Short Term Disability Case Manager resume example with 14+ years of experience

Jessica Claire
Montgomery Street, San Francisco, CA 94105 (555) 432-1000,

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.

  • 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
05/2022 to Current Short Term Disability Case Manager St. 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 05/2022 Claim Specialist UnitedHealth 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 04/2017 Merchant Advocate/Existing Sales Specialist Vantiv 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 06/2011 Merchant Retention Specialist Fifth 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 05/2024 Bachelor of Business Administration | Healthcare Management Thomas More University, Crestview Hills, KY GPA:
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 | Accounting University of Liberia , , GPA:
Additional Information
  • Additional Information Awards , 2013-2014-Vantiv President's Club Recipient 2016-2019-Thomas More College Dean's List

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

Your data is safe with us

Any information uploaded, such as a resume, or input by the user is owned solely by the user, not LiveCareer. For further information, please visit our Terms of Use.

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


  • Bachelor of Business Administration
  • License in Ohio Real Estate
  • Certificate in Computerized Accounting and Bookkeeping
  • Bachelor of Business Administration

By clicking Customize This Resume, you agree to our Terms of Use and Privacy Policy

*As seen in:As seen in: