Disability Case Manager Resume Sample

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Terry Jacobson
4945 Metz Expressway,  Chicago, IL
+1 (555) 966 4449

Work Experience


Long Term Disability Case Manager
07/2016 - PRESENT
San Francisco, CA
  • Provide total claim management
  • Resolve problems within scope of authority, while bringing others to the attention of their manager
  • Interact professionally with a diverse group (executives, managers, legal, and subject matter experts)
  • Prioritize work continually and produce a significant volume of work efficiently within performance standards
  • Provide training to managers, supervisors, employees, labor, safety committees and the medical community about the region's disability management policies, procedures and compliance. This includes Leave of Absence (FMLA, OFLA, WFLA, WFCA, Contractual/KP Policy, etc.), ADAAA, Worker's Compensation and Return to Work Program
  • Maintain applicable certifications and actively participate in education continuation opportunities for all areas of the programs
  • Identify the action plan’s critical junctures
  • Monitor the action plan’s progress on a regularly scheduled basis
  • Revise plan of action as needed
Disability Case Manager
05/2012 - 04/2016
Philadelphia, PA
  • Document and communicate any revisions to the action plan
  • Responsible for the timely, accurate and consistent disposition of assigned claims
  • Create and document “macro view” of the status of each claim’s plan of action
  • Develop systematic approach to follow up on the execution of each claim’s plan of action using prioritization list
  • Ensure, on an ongoing basis, the accuracy of benefit amounts, if applicable
  • Review periodically claimant’s eligibility for other sources of disability income, e.g. social security
  • Recover, as appropriate, any benefit overpayments resulting from changes in claimant’s disability income resources
  • Keep documentation of claim current, relevant, reliable and accessible
Bilingual Disability Case Manager
09/2006 - 12/2011
Los Angeles, CA
  • Maintain files based on established documentation criteria
  • Ensure information on system is accurate
  • Contribute to the overall effectiveness of the Long Duration claims’ department
  • Identify potential backlog in assigned case load prior to jeopardizing department standards/goals
  • Meet quality and service standards of department
  • Actively look for process improvement opportunities
  • Act as a full team member by providing support to peer group during high volume periods and absences
  • Collaborate with others on files

Education


Friends University
2001 - 2006
School's Degree in Health Sciences

Professional Skills


  • Broad grasp of claims practices; related work experience in claims or in a medical field would be helpful, particularly in the areas of worker's compensation, long term care or medical claims
  • Strong written and verbal communication skills, with the ability to effectively deliver difficult messages to clients
  • Solid organizational skills and excellent ability to prioritize
  • Demonstrated decision making, communication, organizational, problem solving, negotiation and computer skills required
  • Demonstrated decision making, communication, organizational, problem solving, negotiation, and computer skills required
  • Strong analytical skills with a focused attention to detail - particularly with numbers, spelling and grammar
  • Excellent writing, customer service, and interpersonal skills necessary

How to write Disability Case Manager Resume

Disability Case Manager role is responsible for analytical, insurance, compensation, security, integration, ergonomics, grammar, excel, word, outlook.
To write great resume for disability case manager job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Disability Case Manager Resume

The section contact information is important in your disability case manager resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Disability Case Manager Resume

The section work experience is an essential part of your disability case manager resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous disability case manager responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular disability case manager position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Disability Case Manager resume experience can include:

  • Utilize Professional Resources effectively to clarify and monitor disability status and medical treatment and occupational requirements to identify and implement return to work opportunities
  • Intermediate PC skills - including data entry, MS Word, Excel, Outlook and Skype for Business
  • Contributes to profitability by effectively implementing Claims Best Practices to manage loss payments and claim expenses to financial results
  • Excellent judgement and discernment, ability to demonstrate discretion and ensure confidentiality
  • Intermediate PC skills - including data entry, MS Word and MS Excel
  • Case Management skills with the ability to plan, develop and implement goal-oriented claim management plans

Education on a Disability Case Manager Resume

Make sure to make education a priority on your disability case manager resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your disability case manager experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Disability Case Manager Resume

When listing skills on your disability case manager resume, remember always to be honest about your level of ability. Include the Skills section after experience. Present the most important skills in your resume, there's a list of typical disability case manager skills:

  • Excellent writing, customer service and interpersonal skills necessary
  • Excellent organizational skills and an ability to follow-up on several files at the same time
  • Strong cross-functional team skills with the ability to work independently
  • Analytical skills with a focused attention to effective case management
  • Analytical skills with a strong attention to detail
  • Analytical skills with a passion for solving problems

List of Typical Experience For a Disability Case Manager Resume

1

Experience For Long Term Disability Case Manager Resume

  • Constant prioritization of conflicting demands with extremely tight turn-around times
  • Focused attention to detail - particularly with numbers, spelling and grammar
  • Review documentation including
  • Conducts initial claim eligibility review
  • Obtains all pertinent and necessary information to evaluate claim credibility
  • Prepares written rationale of claim decision based on a review of the contractual provisions and the analysis of the medical and occupational records
  • Consistent interaction with Claimants and Clients
2

Experience For Short Term Disability Case Manager Resume

  • This role can be a Work-From-Home opportunity
  • Plan, develop and implement goal-oriented claim management plans
  • Communicates with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of Short-Term Disability (STD) and/or Long-Term Disability (LTD) benefits
  • Conducts initial and ongoing investigations to determine whether or not to accept liability. Makes recommendations to approve or deny benefits accordingly
  • Investigates, identifies, and communicates, all appropriate offsets. Assesses financial impact on (including but not limited to) social security, workers compensation and third parties. Forwards overpayments to HO for calculation according to protocols
  • Evaluates and refers appropriate claims to risk management resources such as Vocational Rehabilitation, clinical resources, Special Investigations, Social Security, and Subrogation
3

Experience For HR Compliance & Disability Case Manager Resume

  • Provide LTD and STD Disability Claim Assessment
  • Written and verbal communication to clients and stakeholders within the medical community
  • Maintain productive relationships with internal team members and external related clients to maintain service level targets
  • Provide long-term disability claim assessment
  • Identify, obtain and analyze key medical, contractual and eligibility information
4

Experience For Bilingual Disability Case Manager Resume

  • Communicate and consult with internal/external providers, customers, Third Party Administrators, employers and Plan Administrators
  • Obtain medical and functional information through interviews, standard and customized questionnaires and written correspondence directed at claimants, policyholders and physicians
  • Review Short Term Disability case management plan and provide verbal and written recommendations to STD Adjudicator for review prior to case transferring
  • Execute problem resolution: identify, investigate, resolve or develop recommendations to address and resolve issues identified by internal and external parties
  • Review issues in light of applicable contractual, legal, medical, procedural system and client specific requirements in order to achieve a resolution
  • Sound knowledge of medical terminology, medical management and pharmacology is an asset
5

Experience For LOA / Disability Case Manager Resume

  • Applies claims and target market knowledge to identify how the organization can meet customer claim service needs
  • Manage relationship with key customer/area of responsibility
  • As needs arise, use network of contacts and specialized expertise
  • Adheres to all compliance/regulatory requirements
  • Anticipate, recognize and respond to needs of customers
  • Support implementation of customer initiatives
  • Monitor, process and maintain data for FML leave requests that require integration with short-term disability benefits; Accurately apply FML and STD processes and policies to account for intermittent leaves, benefit payment exhaustion, leave return dates, potential transitional duty positions, etc.; Process STD payments
  • Review Associate employment date, leave history, and benefit elections to determine eligibility and/or discrepancies, forwarding notification to Associate; Resolve any identified issues
6

Experience For Long Term Disability, Case Manager Resume

  • Manage Associate data including, but not limited to, updating Associates’ FML days, correcting eligibility, entering return to work dates, etc
  • Compile metrics that can be used to evaluate the effectiveness of leave management policy, procedures and processes; analyze results and understand impact on staffing and performance in various health ministries
  • Document the claim decision and its rationale
  • Notify employer of decision
  • If decision is a claim denial , ensure communication process is in compliance with state and ERISA requirements
  • Process the benefit payment
7

Experience For Aon Campus Launch Short Term Disability Case Manager Resume

  • Determine accurate earnings definitions based on relevant contract
  • Develop the claim strategy
  • Understand and assess claimant’s circumstances and expectations
  • Understand and assess employer’s circumstances and expectations
  • Utilize, as needed, professional medical and vocational rehabilitation resources to determine anticipated disability duration and return to work possibility
  • Establish with both the claimant and the employer the expectations for claimant’s ability to return to work
  • Document and communicate the claim strategy in the form of an action plan
  • Coordinate the implementation of the claim’s specific action plan
  • Ensure the claimant, employer, and professional resources
8

Experience For Short Term Disability Case Manager, Associate Resume

  • Maintains up-to-date knowledge of company products and services
  • Tenacity to seek out the information required to determine the best next step(s) in your daily tasks
  • Extensive knowledge of disability claim management, either in short-term or long-term disability insurance, and medical terminology required
  • Sound knowledge of medical terminology and medical management
  • Knowledge and ability to apply appropriate disability management tools and techniques
  • Familiar with provincial legislation and regulations
  • Disability management and/or Group Benefit knowledge is required
  • Bilingualism (French & English) would be considered an asset
9

Experience For Disability Case Manager Resume

  • Receive case assignments in the appropriate DMS system
  • Medical information provided by doctor
  • Job duty/responsibility information provided by manager
  • DMS electronic medical protocol/duration guidelines
  • Notify employee of eligibility to take short term disability time
  • Generate letter of approval/denial to be sent to the employee
10

Experience For Long Term Disability Case Manager Resume

  • Update case notes with additional information and eligibility decisions
  • Forward STD denials to FMLA for review
  • Follow case through return to work
  • Ensure doctor provides return to work release
  • Coordinate special accommodations with manager and Occupational Health Nurse as needed

List of Typical Skills For a Disability Case Manager Resume

1

Skills For Long Term Disability Case Manager Resume

  • An ability to work effectively in a team environment;
  • Strong team player, with a high interest in working in a cross-functional team environment
  • Previous disability management experience, assessing disability claims would be an asset
  • Experience working in an unionized plant environment would be an asset
  • Constant prioritization of conflicting demands with tight turn around times
2

Skills For Short Term Disability Case Manager Resume

  • Build strong relationships with our plan sponsors, working in partnership with them to address their workplace absence issues
  • Group Benefits claims knowledge or experience is an asset
  • Medical case management or claims administration experience in a program/policy or administration role
  • Some supervisory experience desired
  • Previous Short Term, Long Term, WSIB disability management experience
  • Strong ability to meet multiple demands and time pressure
  • Previous case management experience within an insurance/financial organization is required
  • Strong customer service focu
  • Experience in individual or group disability from business or legal perspective
3

Skills For HR Compliance & Disability Case Manager Resume

  • Confirms that medical evidence supports claimant's restrictions & limitations
  • Prioritizes caseload and work; maintains appropriate documentation
  • Group Benefits experience would be helpful
  • Strong ability to interpret and apply group contract provisions
  • Experience with Microsoft Office (Word, Excel) required
  • Making decisions on claims using contractual, WSIB Legislative, medical, functional, and vocational analysis
  • Understanding of Social Security law, Workers' Compensation statutes, statutory disability laws and pensions
4

Skills For Bilingual Disability Case Manager Resume

  • Making decisions and payments on Critical Illness claims using contractual and medical analysis
  • Provide on-going management of the claim by developing, coordinating and implementing a strategy tailored to the facts of the claim
  • Processes claims for payment by setting up on claim paying system to ensure accurate and timely receipt of benefit payments
  • Develop case management plans that identify direction, issues and action plan including methodology and timing to resolve issues
  • Compare alternatives for solving problems, or improving procedures or products and provide recommendations
  • Assess claims for benefit entitlement by reviewing contractual, medical, functional and occupational information
  • Communicate decision rationale to claimant first by phone then in writing
5

Skills For LOA / Disability Case Manager Resume

  • Determine benefit period payable, identifying potential offsets and pursue as appropriate
  • Set up on claim paying system to ensure accurate and timely receipt of benefit payments
  • Respond to inquiries regarding cases
  • Process re-certifications required for continuing short term disability leave
  • Review group contract provisions, and submits medical information to identify discrepancies and inconsistencies when assessing disability benefit eligibility
  • Works cooperatively across functions to ensure coordination of services and sharing of best practices
  • Responsible for the management, investigation and decision making of disability claims within delegated authority
  • Manages claims within multiple funding arrangements
6

Skills For Long Term Disability, Case Manager Resume

  • Bilingualism (French and English, written and spoken)
  • Handle calls of a sensitive or emotionally charged nature
  • Able to work in a PC environment
  • Attention to detail is important due to the complexity of claims situations and contractual considerations
  • Adaptability and flexibility are key to success in this role
  • Conduct telephone interviews to obtain information to ensure complete understanding of the absence and types of support required to assist with return to work planning
  • Prioritize work items in order to meet client service standards and Sun Life best practice guidelines
  • Professionally manage stressful situations
  • Deliver difficult news in a tactful and sensitive manner
7

Skills For Aon Campus Launch Short Term Disability Case Manager Resume

  • A positive attitude with a commitment to high quality service
  • A willingness to roll up your sleeves to uncover information
  • Attention to detail with complex claims and contracts
  • Previous knowledge of disability products would be an asset
  • Reviews claim materials against disability policy coverage to determine liability and adjudicates the claim
8

Skills For Short Term Disability Case Manager, Associate Resume

  • Gathers clinical and eligibility information to verify approved period of disability
  • Works with Disability Case Management Nurses and Physician Reviewers to review complex/questionable claims. Maintains up-to-date knowledge of company products and services
  • Knowledge of ERISA, Fair Claims Practices Model Act, privacy regulations, punitive damages statues and state and federal laws governing group insurance as well as the Family Medical Leave Act and state leave laws
  • Monitors and acts on potential benefit reductions under contract fraud, misrepresentation and malingering
  • Assess claims for benefit entitlement by reviewing contractual, medical, functional and occupational information
9

Skills For Disability Case Manager Resume

  • Administers disability income payments on behalf of group policyholders
  • Obtains necessary agreements to determine FICA, and Federal and State income tax requirements
  • At Sun Life Financial, we want to help people shine
  • Engage plan members through open and respectful communication to understand the medical, social and personal dimensions of their workplace absence
  • Develop and maintain outcome-focused case management plans to help plan members return to work
  • Work collaboratively with plan members, plan sponsors, lawyers, health care practitioners and other stakeholders to obtain information, provide claim status, create action plans and provide verbal and written decisions while maintaining confidentiality and privacy
10

Skills For Long Term Disability Case Manager Resume

  • Conduct telephone interviews to obtain information to ensure complete understanding of the absence and types of support required to assist with return to work planning
  • Identify and assess medical and non-medical influencing factors pre and post disability, functional capability, restrictions and limitations to better understand what support is needed to get plan members back to work
  • Prioritize work items in order to meet client service standards and Sun Life best practice guidelines
  • Contribute to a dynamic work environment by identifying opportunities to improve processes and customer service delivery
  • Comprehensive benefits package including:
  • Our commitment to service excellence and quality, innovation and talent development
  • Career progression is based on solid performance, knowledge of our business and products, positive engagement with our customers, and your interests opening up a wide variety of career paths within Sun Life
  • Works with Disability Case Management Nurses, Physician Reviewers, and Vocational Rehab Counselor to review complex/questionable claims

List of Typical Responsibilities For a Disability Case Manager Resume

1

Responsibilities For Long Term Disability Case Manager Resume

  • If additional short term disability time is requested which falls outside of guidelines/protocol, review case with DMS Case Manager III or supervisor
  • Process short term disability suspension due to lack of or insufficient information; Process information and communicate transition from STD to LTD
  • Review contractual benefits and provisions of employer’s policy
  • Review all physicians’ statements, notes and records included with claim submission. Seek advice from clinicians as appropriate
  • Access medical and occupational information presented to decide the claim’s status
2

Responsibilities For Short Term Disability Case Manager Resume

  • In-depth knowledge of LTD claim practices and claim management procedures for all claim levels
  • Demonstrated expert analytical skills with the ability to think creatively and address the strengths and weaknesses of a claim and the fine distinctions in contract language
  • Advanced knowledge of short-term disability claim management and medical terminology required
  • Meet multiple demands within specified time requirements
  • Make claim decision
  • Manage Associate data including, but not limited to, updating Associates’ FML days, correcting eligibility, entering return to work dates, etcCompile metrics that can be used to evaluate the effectiveness of leave management policy, procedures and processes; analyze results and understand impact on staffing and performance in various health ministries
  • The Disability Case Manager I monitors, process and maintain data for FML leave requests that require integration with short-term disability benefits; Accurately apply FML and STD processes and policies to account for intermittent leaves, benefit payment exhaustion, leave return dates, potential transitional duty positions, etc.; Process STD payments

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