Disability Claims Resume Sample

4.9
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Lisa Maggio
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Work Experience


Disability Claims Specialist
03/2017 - PRESENT
Philadelphia, PA
  • Provides technical direction to claim team members on claims adjudication for Short Term Disability
  • Ensures all STD claims eligible or ineligible for payment conform to quality, production standards and specifications
  • Ensures claims processing is consistent with applicable policies, regulations, procedures and department guidelines for disability claims
  • Maintains current and emerging accounting/financial reporting regulatory rules and requirements assess the impact, and collaborates with management to incorporate new trends and developments in current and future strategies
  • Ensures all LTD claims eligible or ineligible for payment conform to quality, production standards and specifications
  • Ensures claims processing is consistent with applicable policies, regulations, procedures and department guidelines for the claims organization
  • Proven ability to achieve business goals through others
Disability Claims Analyst
01/2012 - 02/2017
Los Angeles, CA
  • Review and render determinations on Critical Illness / Accident / Hospital Indemnity claims
  • Respond to all inquiries generated relative to Critical Illness / Accident / Hospital Indemnity claims within established service time frame
  • Respond to all inquiries generated relative to Long Term Disability claims within established service time frame
  • Communicates with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of STD or LTD benefits
  • Calculates the liability for each claim applying all appropriate offsets such as social security, workers compensation and third parties
  • Continually assesses claim details to determine if claims are going to exceed case management authority guidelines
  • Evaluates and refers appropriate claims to risk management resources such as Vocational Rehabilitation, Managed Care, Fraud, Social Security, and Subrogation
Asst Life & Disability Claims Analyst
06/2005 - 11/2011
Philadelphia, PA
  • Strong negotiation, analytical and decision making skills
  • Strong knowledge of ID and LTD policy/contract provisions
  • Thorough knowledge of industry claims practices, procedures and philosophy, along with a detailed knowledge of medical terminology and medical conditions
  • Strong conflict management and organizational skills
  • Proven ability to multi task and balance multiple goals and priorities
  • Fluency in both English and French (written and spoken) considered an asset
  • Provide information in a clear, concise manner with an appropriate level of detail, empathy and professionalism; strong negotiation skills
  • Gather information, analyze facts, and draw conclusions

Education


Wayland Baptist University
2000 - 2004
Bachelor's Degree in Business

Professional Skills


  • Strong critical thinking skills, communication, organization and time management skills
  • Strong critical thinking skills with experience analyzing and problem solving issues
  • Strong interpersonal and demonstrated team-building and coaching skills
  • High attention to detail and excellent critical thinking skills with strong ability to identify and resolve inconsistencies in claim information
  • Strong analytical and problem solving skills; ability to speak to trends, stats, report cards on clients’ disability experience
  • Excellent customer service skills proven through internal and external customer interactions
  • Strong prioritization and work load management skills

How to write Disability Claims Resume

Disability Claims role is responsible for customer, recruiting, analytical, coaching, reporting, training, integration, security, compensation, payroll.
To write great resume for disability claims job, your resume must include:

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

Contact Information For Disability Claims Resume

The section contact information is important in your disability claims 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 Claims Resume

The section work experience is an essential part of your disability claims 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 claims 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 claims position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Disability Claims resume experience can include:

  • Prior experience working with short term disability (STD) policies or claims
  • Exceptional case management skills focused on positive outcomes for plan sponsor, plan member and Sun Life Financial
  • Understand and explain new concepts to successfully transfer knowledge and promote implementation of new skills in the learner
  • Superior communication, organization, risk management and time management skills required
  • Time management skills and ability to multi-task required
  • Time management skills and ability to multi-task in a fast-paced environment

Education on a Disability Claims Resume

Make sure to make education a priority on your disability claims resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your disability claims 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 Claims Resume

When listing skills on your disability claims 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 claims skills:

  • Demonstrated conceptual thinking, risk management, ability to handle complex claim situations effectively
  • Strong administrative abilities, problem solving and judgment skills
  • Demonstrated analytical and clinical critical thinking skills
  • Demonstrated conceptual thinking, risk management, and ability to handle complex claim situations effectively
  • Communication, organizational, problem solving, and computer skills required
  • Advanced technical/computer skills, including MS Word, Excel, PowerPoint, Share Point, etc

List of Typical Experience For a Disability Claims Resume

1

Experience For Disability Claims Specialist Resume

  • Demonstrates an intimate understanding of all aspects of LTD claim management/adjudication
  • Inputting new STD claims
  • Works with staff to address challenges relating to contract interpretation, procedures, claim direction
  • Success in achieving IDP goals, along with ability to influence others development
  • Assists in the development and coordination of training for the team (compliance, legal, medical, risk management systems, etc)
2

Experience For Disability Claims Analyst Resume

  • Works with the team to address challenges relating to contract interpretation, procedures, complex claim assistance and or direction
  • Works with the team to address challenges relating to contract interpretation, procedures, complex claim assistance and/or direction
  • Coaches staff to enable excellence in customer service, and claims management while demonstrating role model behaviors
  • Adjudicate assigned claims according to state regulation and corporate Best Practice Guidelines
  • Responsible for assigned disability claims utilizing a multidisciplinary claim management model to
  • Proactive outreach to claimants, internal team members, and physicians via telephone or e-mail for information needed for initial and ongoing claim management
  • There is a rotational 8pm shift that is required
3

Experience For Disability Claims Manager Resume

  • Identifies, calculates, communicates, and follows-up on overpayments
  • Updates and accurately documents system and claim files on actions taken. Establishes future action plan and case direction
  • Rotational late coverage until 8pm is required
  • Communicates with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of STD benefits
  • Manages assigned caseload of short term and leave management cases
4

Experience For Long Term Disability Claims Manager Resume

  • Position is assigned active open indemnity claims
  • Responsible for day to day supervision of a unit of Short Term Claims Specialists to ensure appropriate, accurate and timely management of claims of aligned product
  • Monitors workload of staff, to include casework volume and complexity of cases, and redistributes work as appropriate. Ensures customer service needs including performance guarantees are consistently and effectively met. Addresses immediate service issues
  • Responsible for day to day supervision of a unit of LMB Claims Specialists to ensure appropriate, accurate and timely management of claims of aligned product
  • Responsible for day to day supervision of a unit of Claims Specialists to ensure appropriate, accurate and timely management of claims of aligned product
  • Conduct analysis of referrals to determine if investigative criteria have been met, assigns claims to an investigative vendor and ensures the vendor has all claim related documentation for the case
  • Prepare written reports to summarize the results of social media investigations and recommend investigative action plans
5

Experience For Manager, Disability Claims Resume

  • Provide the highest level of investigative support for a claims organization and serve as the expert in all aspects of claim management
  • Appropriately engage other claim management resources
  • Capability to identify and implement process improvements and to organize and analyze information to ensure objectives are met
  • Provide review and sign off on staff claim decisions and/or authority referrals
  • Through 1x1 discussions, claim discussions with clinical, feedback from both internal and external customers, observations, and claim reviews, identifies key trends and provides analysis relative to claim management effectiveness
  • Review, distribute and analyze operational reports; utilize data to make informed decisions and recommendations
6

Experience For Senior Disability Claims Consultant Resume

  • Interact with other areas of Group Insurance, Clients, and/or Claimants with solution-based
  • Lead projects and initiatives on team, site or department to assist in organizational goals
  • Absence management knowledge and expertise to support integrated STD/ABS teams
  • Goal-oriented with an ability to organize and analyze information
  • Acts as a liaison to the legal department and U/W depart on complex issues
  • Tracks office measurements to ensure goals are met
  • Partner with various areas of Group Insurance
  • Goal oriented individual with an ability to identify and implement process improvements and to organize and analyze information to ensure objectives are met
7

Experience For Group Disability Claims Director Resume

  • Ensure the department goals are aligned with business objectives
  • Responsible for the financial results achieved by the Disability team
  • Review financial results, identify shortfalls and develop action plans to address shortfalls
  • Ensure effective claim management protocols, practices and procedures are in place and consistently managed through use of various management reports, coaching and training sessions
  • Works in partnership with Group Distribution & Regional RVP’s, to develop positive and effective business relationships with clients, 3rd party distribution and proprietary channels across Canada
  • Assist in the development of new products and services across all Group lines
  • Partner with other RBC Insurance business units to explore potential synergies and develop linkages to add more value to our shared clients
  • Provide input to product and risk strategies
  • Support integration of Sun Life’s group disability philosophy, policy and procedures developed through collaboration of Practice Excellence, Learning and Development and the regional group disability operations
8

Experience For Disability Claims Case Manager Associate Resume

  • Partner with other Disability Claims Consultants, Case Management Consultants and Trainers to facilitate continuous professional development within the region, where appropriate
  • Communicate claim status and decisions via telephone and in writing to claimant and internal team members
  • Initiate communications to claimant, physician, and internal team members in order to assess and facilitate job accommodation opportunities
  • Proactively develop and execute an appropriate plan of action for pending and ongoing disability claims assigned by utilizing, managing and directing appropriate resources
  • Utilize online claim management system to track disability claim milestones, including medical status updates, disability leave details, return to work information, communication regarding claim status changes and document storage
  • Generate output report from claim management system and distribute to internal team members for payroll accuracy
  • Conduct timely and accurate benefit determination in accordance with policy provisions and internal standards while providing sound customer service to all internal and external customers
  • Investigate and analyze claim information to determine coverage and benefit eligibility, and draft claim determination letter
  • Determine eligibility by comparing functionality with job description by reviewing medical information including physician statement and medical records then establish claim action plan and recommended path, including return to work
9

Experience For Associate Disability Claims Case Manager Resume

  • Upervisory or demonstrated leadership experience
  • Experience analyzing and problem-solving issues in a customer service setting
  • Experience providing customer service to policy-holders, employers, internal and external customers
  • Experience managing disability or workers compensation claims
10

Experience For Short Term Disability Claims Manager Resume

  • Problem Solving – Demonstrates independent problem solving and decision making ability
  • Multi-tasking – Ability to manage multiple priorities and meet designated turnaround times
  • Long Term Disability claims processing experience
  • Experience providing customer service to policyholders, employers, internal and external customers
  • Experience with Long Term Disability claims processing
  • Calculate and communicate payable benefits according to plan provisions

List of Typical Skills For a Disability Claims Resume

1

Skills For Disability Claims Specialist Resume

  • Effectively coach and mentor other employees and transfer knowledge effectively
  • Strong internet investigative skills and regular use of social media
  • Customer service skills proven through internal and external customer interactions
  • Exceptional claim/risk management skills and technical knowledge in contract interpretation and administration
  • Ensure customer satisfaction by adhering to tight deadlines & maintaining service standards to ensure a superior customer experience
  • Customize coaching based on the learner’s experience and responsiveness to training
  • Experience with Long Term Disability claims processing
  • Experience providing customer service to policy holders, employers, internal and external customers
  • Solid understanding of LTD contracts and complex provisions
2

Skills For Disability Claims Analyst Resume

  • Analyzes claim reports to identify trends, problems, and effectiveness with defined product or customer
  • Establishment of service standards to ensure superior client experience
  • Achieve budget targets through effective management of expenses
  • Solid knowledge of strategic interventions
  • Solid knowledge of group insurance policy and coverage concepts
3

Skills For Disability Claims Manager Resume

  • Experience providing customer service to policy holders, employers, internal and external customers
  • Knowledge and work experience in group insurance with disability focus
  • Customer service experience to policyholders, employers, internal and external customers
  • Demonstrated superior technical knowledge in the contract interpretation and administration
  • HS Diploma and at least one year of professional work experience
4

Skills For Long Term Disability Claims Manager Resume

  • Strong ability to navigate multiple computer screens and software required
  • Workers’ compensation claim-related experience
  • Experience with Microsoft Word (create documents) and Microsoft Excel (create spreadsheets)
  • Workers’ compensation claim - related experience
  • Proven teamwork and collaboration
5

Skills For Manager, Disability Claims Resume

  • Demonstrated ability to review medical and other claim records, utilize resources optimally and set appropriate claim management direction
  • Demonstrated success at coaching others to elevate their performance
  • Demonstrates an intimate understanding of all aspects of Short Term Disability (STD) claim management/adjudication
  • Models excellent leadership behaviors desired within organization
  • Communicating decisions and on-going expectations with claimants and clients
  • Conducting billing research
  • Analyzing FMLA claims to determine eligibility and certification in compliance with state and federal regulations
  • Communicating absence and return to work information to client
  • Staffing claims with clinician, as appropriate
6

Skills For Senior Disability Claims Consultant Resume

  • Coordinating certain types of leaves with client Human Resources Department
  • Tracking FMLA absences, per client calendar
  • Assisting the Team Lead with the identification of strengths and gaps relative to team and individual performance
  • Working with the Team Lead to address and close performance gaps
  • Processing disability/FMLA paperwork
  • Verifying return to work status
  • Provide telephonic customer service to claimant by offering absence information and answering questions regarding their rights and responsibilities
  • Participate with Underwriting and Sales partners in reviewing new business opportunities and large case renewals to drive profitable growth
7

Skills For Group Disability Claims Director Resume

  • Identify early and ongoing risk trends and make appropriate recommendations for addressing these
  • Assists in the development of training and/or coaching of the team (claim/risk management, compliance, legal, medical, vocational, etc)
  • Assist in developing and recommending claim strategy
  • Determine compliance with claims handling standards, policies and procedures
  • Identifies trends and makes recommendations for changes to process, procedures and training in accordance with findings
  • Monitors field office desk-audits and ensure action plans are addressing applicable trends
  • Decide on staffing levels appropriate for both the STD and LTD units
8

Skills For Disability Claims Case Manager Associate Resume

  • Decision making accountability within set financial approval limits and extra contractual parameters
  • Responsible for working with Sales partners in the acquisition of new business
  • In-depth knowledge and understanding of the Independent Medical Examination process
  • In-depth knowledge and understanding of the High Level Review process
  • Serve as primary contact for client by managing leave of absence administration (FMLA, STD, LTD) as determined by client contract
9

Skills For Associate Disability Claims Case Manager Resume

  • Assist in the development and coordination of investigative training for the claims organization and with identification of potential claim misrepresentation
  • Acts as a liaison with our internal and external business partners including our claims organization, CID department, investigative vendors and legal
  • Insure staff is operating within compliance and with high level of quality in claim management activities
  • Collaborate and facilitate multiple internal resources including claim staff, clinical, vocational, sales & account management, contact center etc
  • Assess individual and team performance, working with the Team Lead to ensure goals are met
  • Steps in to manage other team members’ work assignments as necessary
  • Administers Quality Assurance (QA) program for defined product or customer that is consistent with department metrics
10

Skills For Short Term Disability Claims Manager Resume

  • Conduct quality audits of claims
  • Works closely with claims line managers to report QA results to claims staff (for defined product or customer)
  • Tracks compliance with changes and/or corrections needed as a result of audit findings
  • Continuously improves the QA process for defined product or customer to ensure consistently rigorous claim management decisions, accuracy, and customer service
  • Assist field Operations Manager and other QA staff with roll-up of results; draws conclusions and makes recommendations based in accordance with findings
  • Make claim determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and using case management resources.
  • 100 North 1st Street, Springfield, Illinois 62794
  • Positions are also available in the Windsor, CT and Portsmouth, NH Offices

List of Typical Responsibilities For a Disability Claims Resume

1

Responsibilities For Disability Claims Specialist Resume

  • Experience analyzing and problem solving issues in a customer service setting
  • Experience processing Life, Critical Illness, Accident and/or Disability Claims
  • Working with MS Excel - Reporting, sorting & filtering data
  • Working with MS Word - able to move around a document/template
  • Coaches staff to enable excellence in customer service, claims management while demonstrating role model behaviors
2

Responsibilities For Disability Claims Analyst Resume

  • Proficient ability managing daily call volume (average 30)
  • Partner with various areas of GI
  • Goal oriented individual with an ability identify and implement process improvements and to organize and analyze information to ensure objectives are met
  • Proficient with Microsoft Word (Create documents and work within templates) and Excel (Create and maintain spreadsheets)
  • A personality. We’re all humans here, so let’s have a little fun! #SorryNotSorry
  • Be a planner – time management and the ability to “see around corners” is essential
3

Responsibilities For Disability Claims Manager Resume

  • Proficient with Microsoft Word (create documents and work within templates) and Microsoft Excel (create and maintain spreadsheets)
  • New York State license as an independent claims adjuster or ability to obtain within 6 months of hire
  • Follow through on deadlines imposed by self, Supervisor, regulatory agency, and / or client
  • Resident of / near Buffalo or Rochester NY
  • Passion to provide superior customer service required
  • Knowledge of FMLA regulations
4

Responsibilities For Long Term Disability Claims Manager Resume

  • Proficiency in Microsoft office and other computer applications
  • Long Term Disability, Short Term Disability
  • 5 + yrs of experience in disability claims the directly aligns with the specific responsibilities for htis position, including 2+ years of managerial, supervisory, and/or demonstrated leadership experience
  • Demonstrated customer service, mentoring, leadership, organizational and problem solving skills required, as well as an understanding of production issues and ability to quickly realign resources to insure success of workflow
  • When appropriate, managing cases in accordance with Service Level Agreements outlined in client contract
  • Prepare reports and analysis on various compensation, benefit and absence tracking
  • Communicate thoroughly and accurately with client and claimant on all aspects of claims process either by phone or written correspondence
5

Responsibilities For Manager, Disability Claims Resume

  • Inform claimants of documentation required to process claims, required time frames and claim status information
  • Troubleshoot disability and absence issues
  • Maintain professional client relationships
  • Travel Amount: Less than 10%
  • Assist claimant in transition from short term disability to long term disability, if applicable
6

Responsibilities For Senior Disability Claims Consultant Resume

  • Instills Trust – Maintains strict confidentiality according to HIPPA regulations and the release of Personal Health Information (PHI). Gains the confidence and trust of others through honesty, integrity, and authenticity
  • An infectious positive attitude with a drive to succeed, a commitment to quality and service as well as a passion for your work
  • 100 North 1st Street, Springfield, Illinois 62702
  • Having direct communication with various medical professionals to gather information regarding the claim for, short-term, long-term and rehabilitation disability benefits
  • Support and promote all integration initiatives
  • Handle potentially high levels of inbound correspondence from claimants and medical professionals. There correspondences maybe via written, faxed and/or emails response of the request for medical records. Also guide the disability claims associate as they perform task
  • Network with both claimant and physicians to gather medical records, labs, diagnostic test and any other pertinent medical requests for review and ongoing evaluation of medical information. Also guide the disability claims associates performing task
7

Responsibilities For Group Disability Claims Director Resume

  • Delivery of clients expectations outlined in the scope of work (SOW)
  • Adherence to standard timeframes for processing mail, tasks and outliers as outlined in the scope of work. Also guide the disability claims associate performing task
  • Respond to all telephonic and email inquiries within client service protocols (SOW) in a clear, concise and timely manner. Also guide the disability claims associates performing task
  • Administer claims by
  • Provides technical guidance to staff, to include providing immediate feedback on claims management and customer service, ensuring team receives initial and on-going technical and non-technical training, and assisting with inquires/requests escalated from customers and other department staff. Provides guidance on when to escalate to subject matter experts

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