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senior leave manager for fmla resume example with 8+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Summary
  • Integrated extensive experience, customer-centric focus and pharmacy operations expertise toward supporting the goals of a busy pharmacy
  • Adept at service as an integral member of pharmacy staff, ensuring that the highest operational standards and customer service levels are met at all times
  • Rendered outstanding leadership ability to organize, prioritize workload, interact with medical professionals to interpret medication orders, monitor drug regimens, and clarify patient instructions
  • Adept at Prior Authorization - Reviewed and applied clinical criteria for approval/denial determinations or any appeal levels for Medicaid, Medicare Part D plans, Non-Formulary medications, Quality Limits, Step Therapy, Plan Exclusions and CMS Deletions, Commercial (Retail/Private), and a variety of health care plans such as United Health Care, Aetna, BCBS, etc.
  • Strong teamwork and ability to work in a fast-paced production environment and handle multiple tasks, but focus on expertise and attention to detail
  • Demonstrated excellent professional judgments, quick problem solving, decision making, impeccable time management, interpersonal, listening, verbal and written communication skills, and ability to interact with diverse populations.

Customer-oriented, strategic-thinking Procurement Professional with over 13 years of experience in building relationships, cultivating partnerships, retaining top accounts and growing profit channels. Multi-tasking and self-motivated leader with expertise on expanding network connections, persuasively buying introducing products, implementing pricing/merchandising models, inventory control and projections, territory development and revealing customer needs to deliver solutions. b

Skills
  • Documentation review
  • Report writing
  • Claims file management processes
  • Xactimate specialist
  • Medical terminology
  • Background in insurance
  • Skilled in finesse, interactive absence manager, share point, and admin suite
  • Decision-making
  • Multitasking
  • Organizational skills
  • Problem resolution
Education
Sheffield High School Memphis, TN Expected in 05/2002 High School Diploma : - GPA :
University of Memphis Memphis, TN Expected in Bachelor of Arts : Psychology - GPA :
Experience
Encova - Senior Leave Manager for FMLA
Ohio, IL, 04/2022 - Current
  • Responded to customer inquiries and complaints professionally.
  • Researched and reviewed information to determine validity of insurance claims and contacted companies and customers about decisions.
  • Maintained knowledge of policies and procedures and insurance coverage benefit levels, eligibility systems and verification processes.
  • Oversaw regulatory and strategic initiatives to ensure accuracy of medical claims.
  • Investigated and analyzed requirements to improve timeliness of reports to customers.
  • Analyzed information gathered by investigations and reported findings and recommendations.
  • Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
  • Reviewed policies to determine appropriate levels of coverage and assist with approval or denial decisions.
  • Uploaded documentation and reports to corporate database system using interactive absence manager to facilitate smooth claims processing.
Deluxe Corporation - Total Loss Adjuster
Pennsylvania, AL, 02/2020 - 04/2022
  • Demonstrated leadership by making improvements to work processes and helping to train others.
  • Rejected or approved claims.
  • Litigated claim settlements when needed.
  • Gathered information and reported findings for Statefarm Auto Insurance liability concerning damages or losses.
  • Researched and verified insurance policy coverage.
  • Negotiated settlements with customers and lien holders paid out total loss settlements and obtained necessary documents to process titles for branding.
  • Presented claims to insurance companies.
StateFarm - Auto Claims Adjuster/Underwriter Assistant
City, STATE, 08/2016 - 12/2018
  • Assessed customers risks and determined insurance eligibility by reviewing new applications, existing business, statistical data, various reports and customer information. Also processed policy changes and collaborated with agents to serve customers.
  • Reviewed coverage determinations, investigated and evaluated claims and negotiated settlements.
  • Investigated claim and settlement deals and reviewed coverage determinations.
  • Provides additional support to underwriters in determining whether clients can qualify for insurance policies, products, mortgage, loans, or other financial services. Job tasks could vary, but often include administrative duties, as well as organizing and arranging loan approval packages.
  • Negotiated coverage, policy pricing and service delivery during meetings with customers, agents or brokers.
  • Created master spreadsheet to record procedures, denials and approvals.
KC. Lewis Associates - Onboarding Specialist
City, STATE, 10/2012 - 08/2016
  • Sourced, qualified and conducted screening interviews with job candidates.
  • Prepared employees for assignments by establishing and conducting orientation and training programs.
  • Provided insight regarding job duties to optimize productivity.
  • Liaised between employees and senior leadership to address inquiries, complete contract processing and foster problem resolution.
  • Managed full-cycle recruiting processes for managerial and executive-level vacancies.
  • Managed 18 employees across compensation, benefits, wellness and safety, HRIS, payroll and information and data departments to ensure optimal productivity.
  • Managed recurring HR processes.

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Resume Overview

School Attended

  • Sheffield High School
  • University of Memphis

Job Titles Held:

  • Senior Leave Manager for FMLA
  • Total Loss Adjuster
  • Auto Claims Adjuster/Underwriter Assistant
  • Onboarding Specialist

Degrees

  • High School Diploma
  • Bachelor of Arts

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