Carolyn Belich
Aliquippa,PA
Summary
Highly motivated employee with desire to take on new challenges. Adept at managing individuals and internal operations to promote high levels of quality production. Strong work ethic, adaptability, exceptional interpersonal skills, with the ability to quickly master new skills.
Overview
18
18
years of professional experience
Work History
Long Term Disability Senior Claims Manager II
New York Life Insurance Company
Pittsburgh, PA
10.2022 - Current
- Consult with medical professionals and team to determine functional limitations in support of a claim
- Analyze and interpret employer policy definitions and effective dates of coverage
- Manage up to 50 active claims and mentor new hires while meeting compliance deadlines
- Submit claim decisions with 98% and above accuracy requiring no senior manager review.
Long Term Disability Senior Claims Manager I
New York Life Insurance Company
Pittsburgh, PA
03.2021 - 09.2022
- Consulted with medical directors, nurses, and staff to determine functional limitations
- Complete daily compliance by tracking deadlines, updating information, and making timely decisions
- Assessed employer and medical information for eligibility of disability and composed detailed decision letters
- Manage up to 35 active claims while meeting deadlines
- Composed detailed decision letters.
Intake Service Coordinator
The Watson Institute
Sewickley, PA
01.2017 - 05.2021
- Interviewed parents and assessed their child's needs to identify the appropriate behavioral health services
- Developed rapport with outside providers and agencies, combining efforts to successfully obtain services for clients
- Verified eligibility of Pennsylvania Medicaid, managed care, and commercial insurances
- Compiled required documentation for insurance authorizations of behavioral health services
- Managed clinical staff by assigning new clients, maintaining schedules, and tracking the completion reports and progress notes
- Examined client records for accuracy, contributing to the reduction of reclaimed funds until the goal of zero was achieved
- Aided in fraud, waste, and abuse audits, and the establishment and implementation of corrective action plans
- Initiated discussions and proposed methods to improve processes, such as development and use of online intake forms for families in order to expedite the retrieval of completed forms to promote full testing schedules
- Validated International Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT) codes on billing claims
- Practiced HIPPA guidelines and remained updated on office, state, and county regulations
- Chosen to attend corporate trainings, and coach staff on the navigation and use of a new electronic medical records system.
Assistant Wraparound Service Coordinator
The Watson Institute
Sewickley, PA
10.2007 - 12.2016
- Supported parents by explaining services, processes, answering questions, and resolving issues
- Completed and submitted packets and service plan of cares for payment of wraparound and camp services
- Recruited, interviewed, hired, trained, and created schedules for new employees
- Maintained wraparound program and camp enrollment.
Therapeutic Support Staff
The Watson Institute
Sewickley, PA
10.2005 - 09.2007
- Supported children on the autism spectrum in the home and community settings by utilizing interventions to promote positive behavior
- Developed activities and schedules for the first camp in Pennsylvania for autistic children
- Obtained and recorded client data, and completed daily progress notes.
Education
Bachelor of Science - Psychology
Clarion University of Pennsylvania
05.1992
Skills
- Policy Interpretation
- Procedure Implementation
- Quality Assurance
- Legal Compliance
- Team Management
- Claims Processing
- Insurance Verification and Authorization
- MS Office and Teams
- Adobe Acrobat Pro
- Docusign
- Electronic Medical records (Workbench, Credible, Raintree)
Timeline
Long Term Disability Senior Claims Manager II
New York Life Insurance Company
10.2022 - Current
Long Term Disability Senior Claims Manager I
New York Life Insurance Company
03.2021 - 09.2022
Intake Service Coordinator
The Watson Institute
01.2017 - 05.2021
Assistant Wraparound Service Coordinator
The Watson Institute
10.2007 - 12.2016
Therapeutic Support Staff
The Watson Institute
10.2005 - 09.2007
Bachelor of Science - Psychology
Clarion University of Pennsylvania
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