Ann Jones
Carrollton,TX
Summary
Knowledgeable Senior Integrated Leave Specialist with comprehensive background in leave administration and policy compliance. Successfully managed leave cases, Long-Term Disability and Short-Term Disability cases ensuring adherence to regulations and providing support to employees. Demonstrated problem-solving skills and effective communication to facilitate smooth leave processes.
Overview
4
4
years of professional experience
Work History
Senior Integrated Leave Specialist
Lincoln Financial Group
08.2024 - Current
- Assist in the creation of employee wellness programs to promote overall well-being and reduce the need for medical leaves of absence.
- Manage short-term disability claims by coordinating with insurance providers and verifying claim eligibility for prompt benefit delivery.
- Collaborated with medical professionals to verify documentation supporting employee leave requests, maintaining strict confidentiality at all times.
- Maintain up-to-date knowledge of federal and state leave laws, ensuring compliance with all relevant regulations and avoiding potential legal issues.
- Guide employees through the FMLA process to ensure proper documentation was submitted, protecting their rights and benefits during medical leaves.
- Develop strong relationships with employees on leave, fostering trust and open communication throughout the process.
Senior Claims Supplemental Examiner
WebTPA
11.2023 - 08.2024
- Examined forms to determine insurance coverage and validity.
- Conducted comprehensive reviews of complex applications, ensuring all necessary documentation was obtained before rendering a decision.
- Managed high volume caseloads, prioritizing tasks to meet strict deadlines while maintaining attention to detail.
- Assisted in the development of training materials, improving examiner knowledge and skillsets
- Collaborated with team members to develop best practices for reviewing applications and maintaining accuracy.
- Served as a subject matter expert on specific industries or types of applications, guiding colleagues in their evaluations when needed.
Senior LTD Claim Manager
New York Life Insurance Co
11.2020 - 05.2023
- Proactively managed assigned block of claims regularly communicating with each customers level of functioning.
- Conducted interviews and recorded statements with insured to ensure fair claim investigations.
- Recommended referral to SIU where appropriate and assist in their investigation to provide prompt claim settlement.
- With general management oversight, works within assigned authority limits on claims reflecting a low to moderate degree of technical complexity and severity.
- Asked focused questions to internal resources(e.g nurse, behavioral, doctors, vocational) and external resources( customer, employer, workers compensation) to question discrepancies. close gaps and clarify inconsistencies.
- Responded in a timely manner to high volume of written letters, emails, and verbal communication with a wide range of internal and external clients and providers.
Education
Certification - Medical Insurance Coding
PCI Health Training Center
Dallas, TXBachelor of Science - Health Administration
University of Phoenix
Dallas, TX05-2026
Skills
- Operations Management
- Pre-adjudication process
- Written Correspondence
- Research and Recording
- Responding to clinical and non-clinical appeals
- Eligibility determination
- Employee relations
- Disability management
- Approvals/denial determinations
- Commercial payer knowledge
- Workers Compensation knowledge
- Supplemental and long-term disability claims knowledge
- FMLA expertise
- Fraud Statutes familiarity
- Leave administration expertise
- Claims auditing
- Negotiation skills
- Mediation skills
Timeline
Senior Integrated Leave Specialist
Lincoln Financial Group
08.2024 - Current
Senior Claims Supplemental Examiner
WebTPA
11.2023 - 08.2024
Senior LTD Claim Manager
New York Life Insurance Co
11.2020 - 05.2023
Certification - Medical Insurance Coding
PCI Health Training Center
Bachelor of Science - Health Administration
University of Phoenix