Thomas Gavin Email & Phone Number

New York, Ny, Us

Pittsburgh, Pennsylvania, Us

London, England, Gb

Bloomfield, Ct, Us

Proactively manage my block of claims by regularly talking with and knowing your customers, their level of functioning, and having a command of case facts for each claim in your block.Develop and document Strategic Case Plans that focus on the future direction of the claim using a holistic viewpointDetermine customer eligibility by reviewing contractual language and medical documentation, interpret information and make decisions based on facts presentedLeverage claim dashboard to manage claim inventory to determine which claims to focus efforts on for maximum impactHave discussions with customers and employers regarding return to work opportunities and communicate with an action-oriented approach.Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basisAsk focused questions of internal resources (e.g. nurse, behavioral, doctor, vocational) and external resources (customer, employer, treating provider) in order to question discrepancies, close gaps and clarify inconsistenciesNetwork with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical informationExecute on all client performance guaranteesRespond to all communications within customer service protocols in a clear, concise and timely mannerMake fair, accurate, timely, and quality claim decisionsAdhere to standard timeframes for processing mail, tasks and outliersSupport and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)Clearly articulate claim decisions both verbally and in written communicationsUnderstand Cigna Group Operations and Corporate Compliance, Policies and Procedures and best practicesStay abreast of ongoing trainings associated with role and business unit objectives

Philadelphia, Pa, Us

Responsible for generating reports and pricing analysis for cardiac devicesOther duties included budgeting, sales support, and data entry