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sr disability case manager resume example with 10+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
, , 100 Montgomery St. 10th Floor
:
Professional Summary

Eight plus years experienced in disability and absence management. Efficient in managing complex claims and high priority project without sacrificing quality of care. Operate in high-pressure environments while recommending best resources and courses of action to benefit patient needs and return each to optimal quality of life.

Skills
  • LEADERSHIP
  • FMLA
  • STD
  • ADA
  • ERISA
  • HIPAA
  • QUALITY AUDIT
  • EXCEL
  • CUSTOMER SERVICE
  • INDIVIDUAL INSURANCE
Education
Broward College Coconut Creek, FL, Expected in 2024 Bachelor of Arts : Business Administration - GPA :
Work History
The Escape Game - Sr. Disability Case Manager
New Orleans, LA, 07/2019 - Current
  • Manage 130 high case load of complex disability and leave claims.
  • Provide mentoring in technical skills to less-experienced Disability Benefit Specialists and Leave Specialists.
  • Achieved overall audit score of 100% over past 3 quarters, exceeding 95% department goal.
  • Rehabilitation Consultants and Medical Coordinators to facilitate return to work focused plans.
  • Manage and develop excellent relations with Employees, Employers, External HR, doctors, internal.
  • Submission of claims to clinical review for denial due to non-supporting medical documents.
  • Adjudicated and managed complex short-term, appeals and seamless disability claims from initial claim to return to work within strict service level agreements.
Zurich North America Disability Insurance - Workforce Managament
City, STATE, 02/2017 - 07/2019
  • Optimized personnel coverage, preparing work schedules based on staff availability and forecasted demands.
  • Develop and document standards, policies, processes, and business rules around workforce management for multi-site environment
  • Identify and develop future leadership in Workforce management
  • Interact with various department Cast and Leaders to develop process improvements for this operation
  • Workforce management on call volume, forecasting, resource capacity and efficient staff scheduling to meet service level targets
  • Monitor individual and team performance and ensure KPIs are met to achieve customer satisfaction, operational efficiency and team work
  • Assist with developing and maintaining system and process documentation
Matrix Absence Management Inc. - Claims Examiner II AMS
City, STATE, 05/2015 - 02/2017
  • Determines eligibility under federal and state requirements for leaves submitted and determines eligibility under client's plan/policy.
  • Responds to customer service issues within required time frames.
  • Pro-actively communicates decisions within Best Practice guidelines, consistently meeting Performance Guarantee requirements.
  • Makes claim determinations to approve, deny or delay and or reach out to additional resources for review, based on medical certification review and management.
  • Determines duration associated with leave and or disability based on information given by healthcare provider.
  • Communicates approvals, denials, leave extensions, return to work plans and other important information regarding leave to employee and client.
  • Manages STD and leaves of up to 120 - 145 that run are concurrent with Short Term Disability.
  • Developed and implemented performance improvement strategies and plans to promote continuous improvement
Arriva Medical LLC - Team Leader
City, STATE, 12/2011 - 05/2015
  • Resolved team support issues with efficient approach to keep call center operating smoothly and customers satisfied with services.
  • Communicated policy updates and information to team to enhance goal efficiency.
  • Coached team members on metrics and consumer experience behavior identification to improve satisfaction ratings.
  • Defined and documented office procedures, using updated SOPs to provide thorough and comprehensive training for all administrative support staff.
  • Guided employees through routine and complex administrative situations with decisive but motivational approach.
  • Interfaced with cross-functional support groups to manage daily operations.
  • Evaluated employee job performance and motivated staff to improve productivity.
  • Facilitated individual coaching sessions with CSRs to realign productivity goals.
  • Led team of 43 members while providing exceptional customer service
  • Verified confidential budget reports remained up-to-date for Sr. Management
  • Developed and implemented performance improvement strategies and plans to promote continuous improvement

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Resume Overview

School Attended

  • Broward College

Job Titles Held:

  • Sr. Disability Case Manager
  • Workforce Managament
  • Claims Examiner II AMS
  • Team Leader

Degrees

  • Bachelor of Arts

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