Bruce Johnson

• Managed a high-volume caseload of complex Long-Term Disability (LTD) claims, independently investigating, evaluating, and adjudicating claims in accordance with policy provisions, regulatory requirements, and service standards.

• Served as a primary point of contact for claimants, employers, Human Resources, healthcare providers, and internal business partners to resolve escalated claim and leave-related issues.

• Conducted comprehensive medical and vocational reviews to assess disability status, return-to-work potential, workplace accommodations, and ongoing benefit eligibility.

• Partnered with employers and HR representatives to address leave administration, employee status updates, job protection considerations, and disability-related inquiries.

• Facilitated timely resolution of complex claim issues by collaborating with medical, vocational, legal, and risk management resources.

• Interpreted policy provisions and communicated claim decisions, approvals, denials, and benefit information with accuracy, professionalism, and empathy.

• Calculated and administered disability benefits, offsets, and other income integrations while ensuring compliance with contractual and regulatory guidelines.

• Maintained detailed claim documentation and consistently delivered high-quality customer service while meeting productivity and performance expectations.

• Acted as an escalation resource for claim-related concerns, utilizing strong analytical and problem-solving skills to achieve positive outcomes for claimants and client

• Managed complex LTD and companion leave claims, including Federal, State, Company, and Statutory benefits.

• Served as the primary liaison for claimants, employers, and internal partners, ensuring exceptional customer service and communication.
• Evaluated eligibility, functional capacity, and medical documentation to support accurate claim decisions.
• Collaborated with healthcare providers to verify treatment plans and coordinate return-to-work strategies.
• Processed State and SSI offsets while ensuring compliance with federal and state regulations.
• Streamlined claim investigations and improved adjudication efficiency through strategic process enhancements.
• Partnered with medical, legal, and vocational professionals to strengthen claim determinations and outcomes.

• • Maintained data integrity, met operational performance goals, and managed high-volume, complex caseloads.

• 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.

• 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.

• 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.