Celestine Sears Email & Phone Number

• Responsible for reviewing claims after they are submitted to ensure proper guidelines and processes (per Policy Language) have been followed• Assist with the Setup, Verification and Claims Intake process• Analyze claims to determine eligibility per insurance policy compliance regulations• Provide a positive and informative learning experience for New Hires while assisting them with training material to process claims effectively• Assesses learning needs• Provide Claims Training/System Training to new employees

Greater Detroit Area

Conducts technical claims training for multiple products and states Collects, records, reports learning activities and employee progress Manage the learning environment for classroom setup, systems setup, course materials, media and online learning Provide feedback to management on policy and procedure improvementsAssesses learning needs Designs and maintains course curriculum and skill checksEvaluates effectiveness of learning program and incorporates enhancements Evaluates audit reports to identify learning and development issues. Escalates findings to learning department management

Greater Detroit Area

Evaluates and analyzes documentation thoroughly to determine claim processing according to policy/certificate provisions and state regulations with increased authority limits. Analyzes any additional information/documentation received to determine how to proceed with a review of a claim and determine methods of obtaining information from alternative sources.Thoroughly reviews documents correspondence attached to claimsWorks closely with manager claims examiner, claims assistants, and other departments to complete daily claims processing expectations.Maintains compliance with regulations.Trains other examiner trainees in the system and products. Cross trains to learn additional products.Reviews and authorizes pending payments calculated by peers.

Southfield, Michigan

Established FMLA claim while tracking and coding documentation in accordance with internal workflow processesAnalyzed FMLA claims to determine eligibility and certification in compliance with state and federal regulationsIdentified action plans; Determined benefits that are due and make timely case decisions based on service expectations as established by the client.Communicated decisions and on-going expectations with claimants and clients.Maintained professional client relationshipTrained new hire colleagues on FMLA and Short Term Disability requirements and regulations

Greater Detroit Area

Clerical Duties (generated patient information, prepared/dissembled patient charts, assisted nurses with patient care, scheduled appointments, etc).Assisted in patient care services on different units throughout the hospital. Provided quality customer/patient care

Bachelor Of Applied Science (Basc), Registered Nursing/Registered Nurse

Pursuing a degree and career in Registered Nursing

Medical Assisting Certificate, Medical/Clinical Assistant