Medical Manager
Resume:
Monica Ramos, CLMS
Skills:
Knowledgeable in: FMLA, CFRA, PDL, ADAA, State Leaves, Proficient in Microsoft Office and QuickBooks Accounting Software
Sedgwick CMS – Return-to-Work Specialist January 2017 – Present
Facilitate return-to-work efforts through negotiation with Client, Medical Provider and Employees.
Determine objective, quantifiable, medically supported work restrictions for assigned claims.
Adhere to medical and legal regulations and accreditation standards in written communication.
Contact Supervisors to determine specific information regarding employment area.
Assist Supervisors in modifying job sites or obtaining necessary adaptive equipment as needed.
Work closely with team members to ensure smooth transition from medical case management into job placement.
Perform other tasks related to vocational evaluation and work adjustment training as needed.
Assist Leave Team as needed.
Sedgwick CMS – Client Liaison April 2016 – December 2016
Worked at Client site to continue developing Client relationship and assist Leave Management Department with claim questions as needed.
Evaluated and created a process for the Client as most efficient while working onsite.
Acted as a primary resource for Associates on a short-term medical leave with regards to general leave/process questions, vendor services levels and or process/vendor complaints.
Conducted investigations and gathered information for FMLA, CFRA, Short-Term Disability, Company Medical Leaves and Worker’s Compensation claims.
Gathered documentation for Outside Counsel on Worker’s Compensation claims as needed.
Advised business units and HR on company policy and State/Federal law regulations.
Facilitated the process of analyzing Employee’s ability to perform essential functions of the job.
Documented Return-to-Work program and identified process improvement opportunities.
Educated and advised all necessary departments on specific leave issues based on current leave policies and laws/regulations.
Performed other duties, projects and special assignments as assigned by Management.
Sedgwick CMS – Leave of Absence Representative Senior March 2014 – March 2016
Processed new claims in a timely manner to ensure compliance internally and on a Federal level.
Administered FMLA/CFRA/PDL/Military and Kin Care claims; tracked and coded leave of absence, determined eligibility, followed-up with Employee’s on medical certification and analyzed medical certifications when received to make claim decisions based on Federal and State regulations.
Tracked Personal Leaves of Absence and arranged return-to-work plans for transitioning Claimants.
Communicated decisions and on-going expectations with Claimants and Clients.
Assisted Claims Supervisor in reviewing claim reports to ensure decisions were made timely along with ensuring medical documentation was reviewed within the expected turnaround time.
Trained new colleagues in claims management system and work flow process.
Sedgwick CMS – Leave of Absence Representative March 2013 – February 2014
Processed new claims in a timely manner to ensure compliance internally and on a Federal level.
Administered FMLA/CFRA/PDL/Military and Kin Care claims; tracked and coded leave of absence, determined eligibility, followed-up with Employee’s on medical certification and analyzed medical certifications when received to make claim decisions based on Federal and State regulations.
Tracked Personal Leaves of Absence and arranged return-to-work plans for transitioning Claimants.
Communicated decisions and on-going expectations with Claimants and Clients.
Sedgwick CMS – Claims Assistant July 2012 – February 2013
Accountable for completing the claim set up process.
Determined Federal, State eligibility according to HR feed information received from Client.
Set up Independent Medical Exams as requested by Client.
Continuously assisted on various accounts to ensure performance guarantees were met.
Obtained medical records for ongoing STD/LTD claims.
Hovell & Pilarski Engineering, Inc. – Office Manager December 2006 – March 2012
Managed office, accounting and Human Resource tasks.
Coordinated meetings and with City, County and Clients as required by project.
Assisted in crew scheduling to ensure current jobs were on schedule as required by contract.
Prepared certified payroll and processed City/County prevailing wages report and reported to the corresponding union as required by District.
Processed property site research to determine bidding and accurate information as needed.
Assisted in creating budgets/proposals and tracked budgets throughout the life of the contract.
Developed and implemented RFP procedure, which reduced the company’s liability and cost.
Education:
Disability Management Employer Coalition
Certified Leave Management Specialist Designation Certificate 2019
Los Angeles Pierce College – Woodland Hills, CA
Associate of Arts Degree in Liberal Arts, June 2010
Contact this candidate