Disability Case Manager Resume Samples

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A Ondricka

Alysha

Ondricka

72620 Abshire Fords

New York

+1 (555) 103 6408

72620 Abshire Fords

New York

Phone

p +1 (555) 103 6408

Experience Experience

Detroit, MI

Long Term Disability Case Manager

Detroit, MI

Johns-Roob

Detroit, MI

Long Term Disability Case Manager

Development of case management plans
Develop industry network through attendance at locally approved industry events
Assign a “portfolio management” score to each claim, (LTD) and work through caseload prioritization list
Provide effective risk management for a case load, depending on complexity and product-line, to meet department service and financial goals
Develops and documents claim strategy for ongoing claim management of each file and periodically assesses the effectiveness of the action plan
Contribute to the development of new approaches and methodologies by sharing and adopting best practices
Seek opportunities to accept challenges and developmental opportunities

Phoenix, AZ

Short Term Disability Case Manager

Phoenix, AZ

Schaefer, Emard and Donnelly

Phoenix, AZ

Short Term Disability Case Manager

Steps in to manage other team members’ work assignments as necessary
Constantly prioritizing and reprioritizing conflicting demands with tight turn- around times
Confidently formulating and rationalizing decisions on claims using contractual, medical, functional, and vocational analysis
Responding in a timely fashion to very high volumes of written (letter, email) and verbal (primarily telephone) communication with a very wide range of internal and external stakeholders (clients, providers within the medical community, etc.)
Constant prioritization of conflicting demands with extremely tight turn around times
Maintaining productive relationships with internal team members to maintain service level targets
Ensures a high level of customer satisfaction; resolves customer-impact issues, including customer specific and process issues

present

Detroit, MI

Long Term Disability, Case Manager

Detroit, MI

Watsica and Sons

present

Detroit, MI

Long Term Disability, Case Manager

present

Develop case management plans that identify direction, issues and action plan
Sound knowledge of medical terminology, medical management and pharmacology
Analytical Problem-solving
Knowledge of provincial legislation and regulations
Strategic Decision-making
Identify, obtains and analyses key medical, contractual and eligibility information
Bilingualism (French and English)

Education Education

Bachelor’s Degree in Nursing

University of Tennessee

Bachelor’s Degree in Nursing

Skills Skills

Knowledge of workers compensation rules and regulations
Ability to coordinate OSHA reporting
2+ years of experience in occupational health and absence/disability accommodations experience
Active NP or PA license
Related National NP certification or NCCPA certification)
BLS
ACLS

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Short Term Disability Case Manager Resume Examples & Samples

Strong organizational skills/detail oriented
Respect for confidentiality of information
Strong PC skills including Microsoft Office suite of programs including but not limited to Excel, PowerPoint, Word, etc

Aon Campus Launch Short Term Disability Case Manager Resume Examples & Samples

Use experience and knowledge to manage both disability and leave claims
Obtain and review updated medical evidence for claim decisions
Review guidelines for eligibility
Compose and send communications to employers and employees within appropriate time frames
Assure customer service with client companies and claimants
Provide support for all assigned accounts working by set time frames to meet quality assurance and client performance guarantees
Provide support to Intake/Customer Service team as needed in the Call Center
Strong oral and written communication skills to interact with claimants clearly, concisely, and persuasively
Ability to work in a face-paced environment with short deadlines
Ability to demonstrate teamwork by dealing effectively with and mentoring other individuals within the organization
Knowledge of the Family Medical Leave Act of 1993 and MDA Guidelines a plus – training in these areas will be provided
Basic knowledge of medical terminology (preferred)
This role has will also fall under Aon’s early career development program, known as Launch
Past customer service experience
December 2014 or Spring 2015 graduate
Prior medical/health insurance (Disability or Leave) experience (preferred)

Disability Case Manager Resume Examples & Samples

Lead the Workers Compensation program
Coordinate OSHA reporting
Administer existing workplace accommodations program for employees returning to work from disability leaves
Identify work-related injury trends and opportunities for prevention
Collaborate to identify workplace accommodations with employees and managers, HR, Environmental Health and Safety, disability insurance and workers' compensation carriers
Optimize the current workplace accommodations program
Provide coverage for pre-placement examinations, return to work clearances, and employee sick visits
Actively participate on the Safe Patient Handling Committee and other safety-related, cross-functional committees
Collaborate across the Center to develop policies relating to employee exposure to infectious and non-infectious materials and environmental stressors
Active NP or PA license
Related National NP certification or NCCPA certification)
2+ years of experience in occupational health and absence/disability accommodations experience
Knowledge of workers compensation rules and regulations
Ability to coordinate OSHA reporting
ACLS

Short Term Disability Case Manager, Associate Resume Examples & Samples

At least 3-5 years of medical case management or claims administration experience in a program/policy or administration role
College or professional certification/credential in the area of leave, insurance or disability administration desired (CDMS, CRC, CCM, etc.)
Mental Health experience preferred
Strong organizational skills/detail oriented
Respect for confidentiality of information
Strong PC skills including Microsoft Office suite of programs including not limited to Excel, PowerPoint, Word, etc
Intermediate understanding of disability processes
Experience using a claim or leave administration system
RN/LCSW license preferred

Disability Case Manager Resume Examples & Samples

Engage plan members through open and respectful communication to understand the medical, social and personal dimensions of their workplace absence
Develop and maintain outcome-focused case management plans to help plan members return to work
Work collaboratively with plan members, plan sponsors, lawyers, health care practitioners and other stakeholders to obtain information, provide claim status, create action plans and provide verbal and written decisions while maintaining confidentiality and privacy
Identify and assess medical and non-medical influencing factors pre and post disability, functional capability, restrictions and limitations to better understand what support is needed to get plan members back to work

Disability Case Manager Resume Examples & Samples

Our commitment to service excellence and quality, innovation and talent development
Career progression is based on solid performance, knowledge of our business and products, positive engagement with our customers, and your interests opening up a wide variety of career paths within Sun Life
Ability to work in a dynamic, collaborative environment where you are encouraged to share your ideas

Long Term Disability Case Manager Resume Examples & Samples

Determine, on a timely basis, the status of assigned claim by applying the appropriate contractual provisions to the medical and occupational facts of the claim
Conduct initial eligibility review
Establish case file based on documentation criteria
Review Claim packet: Claimant Statement, Employer Statement and Physician Statement of claim form to identify employee date of hire, class, date of disability and enrollment information
Identify if additional information is required
Review contractual benefits and provisions of employer’s policy
Assess pre-existing & continuity of coverage status
Determine, based on the employment information, if claimant meets the eligibility terms of contract, e.g. actively at work, employee class, etc
Confirm medical evidence supports restrictions and limitations presented
Review all physicians’ statements, notes and records included with claim submission. Seek advice from clinicians as appropriate
Review description of job duties to determine occupational requirements and determine if an occupational analysis is needed from a vocational specialist
Research as needed to clarify diagnosis, treatment plans, duration protocols or occupational expectations utilizing internal sources, e.g Internet,
Consult, as needed, to clarify diagnosis, treatment plans, duration protocols or occupational expectations utilizing internal professional medical and vocational rehabilitation resources
Life Waiver & LTD Analysts should coordinate information to avoid duplicate requests
Obtain all pertinent and necessary information to evaluate claim credibility
Conduct claimant and employer interviews and, as needed, claimant- physician interviews
Understand where professional resources, e.g. medical, vocational rehabilitation, investigative and legal, can add value to the review process
Track status of outstanding informational requests
Follow up as needed with informational resources to ensure claim decision is being made in a timely manner
Consider face to face visit with claimant
Prepare written rationale of claim decision based on a review of the contractual provisions and the analysis of the medical and occupational records
Access medical and occupational information presented to
Identify the action plan’s critical junctures
Determine required professional resources at each critical juncture of the action plan
Develop, document and communicate a periodic review schedule for the action plan
Evaluate the effectiveness of the action plan modifying as needed to ensure effective management of claim
Monitor the action plan’s progress on a regularly scheduled basis
Ensure claimant and employer are actively engaged in the implementation of the plan of action
Facilitate as appropriate periodic reviews by professional resources
Ensure medical and vocational records are reflective of current facts
Proactively evaluates opportunities for claims resolution to promote a balance
Investigate medical forms, records and test results to identify opportunities for case management intervention
Identify candidates for clinical record reviews and analysis
Succinctly articulate issues and facts for presentation to medical staff
Seek agreement on plan of action
Provide follow up and feedback on progress against plan of action
Assess occupational job duties and claimant’s training, education and experience for vocational rehabilitation referrals
Identify candidates for occupational assessment
Succinctly articulate issues and facts for presentation to vocational rehabilitation staff
Understand where, when and how professional resources both internal and external, e.g. medical, vocational, investigative and legal can add value to the process
Establish cooperative and productive relationships with professional resources
Recognize and leverage skills and expertise of professional resources
Seek advice and input into decision making process
Facilitate multi-discipline medical, vocational rehabilitation reviews and strategy sessions as needed
Ensure personal development as a claims professional
Remain current with all Sun Life’s business claims practices and policies
Read interoffice communications
Attend in-house training including Benefits Conference sessions and workshops
Keep current with industry disability management practices
Read industry periodicals disseminated in department
Stay current on relevant medical, occupational, legal and economic trends by participating in department training and communication programs
Identify and develop career objectives and action plans to achieve them
Seek opportunities to accept challenges and developmental opportunities
Develop industry network through attendance at locally approved industry events
Pursue industry courses and professional designations
Sun Life Financial is a leading provider of group insurance benefits in the U.S., helping people protect what they love about their lives. More than just a name, Sun Life symbolizes our brand promise of making life brighter – for our customers, partners, and communities. Join our talented, diverse workforce and launch a rewarding career. Visit us at www.sunlife.com/us to learn more

Disability Case Manager Resume Examples & Samples

Assesses various types of claims for eligibility for benefits and makes decisions within service standards: assessment includes evaluation of medical documentation and contractual provisions and pursuing additional information if necessary to make a sound decision
Communicates with claimants, policyholders, lawyers, physicians and other departments by electronic mail, telephone, written correspondence and occasionally in person
Handling difficult phone calls from agitated and sometimes hostile callers as a result of the decision to decline benefits
Commitment to quality service
Develop, communicate and execute case management plans
Conducting telephone interviews focused on gaining relevant information not evident in existing documentation
Identify and assess non medical barriers pre and post disability functional capacity and medical management in order to positively impact recovery and resolution
Updates information on claim-paying computer system
Negotiating and developing return to work plans with plan members and plan sponsors

Disability Case Manager Resume Examples & Samples

Provides guidance to employees and managers with respect to the American Disability Act (ADA), Transitional return-to-work, Worker's Compensation (occupational and non-occupational injuries), and other disability related benefits
Works closely with the WC Third-Party Administrator and outside defense counsel to manage claims in compliance with jurisdictional WC laws and regulations
Partners with managers/supervisors and affected employees to guide them through the Workers' Comp process
Serves as consultant to managers/supervisors, and local LMP WPS Teams regarding Disability Management
Maintains the data integrity of the charts and systems for each employee in the Workers' Compensation, Transitional Work Program and Workplace Accommodation Collects, documents and reports employee data, enters information into tracking data base. Creates reporting systems and disseminates program related data to Regional and National partners
Serves as resource to disabled employees regarding the Transitional Return to Work Program and other Disability and FLMA/LOA related benefits
Communicates with management and claims administrators as outlined in the Disability Management guidelines
Discuss complex or difficult individual cases with the HR Services Manager, Labor Relations, Physician Advisor, Senior Counsel, and National IDM team as needed
Provides monthly reports to Lead, IDM Case Manager and Claims Administrators as outlined in the Disability Management Guidelines
Provides monthly reports to HRSC as outlined in the Disability Management guidelines to ensure appropriate integration of pay and benefits
Coordinates with the HR Consultant and external vendors to ensure compliance with regulatory requirements
Coordinates with supervisors and the HRSC to ensure prompt and accurate reporting of claims to support timely reporting of claims and appropriate benefit payments
Ensures appropriate integration of all disability related benefits Coordinates with claims administrator (if applicable) to ensure timely and accurate payment of appropriate benefits
Ability to be flexible and adaptable, with the ability to assume other duties and responsibilities asdepartmental objectives and requirements change required
One (1) year of working knowledge of applicable ADA, FMLA/LOA, Return to Work Program, Worker's Compensation or equivalent years of experience requiring the application of knowledge in the areas of employee disability benefits / return to work issues
Four (4) years of experience in a Human Resources environment preferred
Demonstrate effective oral and written communication, consulting, interpersonal and presentation skills, with the ability to effective
Extensive travel throughout the Region preferred
Proficiency in the use of Micro Soft word, excel, power point, access database management, database reporting preferred
User knowledge of mainframe and/or PC database, word processing and statistical analysis software preferred
Innovative and flexible preferred
Ability to prioritize, meet deadlines, and good attention to detail preferred
Possession of interpersonal skills that inspire trust and confidence preferred
Understands team dynamics preferred
Ability to manage several complex projects simultaneously while working under pressure to meet deadlines preferred

Short Term Disability Case Manager Resume Examples & Samples

Maintaining productive relationships with internal team members to maintain service level targets
Constantly prioritizing and reprioritizing conflicting demands with tight turn- around times
Intermediate computer skills - including data entry, MS Word and MS Excel
An ability to work effectively in a team environment
The skills to multi-task, prioritize, and work in a fast paced environment
An ability to manage relationships with external and internal clients
Confidence to pose questions when you require clarification

Disability Case Manager Resume Examples & Samples

Build strong relationships with our Plan Sponsors, working in partnership with them to address their workplace absence issues
Engage plan members through open and respectful communication to understand the medical, social and personal dimensions of their work absence
Conduct telephone interviews to obtain information to ensure complete understanding of the absence and type of support required to assist with return to work planning
Identify and assess medical and non-medical influencing factors pre and post disability, functional capability, restrictions and limitations

Long Term Disability Case Manager Resume Examples & Samples

College degree or equivalent industry-related experience required
Solid analytical skills as well as the ability to negotiate with people
Strong organization skills, with the ability to multitask in a fast-paced environment
The ability to perform complex financial calculations
Strong customer service orientation
Ability to speak directly with claimants in telephone interviews or in person with other Senior Analysts

Short Term Disability Case Manager Resume Examples & Samples

Manages assigned caseload of disability claims for Short Term Disability
Ensures claims integrity and compliance with established procedures, timing requirements and regulatory guidelines
Develops plan to address disability obstacles and coordinates with claimants attending physicians, and employers to return people to work
Monitors other sources of income that coordinate with Short Term Disability Benefits. Can calculate, explain, and recover overpayments on disability claims
Ensures a high level of customer satisfaction; resolves customer-impact issues, including customer specific and process issues
Coordinates with Long Term Disability Claims team when benefits integrate
Coordinates with Life Waiver team when benefits integrate
Steps in to manage other team members’ work assignments as necessary
Knowledge and Skills
Strong organizational, interpersonal, and written and verbal communication skills
Thorough understanding of disability/life products policies, procedures and regulatory requirements
Strong analytical and conceptual thinking abilities
Highly motivated and self-directed
Demonstrated interpersonal understanding and leadership ability
Previous Experience

Disability Case Manager Resume Examples & Samples

What distinguishes us?
A benefits package including
Medical, dental, life and disability insurance
Retirement savings and Stock purchase plan
Paid vacation
Tuition Assistance
Fitness facilities or subsidiaries in specific locations
Comprehensive training programs from the start of employment and ongoing coaching to set you up for success

HR Compliance & Disability Case Manager Resume Examples & Samples

Advises management and employees regarding HR compliance requirements and disability laws, policies, and processes
Builds effective plans to mitigate risk by analyzing HR Compliance and Disability data trends
Leverages data and provides reports to promote value of programs and engages Sr. Leadership to design, implement, and communicate strategic action plans
Ensures local facility practices are in legal and regional compliance
Develops and delivers training and education programs for local facilities regarding HR disability and HR compliance related regulations, laws, policies, and processes
Responsible for management of the interactive process as required by ADA/FEHA, resulting in the offer of reasonable accommodations to include of the transitional work program
Consults with department managers, claims administrators, legal, union representatives/leaders
Human Resource peers, employees and leadership through the course of disability case management
Consults with department managers and employees regarding medical leaves, industrial leaves, general leaves planning (where applicable), maternity leaves and related labor contract/bargaining agreement provisions
Provides a centralized, strategic focus to reduce employee lost time due to medical or industrial leave
Coordinates with supervisors and department managers to ensure prompt and accurate reporting of workers compensation claims to support timely reporting and appropriate benefit payments
Leads efforts to assist and consult with managers to ensure facility readiness and compliance with HR standards for hospital survey accreditation or other external agency reviews
Manages and assists any corrective action plans to resolve findings from survey and audits to ensure compliance standards are met
Coordinates with external vendors to ensure compliance with regulatory requirements
At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees. Must travel as needed to multiple sites
Minimum two (2) years of experience in Human Resources, Disability Management, HR Compliance or related compliance work experience
Four (4) years of experience in Human Resources, Disability Management or HR Compliance

Bilingual Disability Case Manager Resume Examples & Samples

Development of case management plans
Communicate/consult with claimants, internal/external providers and government agencies
Provide technical direction by reviewing and identifying file development needs
Bilingual in English/French required
University degree in a health related field such as Kinesiology, Nursing, Psychology, Physiotherapy, Chiropractic, Rehabilitation or Occupational Health, or other regulated health care disciplines is preferred
Previous work experience in a clinical setting in a health related field is helpful
Previous case management experience within an insurance/financial organization an asset
Disability management and/or Group Benefit knowledge
Familiarity with medical terminology
Proficiency in MS Word, Excel and MS Office 365, MS Outlook, and Skype for Business
Excellent communication skills (both oral and written)
Previous customer service experience in a demanding environment
Flexibility to balance conflicting priorities
Analytical skills with a close attention to detail
Ability to work effectively in a team environment
Organized and deadline driven
Knowledge of Canadian Forces terminology would be an asset

Long Term Disability Case Manager Resume Examples & Samples

Assessment of long term disability claims including the identification, and analysis of medical, contractual, and eligibility information
Technical direction toward the case management plan
Making decisions on Waiver of Premium claims
Post-secondary education or equivalent industry experience
Familiarity with medical terminology
The ability to work effectively in a fast-paced, team environment
Effective relationship management with external and internal clients

LOA / Disability Case Manager Resume Examples & Samples

Provides a timely and thorough review of FMLA, ADA, and certain STD claims and makes professional determinations
Manages LOA cases and interfaces with manager, associates and HR
Partners with management and team to review LOA data and improve LOA results
Counsels managers and HR partners on FMLA law and procedures as well as STD policy and procedures
Ability to coordinate data between systems and create appropriate leaves (web intake)
Distribute necessary information to providers for requested leaves
Requires a BA degree; 2 years experience in health and welfare benefits, disability management, HR operations, and/or benefits administration; or any combination of education and experience, which would provide an equivalent background
MS Office experience
Experience with customer service phone/call center experience preferred
Understanding of federal and state leave regulations, short-term disability and/or Americans with Disabilities Act (ADA) preferred

Disability Case Manager Resume Examples & Samples

Provides Case Management for all of the following: Understand federal and state laws and how these interact with the multiple labor contracts and KPNW policies including leave of absence, ADAAA, Worker's Compensation and return to work. Provide consultation to employees and managers on federal, state and contractual leaves of absence, ADAAA, Worker's Compensation and Return to Work issues. Ensure that the integration of the various disability management programs are facilitated as needed and that any benefits are provided in a timely and accurate manner. Ensure integration with other benefit programs such as Short Term Disability (STD), Long Term Disability (LTD), health benefits, paid time off programs, and other internal and external benefits. Conduct the ADAAA interactive process, including determining appropriate and reasonable accommodation. Facilitate the return to work process for employees with occupational and non-occupational injuries or illness who have restrictions and find available and suitable work within the region. Identify employees with occupational and non-occupational injuries or illness who are unable to return to a suitable position within the region due to their limitations. Refer the employee to applicable resources such as vocational rehab, ADAAA interactive process, or retirement. Document all correspondence, medical documentation, meetings, and interactions with the employee, manager, and any involved parties. This includes tracking the progress of the case and initiating any follow-up. Partner with HR Consultants in managing escalated cases that also involve labor management issues. Collaborate with third party vendors to manage leave of absence or worker's compensation cases, including complex issues
Minimum two (2) years of experience in Return to Work Programs, Disability Management, ADAAA Case Management Workers' Compensation or Leaves of Absence
Experience working with injuries/illness and physical limitations
Minimum three (3) years of experience in all aspects of Disability Management

Short Term Disability Case Manager Resume Examples & Samples

Setting up new short term disability claims. This function will include contractual interpretation and accurate data entry
Making decisions on and payment of Short Term Disability claims using contractual, medical, functional, and vocational analysis
Frequent written and verbal communication to clients and stakeholders within and outside of the medical community, plan members and plan administrators
Maintain productive relationships with internal stakeholders to maintain service level targets
Constant prioritization of conflicting demands with extremely tight turn around times
A focused attention to detail - particularly with numbers, spelling and grammar
Very strong written and verbal communication skills, with the ability to effectively deliver difficult messages to clients by telephone and in the form of very detailed letters of explanation
Strong customer service experience, with proven ability to build and manage relationships with external and internal clients

Long Term Disability, Case Manager Resume Examples & Samples

Provide LTD Disability Claim Assessment
Identify, obtains and analyses key medical, contractual and eligibility information
Develop case management plans that identify direction, issues and action plan
Sound knowledge and ability to apply appropriate disability risk management tools and techniques
Previous Disability Claims Experience is highly preferred
Bilingualism (French and English)
Strategic Decision-making
Negotiating and Influencing