ALICIA A. HUBBARD
Overview
34
34
years of professional experience
Work History
Senior Disability Claims Manager
Sedgwick – General Dynamics
07.2024 - Current
- Reviews and analyzes complex medical information (i.e. attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.
- Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions.
- Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
- Determined benefits due under disability plan, ensuring timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other offsets.
- Oversaw complex claims facets, including comorbidities, concurrent plans, ADA accommodations, and claims outside typical guidelines to ensure comprehensive case management.
- Utilized appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians).
- Communicates clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system.
- Communicates with the claimants’ providers to set expectations regarding return to work.
- Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.
- Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.
- Negotiates return to work with or without job accommodations via the claimant’s physician and employer.
- Refers cases to team lead and clinical case management for additional review when appropriate.
Comcast/ Return to Work / ADA Job Accommodations Specialist
Sedgwick
12.2023 - 07.2024
- Facilitated and negotiated return-to-work (RTW) and job accommodation efforts, including medical leave of absence, modified break schedules, intermittent leave, modified work schedules, light duty, and work-from-home requests with clients, treatment providers, and claimants.
- Reviews all medical and correspondences to determine if documents would certify and substantiate ADA/RTW and FML absences for temporary and permanent accommodation requests.
- Reviews the essential job functions provided by the client along with restrictions/limitations provided by the claimant and their treating provider to confirm the claimant can meet the essential functions with or without the accommodation(s) requested and for certification in compliance with state and federal regulations.
- Communicates effectively with handling human resource, claimants, client, attorney and managers return to work and job accommodations request.
- Engaged with clients to gather detailed information on employment areas, including job search, training needs, physical demands, wages, benefits, and availability.
- Demonstrates a thorough knowledge of the regulations governing federal and state FMLA requirements, company leave policies, and state, local and municipal leaves.
ADA Job Accommodation/Return to Work Specialist
Sedgwick
07.2021 - 11.2023
- Approved and negotiated return-to-work accommodations; renegotiated reasonable alternatives or denied restrictions based on supporting documentation through correspondence with physicians and key stakeholders.
- Enhanced return-to-work efforts for short-term and long-term disability and workers' compensation claims by reviewing medical information for accommodation requests and negotiating disability restrictions.
- Acts as a subject matter expert and resource to supervisors, colleagues, union, or physicians regarding accommodation/work restriction issues and processes.
- Advised and counseled parties while acting as liaison among supervisors, colleagues, unions, and physicians regarding accommodation and work restriction processes.
- Works closely with other members of team to: a) ensure smooth transition from medical case management into job placement; and/or b) discuss the progress on each case suggesting changes in rehabilitation plans.
- Awarded Value in Action awards for delivering excellent service and operating one company, one team.
Senior Disability Claims Manager- Short Term Disability
Sedgwick
05.2011 - 07.2021
- Managed over one hundred active AT&T employees’ disability and workers compensation claims, ensuring compliance with regulations and timely resolution.
- Analyzed disability benefit plans to determine employee eligibility, applying appropriate claim offsets and adjustments from Workers' Compensation, State benefits, and Social Security Disability income to ensure accurate benefit distribution.
- Made timely claim decisions to ensure accuracy and improve customer service.
- Determined employees’ mental or physical impairment from performing job duties, through medical notes, physician’s notes, hospital notes, physical therapy, occupational therapy, psychological assessment, any medical records, lab results and/assessment received.
- Communicated clearly with managers, employees, and physicians regarding claims status and processes through phone and written correspondence, facilitating safe return to work for employees in full-time or modified duty.
- Evaluated referrals for claims to outside vendors for surveillance and independent medical evaluations.
- Received recognition in the first quarter of 2014 for consistently adhering to quality guidelines.
- Honored as the first colleague of the month in 2015 for exceptional service and teamwork.
Leave Solutions Specialist - Family Medical leave
CIGNA Group Insurance
04.2009 - 05.2011
- Educated clients on family medical leave eligibility and non-eligible determinations, enhancing client comprehension of their rights and options.
- Conducted initial interviews for CIGNA’s clients regarding family medical leave, short-term, long-term, disability, workers compensation, and death claims, ensuring thorough understanding of client needs.
- Contributed to implementing new and updated processes for Senior Intake Specialist and Trainers, streamlining intake operations and improving service delivery.
Dispute Operation Analyst / Appeal Analyst
TrailBlazer Health Enterprises
12.2006 - 04.2009
- Investigated and resolved dispute requests, medical records, and documents submitted by Section 1011 providers, determining eligibility for Section 1011.
- Collaborated with Section 1011 divisions (i.e. Medical Review, Compliance Review, Reimbursement and Reporting, Claims, Customer Service, Provider Enrollment, Provider Education) to gather information for informed dispute decisions under ERISA guidelines.
- Developed and delivered training to educate Section 1011 division on the dispute process.
- Examined compliance documentation to ensure that providers adhere to Centers for Medicare and Medicaid Services (CMS) policy and guidelines and enrollment date.
Customer Service Representative I and II
TrailBlazer Health Enterprises
01.2004 - 01.2006
- Utilized resources to resolve complex claims and billing issues for Medicare recipients, ensuring timely and accurate support.
- Provided detailed claim and billing analysis to Medicare recipients, clarifying complex information and ensuring informed decisions.
- Educated Medicare recipients on claims status, CMS coverage policy, and Social Security guidelines to enhance understanding and navigate their options.
Consulting
Venturi Staffing Partners
01.2003 - 01.2004
Strategic Pricing and Promotions Marketing
Sprint
01.1996 - 01.2002
- Negotiated consultant and vendor contracts, achieving annual savings of $6,000 for the company through effective cost management.
- Eliminated client consultant fees, saving $5,400 annually by strengthening vendor relationships to optimize service costs.
- Presented SWOT analysis and Request for Proposal (RFP) business plan criteria of consultants and vendors to the Pricing Director.
- Built and managed relationships with 8 domestic and international consultants, vendors, and contractors, collaborating directly with top officers (GM, Owner, VP, and Pres) to enhance service delivery.
Gold Customer Service Specialist
Sprint
01.1995 - 01.1996
- Resolved customer complaints through effective communication and problem-solving, ensuring customer satisfaction and retention.
- Assisted customers with inquiries about products and services.
- Up-sold products and services to enhance customer experience and meet evolving needs.
- Delivered tailored account solutions for small business customers, addressing receivable issues and billing inquiries while ensuring account accuracy.
- Maintained accurate records of customer interactions and transactions.
Fraud Research Analyst / Department Assistant
Sprint
01.1993 - 01.1995
- Investigated customer accounts to identify fraudulent and abusive patterns, enhancing detection efforts.
- Analyzed data trends to support decision-making processes for Sprint projects.
- Collaborated with cross-functional teams to develop comprehensive research reports.
- Organized client information and prepared reports for National Account Managers, streamlining communication and decision-making.
- Conducted market research to identify customer needs and preferences at Sprint.
Education
BA - Human Relations in Business
Amberton University
TexasAssociates of Arts Degree -
El Centro College
TexasCPDM Certificate - Disability Management Implementation and Sustainability
IEA
Lead Certificate -
Skills
- Claim evaluation
- Medical record review
- Disability claims management
- Claims settlement
- Compliance adherence
- Stakeholder engagement
- Claims adjudication
Timeline
Senior Disability Claims Manager
Sedgwick – General Dynamics
07.2024 - Current
Comcast/ Return to Work / ADA Job Accommodations Specialist
Sedgwick
12.2023 - 07.2024
ADA Job Accommodation/Return to Work Specialist
Sedgwick
07.2021 - 11.2023
Senior Disability Claims Manager- Short Term Disability
Sedgwick
05.2011 - 07.2021
Leave Solutions Specialist - Family Medical leave
CIGNA Group Insurance
04.2009 - 05.2011
Dispute Operation Analyst / Appeal Analyst
TrailBlazer Health Enterprises
12.2006 - 04.2009
Customer Service Representative I and II
TrailBlazer Health Enterprises
01.2004 - 01.2006
Consulting
Venturi Staffing Partners
01.2003 - 01.2004
Strategic Pricing and Promotions Marketing
Sprint
01.1996 - 01.2002
Gold Customer Service Specialist
Sprint
01.1995 - 01.1996
Fraud Research Analyst / Department Assistant
Sprint
01.1993 - 01.1995
BA - Human Relations in Business
Amberton University
Associates of Arts Degree -
El Centro College
CPDM Certificate - Disability Management Implementation and Sustainability
IEA