and compliance with state regulations
- Confirms agent licensing/appointment meets guidelines
- Accurately enters new case data into appropriate systems
- Evaluates submitted forms for: appropriate version received, proper signatures, and ensures cash with application guidelines met
- Works closely with underwriting team to communicate on casework and achieve goals
- Resolves technical and business errors/issues in accordance with established procedures and guidelines
- Provides customer service to internal/external stakeholders; recognizes what needs to be done to meet stakeholder needs and demonstrates flexibility and responsiveness to meet those requirements
- Works with customers to respond to requests
- Takes ownership of issue resolution to provide seamless customer service
- Applies core knowledge, obtained from the role, to effectively and promptly communicate sensitive or technical information while adhering to HIPAA and corporate privacy guidelines
- Escalates issues/concerns to more senior team members and/or management
- Recognizes general issues/concerns and suggests process improvements
Senior Claims Examiner
Lincoln Financial Group
01.2011 - 01.2016
- Served as an original team member in the launch of various projects such as: UPI, DQM (Unknown Project) and BRM Follow up
- Deemed a Subject Matter Expert (SME) and assisted with creating procedures and best practices
- Assisted with training and mentoring new team members as well as serving as a resource for existing team members
- Conducted extensive file research on thousands of policies
- Established and maintained regular correspondence with Insured and Beneficiaries
- Kept Admin Systems up to date to maintain data integrity
- Served as SME on the Champion committee for the new BRMBENE CSD
- Volunteered to serve on the CHEER Committee to enhance employee appreciation and morale
- Proficient in the following: LIFECOMM, ICAS, FTWVANTAGE, CNDVANTAGE, FUSION, AWD, PENFACTS, APS, CSA, SHAREPOINT, ACCURINT, FIDO, CIR-OMIN
Office Manager
Stephen Bilkis & Associates
01.2008 - 01.2010
- Adjourning Court Appearances
- Preparing Retainers
- Ordering Supplies
- Updating Court Calendar and Assigning Attorneys
Legal Assistant
Daryll Boyd Jones, P.C
01.2005 - 01.2008
- Making Collection Calls on Outstanding Balances
- Arranging Advertising
- Preparation of Documents (Divorce, Landlord/Tenant RE Sales Contracts, Demands and Interrogatories) Conducting Legal Research
- Filing Papers with the Court in Person and Via ECF
Education
Bennet College
Greensboro, NC01.1989
Skills
- Claims processing
- Claims investigation
- Verbal communication
- Microsoft office
- Documentation review
- Decision-making
- Critical thinking
- Customer service
- Multitasking Abilities
- Problem-solving
- Eligibility determination
- Attention to detail
Interests
Timeline
Claims Specialist
Lincoln Financial Group
03.2024 - Current
New Business Associate II
Lincoln Financial Group
01.2016 - Current
Senior Claims Examiner
Lincoln Financial Group
01.2011 - 01.2016
Office Manager
Stephen Bilkis & Associates
01.2008 - 01.2010
Legal Assistant
Daryll Boyd Jones, P.C
01.2005 - 01.2008
Bennet College
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