ERICA SESSIONS
Columbia
Summary
Experienced professional with a strong background in claims processing and customer service, adept at supporting change management initiatives within departmental frameworks. Demonstrated ability to meet or exceed quality standards while delivering routine tasks independently and efficiently. Proven track record of effectively communicating with stakeholders to gather necessary information and resolve claims issues, contributing to enhanced operational efficiency. Skilled in leveraging knowledge of medical terminology and claims processing procedures to ensure compliance with company policies and improve service delivery.
Overview
2026
2026
years of professional experience
Work History
Claims Examiner 2
Lincoln Financial Group
Omaha
11.2022 - Current
- Supports and promotes change management and/or department/ enterprise initiatives withing area(s) of responsibility.
- Meets or exceeds departmental quality standards.
- Delivers routine work independently, in accordance with established procedures and guidelines, in a timely manner meets deadlines appropriately.
- Performs task by applying core knowledge obtained from the role and acquires increasingly more knowledge to apply in the role.
- Process voluntary claims for payment or denial in accordance with established procedures & guidelines, in a timely manner while meeting departmental quality/production standards.
- Effectively communicates, verbally and in writing, with internal/external stakeholders to obtain needed information while maintaining a professional demeanor in all interactions.
- Leverages knowledge of coverage, contract provisions, eligibility & benefits well as other appropriate resources (e.g., other internal teams, practices/procedures, etc.) to review submitted claim information for payment.
- Escalates claims issues or concerns to senior team members and/or management, as needed.
- Provides superior customer service to internal/external stakeholders, recognizes what needs to be done and demonstrates flexibility & responsiveness to meet customer needs.
- Identifies general issues or concerns within assigned areas, explains their impact on the customer's service experience, and suggests process improvements.
Associate Leave Specialist/ FMLA
Colonial Life-Unum
11.2013 - 11.2020
- Processed new leaves as well as daily/weekly follow-ups with updated medical information or return to work dates.
- Determine eligibility and availability of leave time for each employee requesting leave for FMLA, State, and applicable Corporate protections.
- Determine and generate appropriate communications to comply with FMLA regulations and customer procedures.
- Review medical certifications and other documentation submitted; consult with Nurse Case Manager and IME unit if needed.
- Determine the appropriate status of leave under FMLA and state leave regulations taking into consideration regulatory requirements, company-specific requirements, and analysis of documentation received (medical, legal, etc.).
- Communicate medical or absence information with other internal units (STD, Intake).
- Management of a leave through duration, reporting status to Employer, employee and other internal units.
- Respond to leave questions and issues from employees or Employer contacts.
Claims Processing Specialist
Aflac
Columbia
- Processed and reviewed claims efficiently, ensuring compliance with company policies and reducing processing time for customer satisfaction.
- Collaborated with cross-functional teams to identify and resolve discrepancies, improving claims accuracy and operational efficiency.
- Utilized claims management software to track, document, and analyze claims data, enhancing reporting capabilities and workflow management.
Education
Business Administration -
Benedict College / Strayer University
Columbia, SCSkills
- Customer service
- Team player
- Analytical skills
- Organizational skills
- Decision making
- Problem solving
- Banking systems
- Microsoft Word
- Microsoft Excel
- Microsoft Power Point
- Microsoft Outlook
- Self-motivated
- Customer service orientation
- Customer service best practices
- Mainframe systems
- GP Claims
- PW Reset FISS Part A
- EDI Team Site
- Medical terminology
- Procedure practices
- Claims processing
- Change management
- Quality assurance
Timeline
Claims Examiner 2
Lincoln Financial Group
11.2022 - Current
Associate Leave Specialist/ FMLA
Colonial Life-Unum
11.2013 - 11.2020
Claims Processing Specialist
Aflac
Business Administration -
Benedict College / Strayer University