Prior role: Disability Case Manager I, Disability Case Manager II
Trained incoming case managers; Facilitate training sessions and meetings; Develop training tools; Served as an internal resource to new employees; Assisted in audits; Assist in the design and execution of LEAN/Continuous Improvement initiatives; Provided accurate claim and policy status, beneficiary information and settlement explanations to claimants; reviewed and analyzed claim data to assess risk; calculated settlement adjustments; ensured that claims are settled in accordance with policy and company guidelines; utilized disability claim system to manage and pay claims whilst meeting service, timeframe and productions standards. Coordination of FMLA, STD and LTD products to ensure a seamless customer experience.
• Attained Presidential Service recognition for exemplary customer service delivery.
• Awarded Quartz Bravo for Call Management and Quartz Topaz Bravo for Employee Events Service.
- Senior Disability Case Manager at Liberty Mutual Insurance
- Claim Service Adjuster at Allstate Insurance Company
- Bankruptcy Paralegal at MR Default Services
- Legal Assistant at Stockwell, Harris, Widom, Woolverton & Muehl
6 years, 3 months at this Job
- Bachelor of Science - Criminal Justice
- MBA - Management
Primary responsibilities consist of making determination’s on short term disability claim’s and managing them ongoing within best practices. Other responsibilities include reviewing medical records, corresponding with employer’s employee’s, physician’s and vendors, documenting clear and concise claim note’s and creating appropriate correspondence.
• Received numerous awards and recognition for providing excellent customer service consistently.
• Promoted to complex case manager and then to complex case manager two.
• Gained knowledge of claim’s process and medical terminology.
- Complex Disability Case Manager at Liberty Mutual
- Recovery Specialist (RSVP)/ Recovery Case Manager at Advanced Behavioral Health
- Lead Consumer Counselor at Tri County Arc
- Client Supervisor at Tri County Arc
2 years, 2 months at this Job
- Bachelors - Science
• Reviews claim materials against disability policy coverage to determine liability and adjudicates the claim Administers disability income payments on behalf of group policyholders.
• Gathers clinical and eligibility information to verify approved period of disability.
• Reviews claim materials against STD disability policy coverage.
• Obtains necessary agreements to determine FICA, and Federal and State income tax requirements.
• Review ongoing disability claims to determine continued liability for the company.
• Administers payments on a monthly and weekly basis.
• Performs calculations for adjustments for Social Security and Workers Compensation awards.
• Mails appropriate State program forms to employees.
• Works with Disability Case Management Nurses and Physician Reviewers to review complex/questionable claims. Maintains up-to-date knowledge of company products and services.
• Knowledge of ERISA, Fair Claims Practices Model Act, privacy regulations, punitive damages statues and state and federal laws governing group insurance and state leave laws.
- Disability Case Manager at Liberty Mutual
- Benefits Administrator at NFP
- Office Administrator at Kids First Pediatrics
- Adminis at Asbury Management Group
10 months at this Job
- BS - Business Administration
• Analyze, approve and authorize assigned claims and determines benefits due
• Reviews and analyzes complex medical information
• Utilize the appropriate clinical resources in case assessment
• Communicate with the claimants to provide expectations in regards to return to work
• Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions
• Monitors third party claims; maintains periodical review of litigated claims, questionable claims and sensitive claims as determined by client.
• Communicate clearly with claimant and client on all aspects of claims process; either by phone and/or written correspondence
• Inform claimants of documentation required to process claims, required time frames, and payment information
• Maintains and build professional client relationships.
- Sr. Disability Case Manager at Sedgwick
- Disability Case Manager at Sedgwick
- Leave of Absence Coordinator at Sedgwick
- Customer Service Rep at Ultimate Staffing
3 months at this Job
- Bachelor of Science - Social and Behavioral Sciences
RESPONSIBILITIES: Currently managing clients' long term disability case files and disability pension with as many as 280 claims. LTD mentor and assign pending LTD claims to the LTD team. Responsible for inputting data into system, calculating monthly benefits and overpayments, monitoring Social Security and Pension benefits, typing correspondence (MS Word) as well as communicating status of clients' pending/ongoing disability case information to the client, the employer and Unit Manager. Interacting with physicians to ensure documentation is accurate and completed in a timely manner. Filing, answering phones and other duties as assigned.
- LONG TERM DISABILITY CASE MANAGER II-AT&T at Sedgwick
- CUSTOMER SERVICE REPRESENTATIVE at Lakeshore Staffing
- Customer Service Specialist II at AT&T Account
- BUILDING SERVICE LABORER at University of Chicago
16 years, 6 months at this Job
- - Business Administration
South Portland, ME
The Hartford helps customers create a secure and prosperous future by anticipating their needs and providing superior financial solutions through health and disability insurance.
Senior Clinician-Behavioral Health Unit Disability Case Manager
• Assessed mental health disability leave request for an ongoing caseload of 85 clients
• Established rapport with clients while completing targeted, telephonic disability reviews
• Communicated with external medical providers regarding complex mental health claims
• Authored written disability determinations that complied with industry and federal regulations
• Identified fraudulent disability claims and alerted the legal department for prosecution
• Publicized the benefit of The Hartford's disability product during marketing presentations
• Resolved supervisory issues and the needs of escalated callers in the Manager's absence
• Facilitated the Voice of the Employee Committee, Clinical Assessment meeting, and Team Huddles
• Mentored new clinicians, clinicians identified as underperforming, and all Maine-based professionals
• Redesigned and defined the Teams' management of claims needing immediate action
• Analyzed disability leave patterns, with findings communicated to employers
• Coauthored and presented a Continuing Education Training to 60 clinicians
- Senior Clinician-Behavioral Health Unit Disability Case Manager at THE HARTFORD, formerly AETNA
- Case Manager-Social Worker at ANNIE E. CASEY FOUNDATION AKA CASEY FAMILY SERVICES
- Clinical Supervisor of the Intake Department at SWEETSER
- Clinical Manager of the Girls Residential Program at BRATTLEBORO RETREAT
7 years at this Job
- BA - Psychology
• Ensures timeliness and accuracy of Short Term Disability benefit payments
• Oversees, coordinates, and executes the implementation of new and existing clients ensuring a standardized claim review process is in place according to client needs
• Prepares and delivers client utilization and financial reporting to internal staff and to the client
• Primary point of contact for client questions
• Leads charge to resolve client issues
• Oversees day-to-day administration of benefit programs including, Short-Term Disability, FMLA and non-FMLA Leave of Absence programs
• Evaluates complex FMLA applications and re-certifications to determine if leave requests meet eligibility criteria as specified in company policy and Federal and State regulations
• Oversees on-the-job training of all new hires
• Directs activities of subordinates to accomplish objectives of business unit and assures that company product standards are achieved and commitments to clients are met
• Participates in interviewing and selection process of prospective employees
• Primary point of contact for User Acceptance Testing
- Disability Case Manager II at Anthem
- Disability Specialist II at SEDGWICK CMS
- Healthcare Analyst at Anthem
8 years, 5 months at this Job
- MBA - Healthcare Management
- Bachelor of Arts - Management
Worked with the Liberty Mutual Leave of Absence Team during the out-sourcing/takeover of the Wells Fargo Leave Management Department; managed and regulated Family Medial Leaves for Wells Fargo Team Members; customer service; spoke with management of both LM and WF on a regular basis to provide status updates and continuous improvement opportunities; created job aids for the leave team; was responsible for a case load of over 1,000 active leave of absences and their prospective team members and in total managed over 2,000 closed and denied cases; mentored and assisted in training new employees in Liberty Mutual Leave Practices.
- Senior Disability Case Manager at Liberty Mutual Leave Services
- Internship at Pretty In Pink Foundation of North Carolina
- Executive Assistant at Pathways To Life Inc
- Marketing Support Specialist at JCMR Technology
3 years, 5 months at this Job
- Bachelor of Science - Communications
Analyzing and reviewing newly filed claims and ensuring all critical information is obtained from the claimant,
employer, and medical providers.
● Communicating disability benefit information to claimants and employers interviewing claimants to gather more information regarding their specific claim over the phone
● Communicating through verbal or written letter both positive and negative claim outcomes by contacting claimants to provide update on claim status.
● Communicating with medical professionals to discuss records and diagnoses for initial and ongoing disability benefits.
● Facilitated meetings between assigned case managers and consulting clinical staff to help resolve claim issues
● Addressing and implementing safe and effective ways for claimants to return to work as earlier as possible; Initiate vocational rehabilitation specialist when needed.
● Accurately and effectively keeping employers notified of the status of their employee's claim as well as estimated return to work capabiliti es
- Long Term Disability Case Manager at Guardian Life Insurance Inc
- Lehigh Valley Physician Group at Pediatric Specialty Care Office
- School Social Worker at Bethlehem Area School District
- Medical Social Worker at Easton Visiting Nurses Association
2 years at this Job
- Bachelor's in Psychology/Social Work-Minor - Accounting
- - Counseling and Psychology
• Successfully assisted in implementing a nationwide case management program for FMLA, Leave of Absence, and WC
• Collaborate daily with our clients, healthcare providers, and third party vendors to provide outstanding customer service
• Work remotely from home office demonstrating flexibility, organization, and ability to perform independently
- RN Disability Case Manager at Ascension Health
- RN Case Manager at Indiana State Department
- Surgery Staff Nurse at Community Health Network
- Cardiac Staff Nurse at St. Vincent Hospital
7 years, 3 months at this Job
- Masters - Nursing Administration
- Associate of Science - Nursing