Crystal Reed
Danville,VA
Summary
Crystal reed Disability Claims manager Professional with a wealth of knowledge and experience in Insurance and Financial Protection. Experienced Disability Claims Specialist with over 8 years of experience in evaluating disability claims to not only determine eligibility but also if they have transferable skills that may allow them to work in an alternate field. Experienced [Type] Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering [Number] years of experience and willingness to take on any challenge.
Overview
13
13
years of professional experience
Work History
Disability Claims specialist
United Health Care
01.2021 - Current
- Managed average of 80 claims caseload of Short-Term Disability
- Determined if claim could be paid, pended, or denied
- Reviewed for eligibility based on policy language., Conducted Pre-Ex investigation when applicable
- Confirmed timely enrollment
- Followed established claims policies resolving any claims issues
- Identifying states that have statutory benefits and calculating the appropriate offset
- Reviewed initial and reconsideration claims
- Managed average of 80 claims caseload of Short-Term Disability
- Determined if claim could be paid, pended, or denied
- Reviewed for eligibility based on policy language., Conducted Pre-Ex investigation when applicable
- Confirmed timely enrollment
- Followed established claims policies resolving any claims issues
- Identifying states that have statutory benefits and calculating the appropriate offset
- Reviewed initial and reconsideration claims
- Managed Continuing Claims
- Outreach to Physicians and other healthcare providers to obtain necessary information
- Conduct phone interviews to determine restrictions and limitations
- Managed Continuing Claims
- Outreach to Physicians and other healthcare providers to obtain necessary information
- Conduct phone interviews to determine restrictions and limitations.
Disability SPECIALIST
Integrated
03.2018 - 08.2020
- Managed claims caseload of Short-Term Disability and FMLA combined claims
- Reviewed ADA claims
- Determined if claim could be paid, pended, or denied
- Reviewed for eligibility based on policy language., Conducted Pre-Ex investigation when applicable
- Confirmed timely enrollment
- Followed established claims policies resolving any claims issues
- Identifying states that have statutory benefits and calculating the appropriate offset
- Reviewed initial and reconsideration claims
- Managed Continuing Claims
- Outreach to Physicians and other healthcare providers to obtain necessary information
- Conduct phone interviews to determine restrictions and limitations.
- Examined claims forms and other records to determine insurance coverage.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Analyzed information gathered by investigation and reported findings and recommendations.
Disability claims Manager
The Standard Insurance
08.2016 - 02.2018
- Managed claims caseload of Short-Term Disability and FMLA
- Determined if claim could be paid, pended, or denied
- Reviewed for eligibility based on policy language., Conducted Pre-Ex investigation when applicable
- Confirmed timely enrollment
- Followed established claims policies resolving any claims issues
- Identifying states that have statutory benefits and calculating the appropriate offset
- Reviewed initial and reconsideration claims
- Managed Continuing Claims
- Outreach to Physicians and other healthcare providers to obtain necessary information
- Conduct phone interviews to determine restrictions and limitations x
Medical Claims Recovery Specialist
Blue Cross NC
04.2013 - 09.2016
- Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
- Responded to correspondence from insurance companies.
- Followed up on denied claims to verify timely patient payment and resolution.
- Researched and resolved complex medical claims issues to support timely processing.
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Paid or denied medical claims based upon established claims processing criteria.
Commercial Claims Assistant Workers Compensation
Liberty Mutual
03.2011 - 01.2015
- Generated, posted and attached information to claim files.
- Verified client information by analyzing existing evidence on file.
- Read over insurance policies to ascertain levels of coverage and determine whether claims would receive approvals or denials.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
- Analyzed information gathered by investigation and report findings and recommendations.
Education
BA - Communication
Ashford University
2012
AA - GENERAL sTUDIES
Indiana University
2006
Skills
- Disability management
- MS office
- Fasets
- Sales force
- MD Guidelines
- Insurance Industry Experience
- Payment and Investigation Escalations
- Medical Records Management
- Policy Requirements and Eligibility
- Prior Authorization Processing
- Excellent Administrative Abilities
- Microsoft Office
- Claims Preparation
- Insurance Calculation
- Policy and Procedure Explanations
- Insurance coverage verification
- Insurance industry experience
- Account management
- Analytical and Critical Thinking
Timeline
Disability Claims specialist
United Health Care
01.2021 - Current
Disability SPECIALIST
Integrated
03.2018 - 08.2020
Disability claims Manager
The Standard Insurance
08.2016 - 02.2018
Medical Claims Recovery Specialist
Blue Cross NC
04.2013 - 09.2016
Commercial Claims Assistant Workers Compensation
Liberty Mutual
03.2011 - 01.2015
BA - Communication
Ashford University
AA - GENERAL sTUDIES
Indiana University
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