Disability Claims Specialist

Ann Alexandre Disability/Appeal Claims Specialist

***** ** *** *****, ******** Pines, FL 33025 305-***-**** ************@*****.***

Disability Claim Specialist Complex Claim Specialist/Offset Management Strategic Planning Team Leadership

PROFESSIONAL SUMMARY

High performing Disability Claims Specialist/Customer Service with over 15 years of progressive experience contributing to organizational success through high-level strategy and the implementation of operational excellence. Strong track record of inspiring effective cross-functional and innovative problem solving in a high-stakes setting. Committed to continuous improvement and lifelong learning.

AREAS OF EXPERTISE/ KEY SKILLS

HIPPA compliance/ERISA

Complaint & Conflict Resolution

Regulation Compliance

Written & Verbal communication

Analytical Thinking

Familiarity w/ healthcare & medical terminology

Time Management /Organizational skills

Manage caseload of complex disability claims

Detailed oriented

PROFESSIONAL EXPERIENCE

Senior Long Term Disability Specialist (LTD) February 2020- Present

MetLife Tampa, FL

In this position responsibilities include administering 80-100 complex disability claims and coordinate with claimants and clients. Authorized assigned claims and manage timely payments.

●Review and interpret disability contracts

●Conduct in depth research to determine company liability

●Perform on-going claim management activities to appropriately contain claim liability

●Communicate 60-85 emails daily both written and verbal with HR, courts, attorneys, claimants and employers

●Effectively utilizes risk management tools

Senior Appeal Specialist December 2009 – February 2020

The Hartford (formally Aetna Life Insurance) Plantation, FL

Responsibilities include conducting appeal reviews to ensure federal regulations are followed. Analyze medical and clinical documents.

●Investigate, secure and analyzed information pertaining to claimant’s medical condition, occupational demands

●Reviewed insured status and other policy provisions to determine eligibility to determine entitlement to disability benefits

●Administered independent risk-assessments and claim decisions on 70-90 complex disability claims.

●Demonstrated accurate and complete documentation of required information to meet regulatory requirements

●Implemented and organized processes to improve efficiency and productivity

Short Term Disability (STD)/LTD Specialist June 2006 – December 2009

The Hartford Plantation, FL

●Monitored claim progress while effectively utilizing risk management tools

●Communicated on-going claim updates and decisions to appropriate parties daily

Team Leader of Operations-Sprint Account April 2004 – June 2006

Precision Response Corporation Margate, FL

In this position responsibilities include delivering exceptional service to 100 + customers per day, building brand loyalty by providing support with Sprint product information and purchase processing. Directed strategic upskilling of incoming colleagues through the design and delivery of high-value training activities on a range of topics.

●Organized and facilitated team meetings to communicate account goals and expectations

●Provided analytic perspective and offered questions and suggestions to maximize efficiency

●Coach and provide feedback towards creating excellent customer service experience

●Administered coaching, verbal, and written documentation for performance and behavior

EDUCATION

Bachelor of Science in Health Services Administration May 2022

Barry University Miami Shores, FL

MBA of Science in Health Services Administration/Public Health August 2022– Present

Barry University Miami Shores, FL

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