Disability Case Mananger/Customer Service Specialist

VIJAY GURPRASAD E-mail:

**************@*****.***

**** ****** ******** ***********, ** L4Z 3S1 905-***-****

DISABILITY CASE MANAGER

Career Summary

Over ten years of experience in customer service and disability case management

Fluent in a variety of insurance software and Microsoft Office

Highly developed and effective communication skills, both verbal and written

Excellent analytical, organizing, prioritizing and problem solving skills

Strong contributor both as an individual and as a team player

Consistently meet and exceed established service standards

Adaptable, ethical, dedicated and professional

Temporary Assignments – 2014 to 2015

Office Administration/Clerical positions

Crawford & Company - Mississauga, Ontario – Jan 2014 to May 2014

*Reviewed disability claims

*Requested updated information

*Interviewed claimants

*Processed new information on claims

*Sent medical information and for review to medical professional

*Calculated benefits and sent request to accounting department for payment

*Investigated and assessed file information and offer lump-sum payment with the intention of closing

file when it is advantageous to both insurance carrier and claimant

*Updated claimant of claim decisions in writing

*Recorded all file transactions.

Industrial Alliance – Nov 2006 to Feb 2012

*Corresponded via phone and letters with claimants, policyholders, administrators, brokers,

government officials, health professionals, legal professionals, etc. to gather and confirm pertinent

information

*Provide effective case management solutions for disability claims taking into consideration,

contractual, medical and other information obtained via investigations to facilitate timely return to

work

*Arranged for Independent Medical Examination (IME) to determine claimant’s medical status and

Functional Abilities Evaluations (FAE) to determine the claimant’s capabilities when required

*Requested medical records to investigate pre-existing medical conditions

*Assessed claims for benefit entitlement by reviewing contractual, medical, functional and

occupational information

*Processed claims within policy guidelines and communicated with all stakeholders to keep all

interested parties involved with the claimant updated regarding approval/denial and disability

duration

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*Pursued all cost recovery measures as well as cost sharing options including subrogation

*Calculated benefits for approved claims and made adjustments for offsets and over-payments

*Liaised with RTW/Rehabilitation Consultant on return to work issues

*Developed and maintained case management plans directed towards ethically influencing early and

timely recovery/return to work

*Initiated Rehabilitation Intervention where appropriate and coordinated resources including

rehabilitation consultants and employers to support and promote early return to work

*Maintained records of all activities on claim files Identified and reported weaknesses and applied

controls to mitigate financial and operational risks

*Ensured compliance with regulatory requirements as well as internal policies

*Participated in client meetings to review claim status and provided updates

*Ensured adjudication decisions are communicated in writing to claimants and that Appeal issues are

acknowledged

*Handled appeals by reviewing and re-assessing new information submitted on files previously

assessed

*Managed the transition of STD claims to LTD and provided medical as well as case summary to the

LTD insurer where applicable to ensure a seamless transition

*Applied waiver of premium benefits where applicable

*Sent out CPP application for disability benefits to claimants and explained the reason for application

for this benefit

*Participated in presentations and various project

United Van Lines – Mississauga, Ontario April 2003 – Nov 2006

*Reviewed, investigated and processed claims for missing and damaged property claims resulting

from transportation

*Responded to customer complaints, performed searches for missing items and expedited settlements

for damaged goods

* Established eligibility or denial according to the provisions of the Policy Contract

*Made arrangements for the assessment and valuation of damaged goods

*Made decisions regarding repairs, replacement or cash payment based on damages and valuation of

damaged items

*Evaluated claims within policy guidelines in the speediest most cost effective manner

*Calculated liability and made payments for approved claims.

*Updated claimants of settlement decision in writing

*Handled appeals and provided explanations

*Dealt with appeals and provided explanations

*Provided front line, direct contact to clients & customers

Assurant Group – Toronto, Ontario - 2000 to 2003

*Reviewed, investigated and processed submitted claims

*Responded to customer complaints, dealt with appeals and provided explanations

*Provided front line, direct contact to clients & customers for claim against their polices

*Established eligibility or denial according to the provisions of the Policy Contract and Evaluated

claims within policy guidelines in the speediest most cost effective manner

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*Provided claim decisions in writing to claimants and employers

Canadian Imperial Bank of Commerce: Insurance - Mississauga, Ontario – 1996 to 2000

*Used approved company process to obtain pertinent information required in the underwriting

process

*Generated requests for medical information from service providers to conduct required test

Coordinated appointments with clients and service providers (medical professionals)

*Updated claimant’s file with pertinent medical information and followed up with service providers

for outstanding medical information

*Requested medical information from the Medical Information Bureau, recorded and updated

claimant's files with “hits” and reported new medical findings to the “Medical Information Bureau”

*Established guidelines and provided assistance to Service Providers in order to meet Company’s

service standards/”turn round time”

*Provided guidance to less experienced team members

*Provided clerical assistance to underwriters

Skills

Microsoft Office, Outlook, Web Page Development

*Insurance software for various companies: Canadian Imperial Bank of Commerce, Canada Life,

Assurant Group, United Van Lines, Industrial Alliance, Crawford & Company

Superior *communication, *organizational, *negotiation, *analytical & *investigative skills

Education

Marketing Support & Web Page Design - Diploma 1995 -1996

Compu-teach, Mississauga, Ontario

Customer Service Representative - Certificate 1994 - 1995

Commercial Business School, Toronto, Ontario

Legal Secretary - Diploma 1990 - 1991

Toronto School of Business, Toronto, Ontario

Other work related Courses

Fraud detection/prevention – identifying “red flags”

Dealing with Difficult Customers

Conflict resolution

Business writing

Privacy laws and how to handle sensitive documents and information

Be Prepared to Speak

Time Management

Loma (Insurance)

Medical Terminology

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