Allison Bauer
Senior Disability Representative at Sedgwick- Claim this Profile
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Topline Score
Bio
Credentials
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Developing Effective Teams (BUS1200)
Sophia LearningJun, 2021- Nov, 2024 -
Introduction to Sociology (SOC1001)
Sophia LearningApr, 2021- Nov, 2024
Experience
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Sedgwick
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Insurance
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700 & Above Employee
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Senior Disability Representative
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Nov 2021 - Present
• Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan. • Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan. • Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians). • Communicates with the claimants providers to set expectations regarding return to work. • Determines benefits due, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets. • Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions. • Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence. • Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system. • Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims. • Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities. • Negotiates return to work with or without job accommodations via the claimants physician and employer. • Refers cases as appropriate to team lead and clinical case management. • Maintains professional client relationships. Show less
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LTCG
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United States
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Insurance
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400 - 500 Employee
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Care Coordinator
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Jan 2019 - Nov 2021
• Assess claimant eligibility by reviewing medical records from all current providers and conducting phone assessments with the claimant or legal representative. In the event of noted inconsistencies in the claimant eligibility, coordinate a benefit eligibility assessment in order to make a final determination. • In conjunction with plan language upon initial assessment and ongoing recertification, determine legitimacy and eligibility of service providers by requesting and reviewing provider licensing credentials, state-specific regulations, internet searches and phone assessments with the servicing provider. • Effectively communicate, verbal and written, all aspects of the claim benefit determination process. • Assist claimants with modifications to their current care plan, including changes in care needs as well as changes in provider. • Monitor daily, weekly and monthly reports to ensure claims are handled timely and appropriately. • Meet quality and production metrics as established and communicated by the department. Show less
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Resident Assistant
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Dec 2018 - Oct 2021
• Provide nursing related services for residents in both home care and memory care • Maintained homelike environment for all residents making it a more friendly living place • Protect and promote resident rights and assisted resident to maintain independence • Provided and/or assisted with routine/daily cares to residents • Reported and documented status of residents to superiors by spending maximum time in the room with residents in both home care and memory care • Provide nursing related services for residents in both home care and memory care • Maintained homelike environment for all residents making it a more friendly living place • Protect and promote resident rights and assisted resident to maintain independence • Provided and/or assisted with routine/daily cares to residents • Reported and documented status of residents to superiors by spending maximum time in the room with residents in both home care and memory care
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BIC Graphic North America
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United States
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Advertising Services
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200 - 300 Employee
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Claims Specialist
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Jun 2014 - Dec 2018
• Problem solver who quickly grasps complex situations and turns them into manageable tasks• Produce quality work even when under time pressure and deadlines• Negotiate Discounts, process full credits, or issue an invoice to customers as needed• Proven ability to understand and follow complex instructions to successfully conclusions• Very accurate and rapid keyboarder• Experienced in editing proofreading lengthy documents with focus on word definitions, spelling, sentence, structure, and grammar Show less
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Customer Service Representative
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Dec 2013 - Jun 2014
• Answer calls through the customer service queue and inside-sales queue to assist with product questions and order status, rushes, inventory, quotes and claims. • Respond to customer emails and faxes.• Track and maintain orders and keeping constant contact with customer to ensure order is being processed and handled correctly.• Submit rushes and contact internal associates to update order information after rushes have been approved.• Submit quotes to the estimating department for shipping via truck, special packaging, for nonstandard imprint areas, or a non-standard printing method.• Enter random sample request via phone call or emails.• Perform and prioritize multiple tasks efficiently in a fast-paced environment.• Strong attention to detail and how details fit into the big picture.• Above average communications & listening skills.• Consistently maintain a positive attitude with both team members and customers via phone conversation and/or email• Effectively working with people of different backgrounds• Accurately record, remember, and communicate detailed information• Work cooperatively with others to produce and deliver required work and/or customer driven request Show less
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ManpowerGroup
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United States
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Staffing and Recruiting
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700 & Above Employee
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Temporary Customer Relations Representative
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Oct 2013 - Dec 2013
• Consistently maintain a positive attitude • Effective working with people of different backgrounds • Accurately record, remember, and communicate detailed information • Work cooperatively with others to produce and deliver required work and/or customer driven request • Consistently maintain a positive attitude • Effective working with people of different backgrounds • Accurately record, remember, and communicate detailed information • Work cooperatively with others to produce and deliver required work and/or customer driven request
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Ebenezer
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United States
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Hospitals and Health Care
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500 - 600 Employee
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Medication Resident Assistant/Resident Assistant
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Jun 2012 - Oct 2013
• Administration of medication doses multiple times a day to residents in both home care and memory care units • Provide nursing related services for residents in both home care and memory care • Maintained homelike environment for all residents making it a more friendly living place • Protected and promoted resident rights and assisted resident to maintain independence • Provided and/or assisted with routine/daily cares to residents • Reported and documented status of residents to superiors by spending maximum time in the room with residents in both home care and memory care Show less
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McDonald's
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United States
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Restaurants
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700 & Above Employee
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Crew Member
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Jan 2011 - Jun 2012
• Training with new hires in all areas of the store • Effective communication and assistance for customers and requests • Preforming duties using high-end cashier machine • Carrying out inventories to help the managers • Listening to and settle complaints of the customers • Preparation of foods using proper safety precautions • Training with new hires in all areas of the store • Effective communication and assistance for customers and requests • Preforming duties using high-end cashier machine • Carrying out inventories to help the managers • Listening to and settle complaints of the customers • Preparation of foods using proper safety precautions
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Fairview Health Services
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United States
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Hospitals and Health Care
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700 & Above Employee
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Hostess
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Aug 2009 - Feb 2010
• Effective communication with residents of all different backgrounds and temperaments • Serves foods in the rooms and cafeteria • Delivers food trays to residents' units and dining area • Preparation of beverages and foods • Clean dining tables and service counter area after meals • Restock condiments on dining tables and visitor stations • Washing of all dishes after meal time • Effective communication with residents of all different backgrounds and temperaments • Serves foods in the rooms and cafeteria • Delivers food trays to residents' units and dining area • Preparation of beverages and foods • Clean dining tables and service counter area after meals • Restock condiments on dining tables and visitor stations • Washing of all dishes after meal time
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Education
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2017 - 2022
Capella University
Bachelor's degree, Business/Health Care Administration/Management -
2007 - 2011
Ellsworth High School
High School Diploma, Graduate
Community
