Case Manager Program Management

Tracey Shepherd

972-***-**** Dallas, TX ****.*********@*****.***

PROFESSIONAL SUMMARY

Ten years of experience in program management and compliance. This includes duties as a case manager and managing a privately owned agency. My proficiencies also include procurement, contracting, and financial management.

WORK EXPERIENCE

New York Life – Remote

Long Term Disability Claim Specialist May 2023 – Present

Network with both customers and physicians to medically review claims from initial medical request to reviewing and evaluating ongoing medical information.

Make Fair, accurate, timely, and quality claim decisions.

Find customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presented.

Ask focused questions of internal resources (nurse, behavioral, doctor, vocational) and external resources (customer, employer, treating provider) in order to question discrepancies, close gaps and clarify inconsistencies.

Find customer eligibility by reviewing contractual language and medical information and make decisions based on facts presented.

A New Beginning 888 (ANB) – Fort Worth, Texas August 2015 – February 2023

Owner/Operator

Fully owned and managed leave of absence processing. Including tracking hours to ensure accurate pay for associates.

Submitted proposals on client’s behalf for all lines of coverage (Medical, Dental, Vision, Social Security, Disability, etc.)

Maintained compliance in accordance with applicable federal and state employment laws (FMLA, ADA, USERRA, Pregnancy Discrimination Act).

Served as the subject matter expert for leave and workers' compensation programs under the general direction and guidance of HR leadership and the legal department.

The Guardian Life Insurance Company – Dallas, Texas May 2013 – July 2015

Disability Case Manager

Worked in conjunction with the medical team to assist in claims determination.

Reviewed medical records and certifications to assist in the determination process.

Conducted assessments by interviewing the claimant and their employer to determine eligibility.

EDUCATION /CERTIFICATES

Completed Course Work – Northeast Louisiana University – Monroe, LA

-Business Management, Accounting, and Finance

PROFESSIONAL SKILLS

Extremely proficient in Microsoft Office programs (Word, Excel, PowerPoint).

Emotionally intelligent with a keen sense of self-motivation and self-awareness.

Skilled negotiator that consistently achieves mutually agreeable solutions.

Proficient with leave tracking software (MDGuidelines and LeavePro).

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