• Provide multi-site, senior leadership and oversight for Integrated Service Operations and program management of 200+ employees managing clients with cumulative revenue of $30+ million• Executed organization’s claims strategy and ensured attainment of performance measure standards for turnaround, quality, service level, and client satisfaction• Facilitate RFP and contract renewal process• Developed value added enhancements that aligned with continuous process improvement objectives• Aggregated and presented quarterly performance reporting to clients on overall performance, trend identification and risk mitigation • Provided transformative solutions to escalated client issues through comprehensive knowledge of; Short-Term Disability, Long-Term Disability, Americans with Disabilities Act, Family Medical Leave Act, call center operations and claim appeals• Establish business plans with goals and objectives to meet and exceed performance guarantees• Facilitates the reduction of process barriers, technology constraints or resource constraints by directing and influencing the activities of other internal departments such as information technology, operations, and business development• Designed and facilitated multi-state inaugural Leadership Development Program to establish pipeline of “Ready Now” team members for succession planning• Delivered ongoing coaching to supervisors/team members to capitalize on employee’s strengths and create an environment that promoted career development

Expert on all disability plans with Cigna. Oversaw the team of claim managers who manage multiple accounts Monitored day to day service and operations such as volume and quality Partnered with the Director(s) to ensure operational goals and metrics are consistently met and/or exceeded Developed claim managers by providing an environment that encourages continuous learning and personal development.

Provided direction to claim managers regarding policies, procedures, work production, and quantity and quality while using independent judgment and discretion to review and resolve complex claims.Partnered with Team Leader to manage team’s claim performance according to published quality and compliance standards including performance guarantees by completing quality reviews, identifying trends and coaching staff. Ensured contingency plans are in place to achieve results when challenges arise (staffing shortages, new business, system implementation, etc.) in addition to working with internal and external business partners to ensure successful implementation of new accounts and changes in additional lines of business with existing accounts.Mentored, supported and coached team members on a daily basis to drive for results.Partnered with cross functional clinical staff to educate customers on available Cigna medical management health resources and promote safe return to work plansInterpreted contract language to ensure compliance with federal/state regulations, HIPAA, ADA, and ERISAResolved anticipated client issues proactively and confronted critical-path items to prevent customer service escalations

Managed a desk load of 160+ claims. Provided support and back-up coverage for Senior Claim Manager and Team Leader while partnering with LTD and FMLA counterparts.Responsible for running and managing daily/weekly reports and scorecards for a team and individual members, as well as completing second-eye review for trainees. Mentored, supported and coached team members on a daily basis to drive for results.

Provided direction to other claims processors regarding policies, procedures, work production quantity and quality. Used independent judgment and discretion to review and resolve complex claims issues. Ensured all claims eligible or ineligible for payment conform to quality, production standards and specifications.

Network with both the customer and their physician to medically manage up to 190 claims from the initial medical requests, to the review and evaluation of on-going medical information.Provide consistent customer service to both our customers and claimants through timely responses to all inquiries, telephone calls and e-mails while delivering on service commitments. Pay all covered claims accurately while building personal relationships with the people they serve to best understand their unique disability issues and provide individualized support.

Performed clerical duties, answered a high volume of calls while noting clear, brief messages, updated patient charts and assisted in drafting company policies. Created, proof read, and attached documents to be distributed to office staff as well as gathered and delivered office mail.Scheduled meetings, prepared agendas and office memorandums and corresponded with field staff to maintain proper client information.