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Skills

  • Confidential information handling
  • Problem resolution
  • Visiting patient homes
  • Complex eligibility assessment
  • Goal setting
  • Team management
  • Assessing needs
  • Budgets
  • Project organization
  • Case tracking in ServiceNow

Work Experiences

  • Collaborated with metric customers to determine their needs and deliver system service.
  • Conducted in-depth medical reviews.
  • Achieved Outstanding Service Award for excellence in case management.
  • Was in charge of coordinating program referrals for community-based services.
  • Contributed to 24% enhanced team efficiency.
  • Achieved 52% first-pass resolution.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Attended continuing education programs to maintain Scrum Master, ensuring up-to-date knowledge of short-term disability laws.
  • Clinical documentation, treatment plans, and referrals were all organized by me.
  • Consistently surpassed performance benchmarks.

Summaries

  • Aligned resource allocations to streamline costs.
  • Boosted satisfaction scores by 23%.
  • Within Miscellaneous, senior Short-Term Disability Case Manager and outstanding performer in quality assurance and stakeholder engagement.
  • Achieved an average 54% faster resolution rate.
  • Collaborated with legal teams.
  • Costs were consistently reduced while profits were increased.
  • Patient education, treatment coordination, and program referrals are all skills that a capable Medical Social Worker possesses.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Boosted output.
  • Client-focused Short-Term Disability Case Manager.

Accomplishments

  • Collaborated with team of 6 in the development of category.
  • Piloted a new RTW (Return-to-Work) tracking system in partnership with vendors, reducing case re-open rates by 45% over 6 months.
  • Optimized the case review process by integrating data analytics tools, leading to a 84% reduction in case backlog over 9 months.
  • Reduced workload inefficiencies by diverting specific cases to specialist teams, streamlining claim resolution rates by 24%.
  • Used Microsoft Excel to develop inventory tracking spreadsheets.
  • Developed a scalable training module for onboarding new hires in disability claims processing, decreasing new hire adjustment times by 16 weeks.
  • Designed and implemented a new checklist-based review process, improving claim completion speed by 48% and reducing errors by 16%.
  • Monitored high-risk cases, reducing fraudulent claims by 64% through proactive risk assessments and targeted investigations.
  • Analyzed and redesigned report templates used for employer updates, decreasing report completion time by 14 hours weekly.
  • Resolved product issue through consumer testing.

Affiliations

  • Healthcare Financial Management Association (HFMA)
  • Society for Human Resource Management (SHRM)
  • Lions Club
  • Case Management Society of America (CMSA)
  • National Association of Injury and Disability Evaluators (NAIDE)
  • Association of Information Technology Professionals
  • Insurance Educational Association (IEA)
  • Rotary International
  • Return to Work Association (RTWA)
  • Society of Claims Law Associates (SCLA)

Certifications

  • Short-Term Disability Claims Management Training - Meridian
  • Medical Disability Examiner Certification
  • Certified Public Accountant (CPA)
  • Disability Claims Adjuster Licensing Ohio
  • SHRM Certified Professional (SHRM-CP)
  • National Association of Disability Examiners (NADE) Certification
  • Certified Health Insurance Specialist (CHS)
  • Certified Business Analysis Professional (CBAP)
  • ServSafe
  • Certified Life Care Planner (CLCP)

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