Experience

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  CompOne Administrators, Inc.

  • United States
  • Insurance
  • 1 - 100 Employee

  • Team Leader

    • Jan 2011 - Present

  • Claims Specialist

    • Jan 2011 - Present

    Short Term Disability for BCBSM/BCN, Delaco Processing, Quality Dairy and Covery'sKey Elements:- With minimal assistance, successfully managed 60+ short term disability claims- Effectively assisted in solving errors and policy issues by providing appropriate feedback and recommendations.- Successfully built strong, positive working relationship with claimants, employers, and third party companies.Responsibilities:- Obtain, verify and update claimant information in MDA Case Manager system for new and existing Short Term Disability claimants- Communicate and enforce Short Term Disability Policy for Union and Non-Union Employees to claimants and employer- Approve, deny, and manage 60+ Short Term Disability claims based off of policies, diagnoses and additional medical information- Respond to correspondence from employer and physicians regarding claimant - Request and review medical documentation- Schedule Independent Medical Evaluations and/or Fit-For-Duty Evaluations and review evaluation reports and invoices- Assign and communicate with Nurse Case Managers for selected claims and review reports and invoices- Assign and communicate with Private Investigators for selected claims and review reports and invoices- Prepare summary report for transition into Long Term Disability for selected claimant files- Complete and submit daily and quarterly claimant update reports to employer- Communicate with claimant and claimant’s employer- Answer and direct calls, faxes, and emails as needed

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  American Community Mutual Insurance

  • Post Issue Claims Analyst

    • Apr 1998 - Oct 2010

    --Provide analysis of medical records identifying pre-existing/misrepresentation of applicants while providing consistent professional customer services and integrity.--Accurately identifies indications for pre-existing/misrepresentation investigations. --Solid knowledge of state and federal laws and regulations pertaining to policy provisions. --Experienced in utilization and review of applications, paramedical examinations, laboratory testing, questionnaires, memos, and medical records.--Conduct daily written and verbal correspondence with policyholders, agents, attorneys, medical providers, Motor Vehicle Reports, and Departments of Insurance in a timely and professional manner. --Experienced in providing customer service to members, agents and medical providers.--Maintains and provide statistics and reports as requested.--Contributes to the training and development of new staff members, orientation process, and departmental policies and procedures. --Reviewed and processed group, individual, COB and Medicare claims with 98% accuracy. --Provided a comprehensive summary of file findings for underwriter’s review.--Contributed to departmental savings of over $18 million for 2009.

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  Alexander Hamilton Life Insurance Company

  • Senior Claims Examiner

    • Sep 1979 - Nov 1997

    Assisted the underwriting process by performing medical reviews and summarization, identifying those conditions and health events that could pose financial risk. Reviewed and processed life, disability, and annuity claims.