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Skills

  • Confidentiality and information security
  • First Aid/CPR
  • Critical thinking for complex claim analysis
  • Project organization
  • Supervision
  • Onsite facility tours
  • Data analysis
  • Collaborating with medical professionals
  • Continuous learning and professional development
  • System equipment

Work Experiences

  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Collaborated with external vendors from Raleigh to develop specialized rehabilitation plans, accelerating claim closure by 22%.
  • Applied conflict resolution skills.
  • Coordinated team development activities and trainings with senior case managers.
  • Analyzed historical claim data.
  • Achieved 12 successful workplace reintegrations.
  • Achieved a 27% reduction in operational bottlenecks.
  • Consistently maintained a case closure rate that exceeded corporate benchmarks by 10 cases per quarter.
  • Collaborated with legal advisors to effectively challenge invalid claims, resulting in a cost-saving of $7 for the organization.
  • Analyzed historical claim data to identify trends, resulting in the development of a targeted intervention process for high-risk cases.

Summaries

  • Collaborated with physicians and specialists in the Miscellaneous space to ensure effective treatment planning and documentation adherence for long-term disability clients.
  • Accomplished at navigating complicated disability regulations across several states, ensuring compliant case management and preventing regulatory setbacks.
  • Achieved a 80% cut in claim-processing time.
  • Social Services Director with experience managing social work programs and a strong understanding of welfare and crisis intervention laws.
  • Contributed to team milestones.
  • Consistently exceeded corporate closure benchmarks.
  • Adept at handling disability claims disputes.
  • Collaborated with the antifraud team.
  • Consistently met performance benchmarks.
  • Excellent track record of resolving issues, increasing customer satisfaction, and driving overall operational improvements.

Accomplishments

  • Proactively identified high-risk claims for early intervention, contributing to a 68% increase in customer satisfaction ratings.
  • Assumed a lead role in launching a new procedure that decreased claim backlog by 72% over the course of the past year, allowing quicker claim Resolution for clients.
  • Resolved product issue through consumer testing.
  • Developed and fostered collaborative relationships with Miscellaneous physicians and therapists to promote effective treatment options for claimants.
  • Collaborated with HR and benefits teams to design targeted benefits packages for clients on LTD, contributing to a 19% rise in employee satisfaction surveys.
  • Conducted regular training sessions for new case managers, improving team compliance with regulatory procedures by 29% following training completion.
  • Introduced a quality control checklist that lowered appeal rates on denied claims by 28% within 15 months.
  • Maintained a zero-audit-finding record by ensuring 100% compliance with long-term disability regulations and state/federal guidelines.
  • Implemented disability claims tracking systems using Asana to enhance reporting accuracy, leading to a reduction of administrative processing errors by 23%.
  • Led initiatives to improve claims processing accuracy, resulting in a 27% reduction in incorrect or incomplete filings and appeals.

Affiliations

  • Society for Disability Studies (SDS)
  • American College of Healthcare Executives (ACHE)
  • Health Care Compliance Association (HCCA)
  • Lions Club
  • American Health Information Management Association (AHIMA)
  • National Association of Disability Representatives (NADR)
  • Rotary International
  • Association of Information Technology Professionals
  • Council for Disability Awareness (CDA)
  • Vocational Rehabilitation Association (VRA)

Certifications

  • Professional in Human Resources (PHR)
  • CompTIA A+ Technician
  • Compliance & Regulatory Certification: Benefits Claims 2017
  • Life and Health Insurance License Georgia
  • Certified Employee Benefits Specialist (CEBS)
  • ServSafe
  • Fundamentals of Insurance Planning (FIP)
  • Certified Healthcare Financial Professional (CHFP)
  • Google Certified Professional Cloud Architect
  • First Aid/CPR Certified

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