Case Manager Disability Claims

TIFFANY CROSS

DISABILITY CASE MANAGER

●***********@*****.*** 813-***-**** Tampa, FL 33619

OBJECTIVE

Performance-driven and customer-focused professional with more than 15 years of robust experience in managing short and long-term disability claims following predefined policies and procedures while consistently developing strong and loyal customer base for diverse top-tier organizations.

Snapshot:

Dedicated individual with can-do attitude skilled at meeting customer expectations and requirements.

Gained extensive experience across healthcare or medical environments with a commitment to preserving confidentiality.

Expert at delivering quality services with ability to function in fast-paced and deadline-driven environments, while maintaining confidentiality.

Demonstrated history of analyzing and investigating disability claims, documenting complete disability assessments, and executing comprehensive disability management strategies.

Competent at responding to routine client calls related to claim status in adherence to policy provisions and state/federal regulation.

Refined communicator; expert at forging and strengthening long-term professional relationships with clients and vendors at all levels.

Technical skills in Microsoft Word, Excel, Outlook, PowerPoint, SharePoint, CSC, and CWAS.

Expertise in smooth handling of diversified administrative tasks, business communications, team collaborations, and customer assistance.

PROFESSIONAL EXPERIENCE

Humana, Inc.

2013 – Present

Claims Representative 2

●Follow and maintain production/quality standards to meet and exceed client expectations.

●Investigate claims and obtain relevant facts to determine coverage, loss, and liability.

●Interact effectively with clients and other public personnel involved in claim process.

●Identify and resolve claim issues promptly and follow up on outstanding issues.

●Define and execute return, deny, or pay claims process as per organizational policies and procedures.

●Carry out all claim procedures emphasizing policies and procedures of specific areas and departments.

Aetna Inc.

2003 – 2013

Short Term Disability Case Manager

●Initiated and performed analysis, investigation, and assessment of disability claims while determining applicable action and eligibility for benefits.

●Achieved internal/external client expectations and requirements by delivering satisfactory customer services.

●Prioritized and controlled workload to meet deadlines, company objectives, and department standards.

●Accomplished Group Benefits Claims Diversity and Inclusion initiatives by providing and maintaining team environment.

●Collaborated with customers to extract information relevant to short-term disability claims.

●Utilized verbal and numerical critical thinking skills to obtain facts, employ solid reasoning, and create appropriate conclusions.

●Gained and enhanced business acumen & technical expertise to offer strategic insight with a mixture of management oversight.

●Used operational and financial reports to find trends and opportunities ensuring optimal claim management results.

●Addressed and responded to routine client calls related to claim status in adherence to policy provisions and state/federal regulation.

Aetna Inc.

2002 – 2003

Short Term Disability Intake Analyst

●Served efficiently to explain the procedure, answer queries, and set expectations with the caller.

●Received and processed incoming claims by operating electronic and telephone channels and forward completed claims for reassignment.

●Recovered diverted calls, emails, and images while analyzing and rectifying imaging errors in collaboration with internal/external vendors & contacts.

●Located, processed, and validated data related card inquiries as well as assembled, configured, and entered relevant claim processing systems.

CERTIFICATIONS & VOLUNTEER WORK

●Certification – Computer Operations

Erwin Technical Center– Tampa, FL

●Volunteerism & Community Involvement

Breast Cancer Walk – Paint Tampa Bay – Habitat for Humanity

PROFICIENCIES & STRENGTHS

●Disability Case Management

●Effective Cross-functional Collaborator

●Excellent Customer Relations & Services

●Disability & Life Claims

●Solution-Oriented & Detail Focused

●Reporting & Documentation

●Administrative Support

●Workflow Management

●Attention To Detail

●Disability Practices & Standards

●Continues Process Improvement

●Team Collaboration & Leadership

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