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 internal and external customers, 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 / Lincoln Financial Group
- 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, 4 months at this Job
- Bachelors - Science
Previously Held Position: Standard Disability Case Manager * Assessed a caseload of up to 150 Long-Term Disability claims including conducting interviews, gathering medical and vocational information, providing updates to internal and external parties, and making initial and ongoing liability determinations. * Developed training modules and coached and mentored peers and less senior case managers on complex claims management on current disability leave, and employment policies and procedures. * Conducted research using various clinical, vocational and investigative resources, along with federal, and state regulations to evaluate claims and formulate the appropriate liability determinations. * Collaborated with team manager and employees on maintaining team performance metrics while encouraging open communications and brainstorming new ideas. * Collaborated with internal legal department and employees' legal representative ad hoc. * Actively participated in employee compensation survey in 2017 and provided critical data to evaluate organizational compensation. * Consistently made high level claim determinations while utilizing sensitive information with the utmost discretion. * Succeeded in completing 3 month of Learning Management Solutions (LMS) training and utilizing problem solving methodologies going forward.
- Senior Disability Case Manager at Liberty Mutual Insurance/Lincoln Financial Group
- Customer Service Representative at CBRE
- Customer Service Supervisor at AON Hewitt/Alight Solutions
6 years, 8 months at this Job
- Bachelor of Arts in Media Studies - Liberty Mutual Insurance
Dover, NH 2015-Present LTD Disability Case Manager Manage an inventory of claims to evaluate compensability/liability Communicate with claimants, employers and various medical professionals regarding the ongoing management of Short Term and Long Term disability claims Establish action plan based on case facts, best practices, protocols, regulatory issues and available resources Negotiate settlement within authority limits; escalate to team manager as appropriate Evaluate and refer appropriate claims to risk management resources such as Vocational Rehabilitation, Managed Care, Fraud, and Social Security and periodically assesses the effectiveness of the action plan;
- Long Term Disability Case Manager at LIBERTY MUTUAL INSURANCE
- Long Term Disability Benefit Analyst at SUNLIFE FINANCIAL
- Claims Analyst at DISABILITY RMS
- Claims Representative at UNITED HEALTHCARE
3 years at this Job
- - Marketing/ Communications
• Use experience and knowledge to manage both disability and leave claims.
• Makes three-point contact: employee, physician and employer
• Obtain and review updated medical evidence for STD/Salary Continuation claim decisions.
• Review guidelines for eligibility.
• Assure customer service with client companies and claimants.
• Provide support for all assigned accounts working by set time frames to meet quality assurance and client performance guarantees.
• Resolve problems within scope of authority, while bringing others to the attention of their manager.
• Provide support to Intake/Customer Service team as needed in the Call Center.
• Follows policy guidelines to determine participants disability eligibility
• Composes and sends communications to physicians, providers and employers within appropriate time frame.
• Makes determination of STD/Salary Continuation approvals or denials
• Follows client performance standards on disability determination to meet expected timeframe.
- Disability Case Manager at Liberty Mutual
- Retention Specialist-CRC at Liberty Mutual
- at Liberty Mutual
- at Liberty Mutual (Contractor)
1 year, 4 months at this Job
•Uses experience and knowledge to manage both disability and leave claims
•Provides total claim management
•Obtains and reviews updated medical evidence for claim decisions
•Reviews guidelines for eligibility
•Composes and sends communications to employers and employees within appropriate time frames
•Delivers excellent customer service with client companies and claimants through written correspondence and by answering inbound calls
•Provides support for all assigned accounts by setting time frames to meet quality assurance and client performance guarantees
•Resolves problems within scope of authority, while bringing others to the attention of their manager
•Provides support to Intake/Customer Service team as needed in the Call Center
- Short Term Disability Case Manager at Reedgroup
- FMLA Caseworker at Accenture
- Leave Representative II at Sedgwick
- Customer Care Team Lead at TASC
1 year, 3 months at this Job
- High school or equivalent
* As a SME (Subject Matter Expert) I am dedicated to the Leave Status Feed Program with my Client Amazon. LSF project-analyze Disability and LOA case information in its entirety to make corrections where needed to ensure compliance. Provide concise feedback to Case Manager and Client of findings and changes made. Update spreadsheet daily. * Team Mentor assisting with training of new processes and procedures especially those related to my project. Remain current with guidelines/expectations specified in our tools such as SharePoint and call flows. Collect and Analyze Data * Handling case assignments, review case progress and determine case closure. Take the extra mile and interact with employees to keep track of their progress and to ensure satisfaction.
- Short Term Disability Case Manager at Reed Group
- Triage Communication Specialist at Orlando Health Heart Cardiology Group
- Advanced Tech Support II at AT&T
- Lead Hostess at Jimmy Buffet's Margaritaville
1 year, 8 months at this Job
- Associates Degree - General Studies
• Adjudicated and managed complex and seamless short-term disability claims from initial claim to return to work within strict service level agreements.
• Managed caseload of up to 100 claims.
• Communicating disability benefit information to claimants and interviewing claimants to gather more information regarding their specific claim over the phone
• Reviewed Employee Statement for any additional earnings receiving, SSI, Workmen's Compensation, Pension, Commissions, State Disability.
• Reviewed and researched the policies, agreements and legal precedents affecting disability claims.
• Liaise with medical, legal, human resources and occupational health and other health experts in the assessment of continuous benefits
• Manage and develop excellent relations with Employees, Employers, External HR, doctors, internal Rehabilitation Consultants and Medical Coordinators to facilitate return to work focused plans.
• Utilized communication skills by accurately and effectively keeping employers notified of the status of their employee's claim status and estimated return to work capabilities
• Provided exceptional customer service to external and internal customers
- Disability Case Manager II at Anthem/Blue Cross
- Workers' Compensation Claim Adjuster at Underwriters Safety & Claims
- temp assignments at The Claims Solution, Inc
- Benefits Representative at ADP Incorporated
1 year, 2 months at this Job
- Bachelor of Science
Filed claims for Amazon employees, processing eligibility for short term disability, FMLA, any state leaves or if employee would be eligible for a company leave with Amazon. Advised employees of decision due dates, faxing out paperwork to both the employee and doctor's office. Also completing interviews with both the employee and doctor's office obtaining medical information pertaining to the condition of the employee. Leave of Absence Coordinator Sedgwick Claims Management Services - Orlando, FL December 2015 to March 2017 Filed FMLA claims for Wal-Mart associates, approving or denying claims. Reaching out to associates to make sure that all information was submitted within the allotted time frame. Reviewing medical records for serious health conditions so that a decision could be made on the claim.
- Disability Case Manager at The Reed Group
- Mail Sorter at DHL
- Senior Prior Authorization Coordinator at Express Scripts
- Psychiatric Technician at Florida State Hospital
1 year, 5 months at this Job
- High School Diploma
• Fully knowledgeable with short term disability, ADA, HIPAA, ERISA and leave management processes
• Able to build and maintain strong credibility, trust, and effective relationships with the team and other stakeholders to ensure business needs are met through operational and technological advancements.
• Develop effective action plans with operations that result in improved team and individual performance.
• Assisted management with meeting business goals in claim decision process including accuracy, problems, timeliness and other important facets.
• Instrumental part in working with colleagues and operations to develop any necessary enhancements to practices.
• Worked alongside worker's compensation and LTD teams to successfully transition employees
• Manage a high number of caseload of short term and leave management cases
• Authorize payments within the accurate terms of the contracts.
• Continually assesses claim details to determine if claims are going to exceed case management authority guidelines.
• Maintain high level customer focus and provide service deliverables on time
• Prioritize workload daily, update, and accurately documents system and claim files on actions taken. Establishes future action plan and case direction.
• Ensure the accuracy of case management and claim information, and compliance with policy provisions and state/federal regulations
- Disability Case Manager at Reedgroup
- Reedgroup - Leave of Absence Coordinator at Federal State Leaves
- Benefit Specialist at Aon Hewitt
3 years, 2 months at this Job
- Associates of Arts - Marketing
- High School Diploma
• Makes claim determinations to approve non-complex and complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
• Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
• Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system.
• Refers cases as appropriate to team lead; maintains professional client relationships.
- Sr. Disability Case Manager at Sedgwick
- LOA Coordinator at Sedgwick
- Service Center Representative at Sedgwick
- Benefits Consultant at Aon Hewitt
2 years, 2 months at this Job