Case Management

Edeline Louis Jean

*******.*********@*****.*** 754-***-**** Plantation, FL https://www.linkedin.com/in/edelinelouisjean/ SUMMARY Seasoned professional with years of experience in leave of absence, disability case management, and claims resolution. Expert in ADA accommodations, FMLA, and managing high-volume disability claims with a proven track record of accuracy and regulatory compliance. Seeking a Claim Adjuster role to leverage extensive background in facilitating effective return-to-work strategies and mitigating legal risks. WORK EXPERIENCE Amazon (US Tech Solution) FL (Remote) Regional Accommodation Consultant/HR Specialist III Jul 2022 – Dec 2023

• Enhance collaboration and streamline accommodation processes through effective management of communication channels, ensuring adherence to organizational objectives and compliance standards.

• Offer expert consultation and coaching on accommodations, mitigating legal risks and ensuring regulatory compliance for HR business partners, managers, and employees.

• Facilitate ADA accommodations and return-to-work strategies, promoting an inclusive workplace culture and addressing employee needs with efficacy.

• Maintain meticulous oversight of accommodation, leave, and disability cases, ensuring a 100% accuracy rate in process execution within established timelines. Broadspire Services Inc. Sunrise, FL

Longer Term Disability Benefit Specialist Mar 2017 - Jul 2022

• Managed a caseload 200 of moderately complex Long-Term Disability (LTD) claims, including pending, ongoing, active, and appeal reviews, with some level oversight.

• Calculated monthly benefits after elimination period, encompassing Cost of Living Adjustments (COLA), Social Security offsets, Rehab Return to Work benefits, and other

non-routine payments.

• Provided timely and detailed written communication to outline the status of claim evaluations and determinations, while ensuring resolutions and adhered to established service standards.

• Collaborated with senior leadership to address and resolve intricate disability claims, enhancing overall claim resolution processes.

• Partnered with training consultants to improve standard operating procedures, leading to more efficient operations and reduced case escalations.

• Provided guidance to new Disability Benefit Specialists, improving their case management skills and customer service capabilities. Aetna Inc. Plantation, FL

Sr. Leave of Absence and Disabilty Case Manager Jan 2007 - Mar 2017

• Managed a claimant caseload of 325 regarding leave of absence that included FMLA, military, and parental leaves, ensuring compliance with internal and external regulatory requirements.

• Processed a high volume of short-term disability claims, achieving a 90% approval rate through meticulous attention to detail and documentation management.

• Demonstrated the ability to execute and independently managed disability claims, while providing clinical guidance on more complex claims

• Improved benefits calculation precision by 25% by implementing enhanced review processes, ensuring accuracy in adjustments and disbursements according to plan and regulatory standards.

• Analyze claim activity and prepares reports for clients/carriers and management as needed; while verifying on-going disability and participates in claim reviews with specialized resources including nurses, physicians, vocational rehabilitation, etc.

• Conducted in-depth investigations for various claims, supporting operational integrity and streamlining service delivery through collaborative communication with medical and HR professionals

Plaza South A.C.L.F. Miami Beach, FL

Operations Manager May 2000 - Jan 2007

• Directed daily operations and guided staff to ensure compliance with established standards and procedures, resulting in consistent organizational practices.

• Developed and executed operational policies that improved efficiency and financial management, ensuring optimal use of resources within budgetary limitations.

• Oversaw patient admissions and upheld meticulous record management, leading to increased client satisfaction and adherence to regulatory mandates. EDUCATION Liberty University

Bachelor of Science, Psychology

Everest Institute

Medical Coding and Billing Certification

Aug 2023-

Present

CERTIFICATIONS Certified Leave Management Specialist (CLMS), DMEC 2020 Certified Project Management Professionals (PMP), PMI 2023 SKILLS Userra • STD • LTD • Problem-Solving • Organizational Skills • Critical Thinking • Analytical Skills • Microsoft Office Suite • Salesforce • Workplace Accommodation • Customer Service • Attention to Detail • Communication • Medical Coding & Billing • French • Spanish • Case Management • ADA • HIPPA • FMLA