Short Term Disability Case Manager resume example with 14+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105(555) 432-1000, resumesample@example.com
Summary
Knowledgeable, proactive, organized self-starter with 10+ years of professional experience in accounting, business development, real estate, healthcare and disability claims. Possess excellent interpersonal, analytical, organizational, critical thinking and computer skills. Excel within highly competitive environments where leadership skills and relationship building are the keys to success.
Skills
Cisco Jabber
Computer Skill
OnBase Solution
Microsoft OfficeSuite
MAS Accounting System
Salesforce/Service Cloud
Process Improvement
Genesys Workspace Desktop
SystemOne Benefit Claim System
CPS Claims Management System
QuickBooks Financial and POS System
Managed Care
Risk Assessment
Time Management
Medical Terminology
Claims Management
Health Care Insurance
Medicaid And Medicare
Medical Billing And Coding
File and Record Management
Verbal and Written Communication
Disability And Workers Comp Insurance
Experience
05/2022 to CurrentShort Term Disability Case ManagerSt. Croix Regional Medical Center | Lindstrom, MN,
Manage 200+ Short-Term Disability claims
Investigate, evaluate and settle claims by applying technical knowledge, and human relations skills to achieve fair and prompt disposal of cases and to contribute to reduced loss ratio
Verify and analyze data used in settling claims to validate claims and settlements according to company’s practices and procedures
Process and approved or denied claims within designated authority level
Complete accurate financial calculations consistent with company and state guidelines
Enter claim payments, reserves, and new claims into computer system, input concise yet sufficient file documentation
Report overpayments, underpayments and other irregularities
Resolve complex, severe exposure claims, using high service oriented file handling
Review police reports, medical treatment records to determine extent of liability
Collect evidence to support contested claims in court
Contact or interview claimants, doctors, medical specialists, or employers to get additional information
Interview or correspond with agents and claimants to correct errors or omissions and to investigate questionable claims
Correspond with claimants and physicians to determine claim settlement, denial, or review status
Refer questionable claims to investigator and medical team for investigation and settlement
Negotiate claim settlements and recommended litigation when settlement could not be negotiated
Collaborate with fellow case managers, nurse case managers and consulting physicians to make appropriate and timely claim determinations
Review complex medical records and effectively leverage a variety of tools and resources to understand appropriate approval durations and future action planning
11/2018 to 05/2022Claim SpecialistUnitedHealth Group | City, STATE,
Communicated with customers via phone and email and identify the type of assistance they need regarding level of benefits, eligibility, and coordination of benefits, billing, payments, authorizations for treatment and explanation of benefits
Actively listen and asked appropriate questions to identify specific questions or issues while documenting required information in computer systems
Reviewed and researched incoming healthcare claims from providers and facilities by navigating multiple computer systems and platforms and verify pricing, prior authorizations, applicable benefits information necessary to process the claims
Ensured that the proper benefits were applied to each claim by using the appropriate processes policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates and processed claims
Communicated and collaborated with members and providers to resolve issues on claims
Met performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance.
06/2011 to 04/2017Merchant Advocate/Existing Sales SpecialistVantiv Inc | City, STATE,
Managed up to $3 million in annual merchant credit card volume
Worked closely with sales executives and channel sales teams to renegotiate rates and fees, renewed and extended contracts of existing clients
Create action plan to achieve results
Accountable for growth, retention, and profitability of existing merchant portfolio
Analyzed merchant contracts to provide accurate, timely rate reviews and guidance clients
Proactively consulted with merchant to ensure proper pricing
Analyzed and reviewed competitor's bids
Reached out to existing merchants and actively identified opportunities for additional products
Managed, tracked, and implemented projects within the portfolio
Extensive knowledge of pricing and interchange
Maintained a strong focus on results and time management
Collaborated with Internal Teams with account conversion efforts and installation of products
Create action plan to achieve results
Met performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction and attendance
Successfully met monthly sales goals
Generated $2M & $2.2M in annual revenue in 2013, 2014 respectively, earning the President's Club Award as a top performer, two years in a row.
08/2007 to 06/2011Merchant Retention SpecialistFifth Third Processing Solutions | City, STATE,
Provided customers with courteous and accurate processing solutions
Performed rate reviews, account analyses, renegotiations contract and rate for credit card processing accounts
Assisted channel sales teams by providing background research on merchant rates and fees
Maintained a strong focus on results and time management
Collaborated with Internal Teams with account conversion efforts and installation of products
Created and maintained relationships with existing customers to ensure continued credit card processing and encourage customer adoption
Upgrades and satisfaction
Provide exceptional customer service and proactively recognize customer needs and areas of opportunity
Education and Training
Expected in 05/2024Bachelor of Business Administration | Healthcare ManagementThomas More University, Crestview Hills, KYGPA:
Expected in License in Ohio Real Estate | Hondros College of Business, , GPA:
Expected in Certificate in Computerized Accounting and Bookkeeping | Computer-Ed Business Institute, Monrovia, GPA:
Expected in Bachelor of Business Administration | AccountingUniversity of Liberia , , GPA:
Additional Information
Additional Information
Awards
, 2013-2014-Vantiv President's Club Recipient
2016-2019-Thomas More College Dean's List
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Resume Overview
School Attended
Thomas More University
Hondros College of Business
Computer-Ed Business Institute
University of Liberia
Job Titles Held:
Short Term Disability Case Manager
Claim Specialist
Merchant Advocate/Existing Sales Specialist
Merchant Retention Specialist
Degrees
Bachelor of Business Administration
License in Ohio Real Estate
Certificate in Computerized Accounting and Bookkeeping