Damian Butler
Irving
Summary
LOA Coordinator at Sedgwick specializing in claims analysis and disability compliance. Expertise in managing complex medical information and improving customer relationships. Proficient in navigating healthcare claims to ensure accurate benefits application, resulting in timely claims processing and enhanced member satisfaction. Strong communication skills focused on achieving optimal outcomes.
Overview
13
13
years of professional experience
Work History
LOA Coordinator
Sedgwick
03.2024 - 02.2025
- Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to a disability plan.
- Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.
- Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians).
- Communicates with the claimants providers to set expectations regarding return to work.
- Determines benefits due, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
- Medically manages disability claims ensuring compliance with duration control guidelines and plan provisions.
- Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence.
- Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system.
- Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.
- Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.
- Negotiates return to work with or without job accommodations via the claimant’s physician and employer.
- Refers cases as appropriate to team lead and clinical case management.
- Maintains professional client relationships.
- Ensures the organization pays employees accurately, compliantly and on time.
Medicaid Member Advocate
Aetna
Arlington
07.2018 - 03.2024
- Assist with member needs (benefits and eligibility, billing and payments, authorizations for treatment, and explanation of benefits)
- Act as a liaison for the member locate and contact doctor offices eye doctor and dental offices to schedule new patient or follow up appointments
- Verify prescription coverage, contact pharmacy or prescription refills and or pick up times
- Review and research incoming healthcare claims for members by navigating multiple computer systems and platforms, verify data/information necessary for processing(pricing prior authorization applicable benefits)
- Ensure that the proper benefits are applied each claim by using appropriate process and procedure (claim processing and procedures, grievance procedures, state mandates, CMS/Medicaid guideline, benefits plan)
Medicaid Member Advocate
United Healthcare
Irving
06.2017 - 07.2018
- Assist with member needs (benefits and eligibility, billing and payments, authorizations for treatment, and explanation of benefits)
- Act as a liaison for the member locate and contact doctor offices eye doctor and dental offices to schedule new patient or follow up appointments
- Verify prescription coverage, contact pharmacy or prescription refills and or pick up times
- Review and research incoming healthcare claims for members by navigating multiple computer systems and platforms, verify data/information necessary for processing(pricing prior authorization applicable benefits)
- Ensure that the proper benefits are applied each claim by using appropriate process and procedure (claim processing and procedures, grievance procedures, state mandates, CMS/Medicaid guideline, benefits plan)
Asset Protection
El Rancho Supermarket
Grand Prairie
03.2016 - 05.2017
- Recover stolen merchandise and apprehend shoplifters and other people who commit fraud or other criminal acts against the company
- Investigate criminal violations against the person or property of any customer or associate that is committed on company premises
- Prepare prompt and complete reports relative to all theft incidents, merchandise recoveries, accident investigations, audits, and other activities as assigned by the Asset Protection Manager
- Have knowledge of and maintain strict compliance with the law and company policies concerning apprehensions, searches and seizures, and the preservation of evidence
- Works on special assignments, investigations, and surveillance as directed by Store Asset Protection Manager
- Responds to alarm conditions at assigned store
Senior Customer Service
Uniden
Dallas Fort-Worth
09.2012 - 01.2016
- Provide support to resolve customer technology problems through a series of trouble shooting activities in a virtual call center environment.
- Common solutions include verifying proper hardware and software configuration and set up, power cycling devices, navigating customers through application menus, and troubleshooting
- Sell new/refurbished home telephones and or accessories
- Update customers contact information for shipments on new/refurbished phones or accessories
Education
High School Diploma -
Winfree Academy
Richardson, TX01.2005
Skills
- Claims analysis and processing
- Durable medical equipment expertise
- Disability compliance knowledge
- Medical terminology proficiency
- Customer relationship management
Timeline
LOA Coordinator
Sedgwick
03.2024 - 02.2025
Medicaid Member Advocate
Aetna
07.2018 - 03.2024
Medicaid Member Advocate
United Healthcare
06.2017 - 07.2018
Asset Protection
El Rancho Supermarket
03.2016 - 05.2017
Senior Customer Service
Uniden
09.2012 - 01.2016
High School Diploma -
Winfree Academy