Bruce Johnson
Haslet,TX
Summary
Experienced Claims Examiner with comprehensive understanding of the medical claims industry and social services. Skilled in formulating objectives and strategies to effectively manage benefits and compensation. Proficient in compiling, coding, categorizing, and auditing information to efficiently process claims and consistently meet performance guarantees. Adept at leveraging deep knowledge and solid abilities to ensure accurate and timely claim adjudication.
Overview
14
14
years of professional experience
Work History
Long Term Disability Case Specialist
Sedgwick Claims Management
04.2023 - 03.2025
- Execute modifications related to State and SSI offsets.
- Ensure compliance with state and federal leave regulations.
- Reviewed compliance with requirements.
- Assessed functional capabilities.
- Verified treatment plans through collaboration with medical.
- Interacted and communicated effectively with claimants, customers, attorneys, brokers, and family members during claim evaluations.
- Compiled file documentation and correspondence requiring extensive policy and factual detail.
- Analyzed information to determine if additional data was needed to make reasonable and logical claims determinations.
- Collaborated with external and internal resources, such as physicians, attorneys, and clinical/vocational consultants, to gather medical and occupational information for thorough decision-making.
- Clarified and reconciled inconsistencies in claim information and coordinated with Fraud, Waste, and Abuse resources as needed.
- Addressed and resolved escalated customer complaints in a timely and thorough manner.
- Identified and referred appropriate matters to appeals, complaint, or litigation support areas.
Senior Disability Representative
Sedgwick Claims Management
12.2019 - 04.2023
- Managed 250-300 claims per day.
- Maintained contact with claimants, medical provider and employer to determine treatment and claim status.
- Verified eligibility and determined fair compensation.
- Reviewed medical treatment records and determine inpact of ones condition.
- Read over benefit policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Organized, planned, and documented materials for Short Term Disability claims.
- Identified and forwarded claims to specialized internal and external resources in areas such as medical review, investigations, appeals, SSI, ADA Specialist and clients.
- Applied fundamental liability concepts, practices and procedures of state or federal laws and requirements.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Reviewed and analyzed suspicious and potentially fraudulent claims.
Social Services Director
Gateway Care Center
02.2019 - 11.2019
- Facilitate and administer comprehensive assessments of personal and work readiness needs of clients/students in conjunction with on-going counseling support.
- Develop and identify curricula designed to address soft skills, dysfunctional behavior, personal development, and workplace readiness.
- Address employment and educational deficiencies for youth participating in workforce programs to increase job retention.
- Research and identify appropriate social services including counseling and case management for program participants.
- Provide guidance and support for workforce and educational assessment and testing for post-secondary acceptance and/or job readiness.
Social Service Coordinator
Crestview Recovery
01.2016 - 01.2017
- Maintain comprehensive and up to date list of individuals in service queue.
- Provide reports & approved the medical doctor's schedule. Develop and facilitate group programming for children, adolescent, addiction/mental health.
- Responsible for strictly following agency procedures and funding guidelines concurrent with protecting consumer rights as they relate to health programs and services.
- Implement, evaluate health projects, and monitored their progress to identify and rectify problems.
- Assess current programs and reports to community and medical professionals on their progress.
- Respond to telephone inquiries regarding services.
- Develop effective working relations with medical team and facilitate multiple care aspects.
Case Manager
Parrot Creek Family Services
02.2014 - 01.2016
- Implemented service management plans and updated clients progress related to program requirements.
- Provided direction and resources to residents to enhance their independence.
- Supported and created initial treatment and aftercare plan.
- Facilitate therapist treatment plans and follow up on evaluations.
- Managed patient appointment schedules, and ensured timely collection of payments for medical services rendered.
- Assisted Quality Assurance with upkeep of medical records policies and procedures.
- Maintained, stored and retrieved medical records data in accordance with federal, state, and accrediting agencies' requirements.
- Established and maintained client files and maintained contact notes with medical providers and staff.
- Provide crisis counseling for individuals, adults and teenagers, with suicidal ideation.
Administrative Manager
The Randall Group
01.2011 - 01.2014
- Managed administrative responsibility and implemented functions to monitor business operations.
- Supervised facilities functions in a production setting, while monitoring building operations.
- Assisted and supported financial department, preparing budgets and other reports/statements.
- Developed logistics in organization records, files and statements in an effective manner.
Skills
- Policy Investigation
- ADA Claim Management
- Efficient and detail oriented
- Community recourse specialist
- Liaison between claimant and client
- Crisis intervention
- Payroll and Time Tracking
- Benefit administration
- Treatment plan facilitator
- Knowledge of Medical / Pharmaceutical terminology
- Report generation
Timeline
Long Term Disability Case Specialist
Sedgwick Claims Management
04.2023 - 03.2025
Senior Disability Representative
Sedgwick Claims Management
12.2019 - 04.2023
Social Services Director
Gateway Care Center
02.2019 - 11.2019
Social Service Coordinator
Crestview Recovery
01.2016 - 01.2017
Case Manager
Parrot Creek Family Services
02.2014 - 01.2016
Administrative Manager
The Randall Group
01.2011 - 01.2014
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