Audrey B. Email & Phone Number

United States

As a professional disability case manager, I am responsible for conducting clinical research and analyzing medical information to determine short term disability eligibility. My decision-making skills are at the forefront of my role along with providing customer service and a clear understanding of the disability management process.

Remote

• Analyze plans and policies to determine short term disability/ FMLA eligibility for compensation
• Review and evaluate proof of loss medical documentation to support claims of disability
• Manage STD caseload, resolve payment escalations and make timely decisions on short term disability claims while providing world class customer service

Tampa, Florida, United States

• Evaluate and determine compensation to providers for member medical services
• Perform adjudication, calculations, and review of contracts in relation to member planpremiums and Center for Medicare and Medicaid Services guidelines
• Investigate and reconcile payment and processing discrepancies

Tampa, Florida, United States

• Explanation and evaluation of benefits and eligibility for paid disability leaves by reviewof medical records and documentation provided by clients and medical professions inconjunction with company procedure and.
• Administration and consolidation of payroll/HR related issues based on company policy,procedure and medical evaluation.
• Adjustment of medical claims by verification and correction of discrepancies in claimsprocess and medical documentation to satisfy company and regulatory guidelines.

Tampa, Florida, United States

• Administrator of FMLA benefits to employees
• Specialize in case management, investigation of medical claims, referrals and payrollescalations that included contacting medical providers, and legal representatives.
• Liaison between employees and direct HR executives for HR related issues such as workaccommodations and specific employee assistances

Tampa, Florida, United States

• Maintain internal financial operations and controls by confirming customer requests andassociated legal documentation is submitted accurately and resolve escalated issues forclients related to bank and account.
• Investigation of accounts and activities for red flags such as suspicious account activity.
• Identify patterns in claims abuse and educate frontline teams on new fraud trends andprevention, such as phishing and account take over.
• Review accounts and relationships for compliance against BSA/AML guidelines andprocess account closures due to fraud findings.