Case Manager

Contact: 561-***-**** *************@*****.***

Silvana Battle

Experience

August 2023-Present Innova Solutions Contractor for MassMutual Springfield, MA

Case Management/Underwriter ~ (Remote Full Time)

Key Responsibilities and Job Summary: Utilized exceptional organizational and communication skills to manage and resolve complex life insurance claims, ensuring timely and accurate benefit delivery to policyholders. Review and analyze claim submissions, medical records, and policy documentation to determine coverage eligibility. Conduct thorough investigation, including phone interviews with claimants, beneficiaries, and medical professionals. Ensure and comply with company policies, industry regulations, and legal requirements.

Duties: Act as case-level point-of-contact (POC) and Subject Matter Expert (SME) on pending business. Process basic and intermediate transactions including regulatory, contractual and case issue. Handle BGA’s concerns to solution, taking actionable steps to resolve timely. Manage escalated advisor requests to explore alternative coverage options when applicable. Respond via email, call, or text to associate/team needs, i.e. answering questions, providing feedback, and communicating effectively to proactively mitigate issues. Provide superior customer service and proactively develop knowledge of various third party operating models. Partner with leaders and other advocates to help the team meet metrics and quality. Attention to detail, ensuring that supporting forms and requirements are complete with proper signatures and meet appropriate regulations. Collaborate effectively with underwriters and management when determining complex decisions. Able to independently work assigned requests with minimal direction. Practice inclusiveness and collaboration with all field business partners and fellow teammates.

June 2022-Present South Florida Neurology Associates LLC Boca Raton, FL

Insurance Specialist ~ (Remote Part Time)

Insurance Verification and Eligibility: Skilled in verifying patient insurance coverage and determining eligibility for services. Ability to communicate with insurance companies to obtain pre-authorizations and resolve coverage-related issues. Thorough understanding of medical terminology and insurance policies. Conducted insurance eligibility checks and obtained pre-authorizations for medical services. Verified patient insurance coverage, obtained pre-authorizations, and resolved insurance-related inquiries. Strong knowledge leveraged in depth of Medicare, Medicaid and commercial insurance to support eligibility verification, billing, and program compliance with emphasis on a clear understanding of plan distinctions.

Communication and Interpersonal Skill: Excellent verbal and written communication skills to interact effectively with patients, healthcare providers, and insurance representatives. Ability to explain complex insurance concepts to patients and address their concerns professionally. Strong problem-solving and customer service skills. Assisted patients with insurance-related questions, explaining coverage details, and facilitating the resolution of claim issues.

Customer Service Skills: Dynamic and results-driven Customer Service Representative with a proven track record of delivering exceptional support in high-volume environments. Adept at handling a diverse range of inquiries with professionalism, empathy, and a solution-focused mindset. Skilled in resolving complex customer concerns, accurately processing service requests, and ensuring client satisfaction across various communication channels including phone, email, and chat.

November 2010-May 2023 DRB Capital LLC Delray Beach, FL

Underwriting Contract Analyst ~

Analyzed and reviewed contracts, identifying risks, inconsistencies, and potential areas of improvement. Conducted thorough legal research to ensure compliance with applicable laws and regulations. Collaborated with cross-functional teams to negotiate and draft contracts that align with company objectives and mitigate risks. Implement incentives agreements to engage, retain, and develop top talent within the organization. Develop forms, agreements, and manual updates on business and its relevant services. Developed and implemented standardized contract templates, improving efficiency, and reducing contract time. Monitored contract performance, ensuring compliance with contractual terms and conditions. Assisted in resolving contract disputes and facilitated contract amendments as necessary. Maintained accurate and organized contract records and documentation. Collaborated with external legal counsel to seek advice and guidance on complex contractual matters.

Underwriting:

Strong understanding of legal and financial aspects related to structured settlements. Extensive knowledge of industry regulations and compliance requirements. Maintain accurate and detailed underwriting records, including notes, calculations, and supporting documentation. Exceptional attention to detail and accuracy. Strong communication and interpersonal skills. Ability to work independently and meet deadlines. Communicate with brokers, attorneys, and other stakeholders to gather necessary information and resolve any underwriting concerns. Generated reports and maintained underwriting files, ensuring all documentation was properly organized and accessible. Collaborated with team members to improve underwriting processes and increase overall efficiency.

Medical Underwriting:

Reviewing medical records: You analyze medical documentation, including reports, diagnoses, treatment plans, and prognoses, to understand the seller’s medical condition and its impact on their future dollar amount needs.

Assessing medical risks: Based on the medical information provided, you evaluate the potential risks associated with the seller’s condition. This assessment helps determine the appropriate settlement amount to cover for the seller’s medical expenses and ongoing care.

Analyzing financial implications: By considering the medical risks and related costs, to assess the financial implications for the structured settlement. This involves evaluating the seller’s anticipated medical expenses, potential treatments, rehabilitation needs, and other healthcare requirements.

Calculating settlement amounts: Using a combination of medical expertise and financial analysis, you determine the appropriate settlement amount and structure. This ensures that the settlement adequately addresses the claimant's medical needs while considering their long-term financial security.

Collaborating with medical professionals: You may need to consult with doctors, specialists, and other healthcare professionals to gain insights into complex medical conditions or to seek expert opinions on the claimant's prognosis.

Documenting and reporting findings: You compile comprehensive reports outlining your medical underwriting analysis, including the rationale behind your recommendations. These reports serve as a resource for attorneys, insurance companies, and other stakeholders involved in the settlement process.

Legal: Collaborate with legal and claims departments to address any legal or contractual issues related to structured settlements. Conduct thorough analysis of legal and financial documents related to structured settlements. Evaluate and underwrite structured settlement contracts in accordance with company policies, industry standards, and regulatory guidelines. Coordinate with internal teams, such as legal, compliance, and finance, to ensure smooth and efficient transaction processes. Collaborate with attorneys, financial advisors, and insurance companies to gather necessary information for evaluation. Review and interpret legal documents to ensure compliance with relevant laws, regulations, and internal guidelines.

Compliance and Quality Control: Provide recommendations and guidance to management regarding the approval or denial of structured settlement contracts. Conducted initial screenings and assessments to determine the eligibility of applicants for structured settlement contracts. Review the insurance carrier information such as explanation of benefits and change of beneficiaries and any request for benefits with the seller. Resolve and review matters with any of the insurance carriers with any discrepancies on payments or payment streams. Searches are completed for contracts such as Accurint, Lexis Nexis, West Law, Credit Reports and Life Expectancy Reports (Fasano)

Pricing Analytics: Proficient in evaluating the value of future payments and calculating present value. Excellent analytical and problem-solving skills. Expertise in negotiating purchase agreements and establishing mutually beneficial terms. Skilled in assessing the value of structured settlements, negotiating purchase agreements, and ensuring compliance with legal and financial regulations. Committed to providing exceptional service and maximizing value for both clients and the company. Evaluate structured settlement annuities and assess their present value based on factors such as payment schedule, total amount, and discount rate. Monitor and manage contracts and premium payments that need to be priced and analyzed. Conduct comprehensive financial analysis, including cash flow projections, annuity valuations, and present value calculations. Prepare comprehensive reports detailing the value of structured settlements and proposed lump sum purchase offers. Negotiate purchase agreements with clients, ensuring that terms are fair and compliant with applicable regulations. Work in excel with pivot tables and VLOOKUPs for pricing analytics.

Funding: File reviews to determine which documents are outstanding and which documents need to be updated or obtained to complete compliance for the contract. Drafted disclosure agreements, vendor contracts and contract amendments. Assisted underwriters in evaluating and underwriting various insurance policies, including structured settlement contracts. Prepared and reviewed applications, supporting documents, and financial statements for accuracy and completeness. Denials and any amendments needed to obtain would do all quality control and send to outside counsel. Present payment and escrow release information and respond in a clear and concise manner to inquiries from customers and internal groups.

Life Settlements: Work with life policies in Premium Finance and Life Settlement departments. Paid all grace notices and assisted with the pricing team obtained all copies of premium payments. Conducted compliance calls for insureds, reviewed life expectancy reports, HIPAAs and medical records to determine projected maturity dates of life policies. Worked with agents, trustees, and prominent life insurance carriers to service policies, estimated grace period dates and maintained active policies within applicable regulations that pertain to the policy. Verification of Survival status letters and calls to prove that the insureds are still living worked closely with Berwyn to obtain legal documents. Managed all documents for seller such as any correspondence, any denials and verification of survival court documents, court orders, amendments, and disclosures per all 50 states.

Confidentiality and Privacy: Implemented strict access controls and user permissions to limit unauthorized access to sensitive structured settlement data. Adhered to any non-disclosure agreements or confidentiality agreements. Provided training and guidance to team members on the proper handling and protection of structured settlement confidential information. Conducted regular audits to assess the effectiveness of confidentiality procedures and identify potential vulnerabilities, taking proactive steps to address any issues. Developed and maintained secure databases to store confidential structured settlement information, ensuring efficient retrieval and accurate record-keeping. Managed highly confidential information pertaining to structured settlements for diverse clients. Demonstrated strict adherence to privacy protocols and safeguarded sensitive data throughout the handling and processing of structured settlement information. Searches completed for each contract and customer such as the following NASP, credit reports (Optum, Xactus credit reports), Westlaw, PACER, TLO (skip tracing, liens and judgments searches), Uniform Commercial Code, Exam One (RX searches), Lexis Nexis, Fasano (medical underwriting reviews), Moody’s, Standard & Poor’s, AM Best, Fitch Ratings

Customer Service: Handle inquiries related to structured settlement payments. Maintained a high call volume in a fast-paced environment. Handled 50 to 100 calls a day customer-first attitude while maintaining a positive outlook during stressful situations. Assist recipients in understanding their payment schedule, payment amounts, and any changes that may occur. Any questions or concerns regarding structured settlements, such as changes in personal circumstances, the need for additional funds, or updates to their contact information. Helping address these concerns and provided appropriate solutions or guidance. Demonstrated a deep product knowledge to educate customers and improve their overall experience. Resolved customer complaints efficiently, resulting in 100% customer satisfaction ratings.

July 2003-January 2010 The Weitz Company LLC West Palm Beach, FL

Contract Construction Coordinator ~

Communication and Documentation: Facilitating effective communication among project stakeholders, including the project team, clients, subcontractors, and regulatory agencies.

Permitting and Regulatory Compliance: Assisting with obtaining necessary permits and ensuring compliance with local building codes, zoning regulations, and other legal requirements. Modified, drafted, updated, and maintained third party or vendor contracts and associated documentation, processing, and communicated changes. Assisted project team with pre-qualifications, contract execution, invoices, change orders and other requested documents.

Schedule Development: Collaborating with project schedulers to develop project schedules that outline the sequence of construction activities, milestones, and deadlines.

Subcontractor Coordination: Working closely with subcontractors to evaluate their capabilities, track their performance, and ensure compliance with project requirements.

Bid Packages and Procurement: Assisting in the preparation of bid packages, which include the necessary documents, specifications, and instructions for subcontractors to submit their bids. Purchase order agreements along with scope of work packages were managed, negotiated, analyzed and coordinated.

Value Engineering: Participating in value engineering exercises to identify opportunities for cost savings without compromising the project's quality or functionality.

Cost Estimation: Collaborating with estimators and cost engineers to develop accurate cost estimates for materials, labor, equipment, and other resources required for the project.

Project Analysis: Conducting detailed analysis of project plans, specifications, and requirements to gain a thorough understanding of the project scope, objectives, and constraints. Collaborated with project team to complete requests for information (RFI). Maintained and distributed accurate project logs (buyouts, subcontractor material status reports, submittals, RFIs)

Insurance: Collaborated with project managers, architects, and legal teams to review and negotiate contracts, ensuring the inclusion of appropriate insurance provisions, indemnification clauses, and waiver of subrogation requirements. Maintenance of project insurance documentation, including certificates of insurance and additional insured endorsements. Assisted in conducting risk assessments and implementing safety measures to ensure compliance with regulatory standards and industry best practices. Assisted in monitoring insurance policies and claims, ensuring timely updates and resolution of issues. Coordinated with insurance providers to obtain accurate and comprehensive insurance coverage for projects, including general liability, workers' compensation, and professional liability policies. Proficient in coordinating waiver of subrogation requirements, insurance policies, and claims management.

Estimating Coordination ~

Cost Estimation: Estimating coordinators work closely with the estimating team to collect and analyze data, such as material costs, labor rates, and equipment expenses, to develop accurate cost estimates for construction projects.

Quantity Takeoff: Performing quantity takeoffs, which involve measuring and quantifying the materials and resources required for a project. Gathering crucial information for determining project costs and creating comprehensive estimates.

Bid Coordination: In charge of bid coordination activities, such as reviewing bid documents, soliciting quotes from subcontractors and suppliers, and compiling the necessary information for bid submissions.

Project Management: Maintained project documentation, including records of estimates, quantities, and bids. Implemented documentation that served as a reference throughout the project and supports decision-making processes.

Communication and Collaboration: Worked as part of a team, collaborating with project managers, architects, engineers, and subcontractors. Strong communication skills that are used to effectively coordinate with various stakeholders and ensured accurate information exchange.

Technical Proficiency: Proficiency in construction estimating software and tools is crucial. Comfortable working with spreadsheet software (e.g., Microsoft Excel) and construction-specific software (e.g., IsqFt) to perform calculations, generate reports, and manage project data.

Attention to Detail: Ensured that all project components were accurately accounted for in the estimates and that potential risks and contingencies were adequately addressed.

Time Management: Worked on multiple projects simultaneously and faced strict deadlines. Effective time management and organizational skills meet vital project milestones and delivered accurate estimates in a timely manner.

Education

Palm Beach State College Boca Raton, FL

Associate’s degree ~ Construction Management

Accreditations

Notary Public of Florida

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