Tanisha O’Day

**** ********** **

Columbus, OH **219

614-***-****

Experience

State of Ohio, Department of Administrative Services, Columbus, Ohio

Benefits Management Representative

April 2016 to Present

Processes and approves/disapproves disability claims based on established policies & procedures. Communicates with employees, agency representatives, medical providers and third party administrators to process disability claims. Provides technical assistance to state workers and state agencies to resolve issues related to disability leave benefits. Coordinates and case manages disability benefit claims and return to work process of basic to moderate complexity. Analyzes medical information to facilitate the case management process. Acts as liaison between Benefits Administration Services, state agencies and state employees on disability claims issues. Conducts research, resolves complaints and provides assistance and information to hearing representatives and represents management in appeals of disability claims. Makes recommendations to improve processing and claims management.

Sedgwick, New Albany, Ohio

Disability Specialist

December 2015 to April 2016

Makes claim determinations to approve non-complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan. Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets. Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system. Refers cases as appropriate to team lead; maintains professional client relationships.

Leave of Absence Coordinator

June 2013 to December 2015

Establish and analyze FMLA claims to determine eligibility and certification in compliance with state and federal regulations. Make timely case decisions based on service expectations as established by the client. Communicate decisions and on-going expectations with claimants and clients. Maintain professional client relationships. Management of all reassignment, ADA accommodations and pending ADA leaves which averages to 800 claim case load. Work closely with SASC team to assist associates with returning to work.

Palmetto Gba, Columbus, Ohio

Appeals Specialist

October 2010 to May 31, 2013

Perform reviews using clinical/medical information provided by physicians/providers and established criteria set or clinical guideline on Medicare appeals Provide support and review of claims and utilization practices. Perform non-medical reviews and process redetermination letters. Follow all federal guidelines and policies regarding Medicare claims.

Anthem Blue Cross/Blue Shield

Provider Services Rep

November 2009 – May 2010

Respond to customer questions via telephone and written correspondence

regarding insurance benefits, provider contracts, eligibility and claims.

Analyze problems and provide information/solutions. Operate a PC to obtain

and extract information. Thoroughly document inquiry outcomes.

Verizon Wireless, Dublin, Ohio

Customer Service Representative

August 2006 - March 2009

Take high volume of incoming calls. Research and resolve billing inquiries. Up sell all products, services, and equipment to customers. Troubleshoot service equipment issues.

Prioritize and organize daily follow-ups to ensure timely resolution

JP Morgan Chase, Columbus, Ohio

Customer Service Representative

June 2005 - June 2006

Reviewed mortgage information with customers including payments, taxes, contracts, and title information. Review and analyze title searches. Ensure compliance with company policies and procedures. Any and all duties to assist and counsel customer with their mortgage information

MedcoHealth Solutions, Columbus, Ohio

Customer Service Representative

April 2003 - April 2005

Take inbound calls from patients regarding prescriptions for medications. Advocate for patients needs and concerns. Responding to inquiries and determining appropriate actions.

Dept. of Transportation (Solutions Staffing)

Secretary

September 2001 - February 2003

Answered incoming calls assisting customers with inquiries and directing to the appropriate area. Sending out any correspondence to consumers regarding real estate projects. Prepared and distributed real estate documents for Real Estate Specialists in the department. These documents included contracts, titles, and any other documents needed for property purchase. Any other office or clerical work needed throughout the office

Education Mifflin High School, Columbus, Ohio

September 1997 - June 1998

College Prep

References References are available on request.

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