Chesica Flint

Establish FMLA and unpaid state and/or company specific claims, track and code documentation in accordance with internal workflow processes.

Analyze FMLA, Workers' Compensation, Short Term Disability and unpaid state and/or company specific claims, to determine eligibility and certification in compliance with client plans, state and federal regulations.

Review claim information and medical certification received to identify action plan, determine benefits due and make timely decisions based on plan descriptions and service expectations as established by the client.

Communicate with Health Care Providers when medical clarification is needed.

Approve or deny absences.

Communicate decisions and on-going expectations clearly and professionally with claimants and clients by phone, written correspondence and/or claims system.

Maintain professional client relationships and provide excellent customer service.

Investigated claims and worked with parties involved to expedite compensation by analyzing denials or partial payments.

Month-end close reports, payment adjustments and transfers.

Reviewed weekly reports and made account administrative changes.

Examined existing accounting systems as well as historical data to determine the strengths and weaknesses of existing methods and controls.

In charge of resolving disagreements and negotiating mutually beneficial agreements between parties.

Collected customer accounts through both inbound and outbound telephone calls as well as correspondence in a call center and remote setting.

Assessed the risk of consumer credit to determine payment commitments, adhering to credit evaluations and federal regulations and processed payments accordingly.

Utilized customer and account information to develop solution-focused action plans for timely case resolutions, in line with plan descriptions and service expectations set by company policy.

Exhibited superior decision-making and problem solving skills, preventing customer escalations.

Maintained professional customer relationships and provided excellent customer service.

Developed workflow processes to streamline dispute resolution, job aids, enhancing efficiency.