Benefits Admin, Worker's Compensation Claims Admin, Customer Service

SUE A. PAIVA

Wallingford CT ***** 203-***-**** EMAIL: *.*********@*****.***

BENEFITS SPECIALIST HUMAN SERVICES

Highly organized, skilled individual with interpersonal and communication skills both written and verbal

Knowledgeable HR Benefits Specialist with an updated understanding of common human resources benefits, including health insurance, short-term and long-term disability and retirement savings. Consistently advocating on behalf of employees. Specializes in providing comprehensive HR support that includes conducting preliminary interviews and ensuring that employee data remains secure.

Managerial skills: Coordinated benefits for over 500 employees. Holistic perspective of managerial, employee, employer needs, accommodations and expectations.

Office Management

Records Management

Database Administration

Microsoft Office/Excel

Benefit Administration

FMLA & Cobra

Employee /Labor Relations

Training & Development

Communication Skills

Multitask/Fast Learner

Interpersonal Skills

Conflict Resolution

Coaching & Counseling

Event Coordinator

Professional History

Retiree Benefits

Administered the retiree medical benefits.

Resolved retiree questions.

Liaison to the Medicare TPA.

Participated in several Departmental Safety Committees.

Managed Retiree, Worker’s Compensation, Heart & Hypertension personnel file.

Benefits & Wellness

Coordinated yearly medical, dental, life, and voluntary benefits renewals.

Assessed the TPA’s benefits cost analysis and provided commentary to management for review and approval.

Advised (4) Payroll departments of all Healthcare deductions to be drawn weekly.

Provided benefit orientation for new hires and existing employees.

Prepared COBRA and FMLA documentation counseled the recipients.

Audited Benefits invoices monthly and submitted for payment.

Apprised the employees of all policy changes and procedures.

Implemented yearly Open Enrollment of all Healthcare Plans for 500 employees in CT, MA, FL, and PA. Processed all electronic applications via Web Enroll for new enrollees, cancellations, new hires, terminations, demographic changes, qualifying events, and beneficiary changes. Counseled employees and liaised with carriers and physicians regarding benefits questions and issues.

Worker’s Compensation

Investigated injury claim with property manager.

Disseminated pertinent information from the injured employee and witnesses

Prepared incident reports.

Submitted all notice, medical, and loss claims to the carrier.

Directed employee to the nearest Occupational Health facility as per procedure.

Maintained the insurance database, the loss reports, the OSHA reports, and 300+active files.

Contacted claims adjuster and Attorneys for file status, reserves, and settlement.

Authorized payment of invoices to the carriers and finance companies.

Audited, researched and assisted with rectification of insurance billing errors.

Participated in claims and OSHA Safety meetings.

Provided medicals and employee scheduling assistance for discussions or resolution of claims issues with carriers, adjuster, nurse case managers, and investigators.

Benefits Coordinator 10/04/16 - 11/09/16

Willimantic Board of Education, Willimantic, CT

Creative Financial Staffing

Retiree Benefits/Wellness & Worker’s Compensation Coordinator 09/28/15 - 04/06/16

City of Bridgeport, Bridgeport, CT

Benefits/Wellness & Worker’s Compensation Coordinator 08/21/00 - 09/25/15

Carabetta Management Co. Meriden, CT

Accomplishments 2001-2016

Recovered erroneously charged medical premium from Cigna in excess of $5,000.00; life insurance premium in excess of $1,500.00; and several hundreds of dollars dental premium from United Healthcare.

Researched an extensive medical census and discovered three erroneously insured individuals, over a period averaging 7 years a piece, costing the employer hundreds of thousands of dollars in unrecoverable premium.

Assisted with (2) employee medical appeals processes regarding the authorization of denied procedures.

Procured the authorization for the distribution of growth hormones for a dependent.

Procured the authorization for the distribution of medical marijuana for an elderly employee member of management.

Captured retro payment from the carrier for an Out-of –Network physician who had rendered services one year prior and had not been paid despite timely process.

Education

Bachelor of Arts, English Literature/University of Connecticut, Storrs, CT

Associate in Science, Paralegal Studies/Manchester Community Technical College, Manchester, CT

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