DeMartha Nelson
Memphis,TN
Summary
Focused on delivering exceptional service in disability claims management, utilizing strong analytical skills to assess eligibility and benefits. Experienced in navigating complex claim scenarios and ensuring regulatory compliance. Proven ability to manage high-volume caseloads while maintaining accuracy and quality in documentation.
Overview
10
10
years of professional experience
Work History
Senior Disability Representative
SEDGWICK CLAIMS MANAGEMENT
11.2024 - Current
- Evaluate and determine eligibility for complex disability claims in accordance with plan provisions and company guidelines.
- Analyze medical records, physician statements, operative reports, and clinical documentation to assess disability status.
- Manage complex claims involving comorbidities, accommodations, concurrent plans, and non-standard claim scenarios.
- Calculated and administered disability benefits, incorporating offsets like Social Security Disability and Workers' Compensation to ensure accurate compensation.
- Communicated claim decisions, payment details, and documentation requirements effectively to claimants, employers, and medical providers to facilitate understanding and compliance.
- Ensured compliance with duration guidelines, plan provisions, and regulatory requirements to maintain integrity of claims process.
- Maintain high-quality claim management while meeting productivity and service standards.
- Worked remotely from home to manage claims efficiently.
Disability Representative
SEDGWICK CLAIMS MANAGEMENT
05.2023 - 11.2024
- Evaluated eligibility, calculated benefits, verified certifications, and determined payments to facilitate timely claim processing.
- Administered FMLA and paid leave claims, ensuring compliance with federal, state, and client-specific regulations to support claim accuracy.
- Managed ongoing claim activities, maintaining accurate documentation in claims systems to support efficient operations.
- Communicated claim decisions and expectations to claimants, employers, and clients.
- Developed action plans and made timely claim decisions while maintaining service level expectations.
Consumer Care Advocate
SEDGWICK CLAIMS MANAGEMENT
01.2022 - 05.2023
- Provided customer support to claimants, providers, attorneys, and clients regarding claim status and claim-related inquiries.
- Resolved complex issues while ensuring adherence to company policies and procedures to uphold service quality.
- Documented claim activity and updated records to maintain accuracy in claims coding and support efficient processing.
- Initiated referrals to legal, pharmacy, utilization review, and Special Investigations departments to facilitate comprehensive claim resolutions.
- Assisted with independent medical examination scheduling and claimant support services.
Jail Processing Assistant
SHELBY COUNTY SHERIFF'S OFFICE
Memphis, TN
10.2020 - 11.2021
- Processed inmate intake, booking, and release documentation, ensuring compliance with state and local regulations to facilitate timely processing.
- Reviewed criminal histories to assess warrant status and determine fugitive hold requirements, enhancing security measures.
- Coordinated with judicial commissioners and law enforcement agencies to confirm legal compliance, supporting effective judicial processes.
- Conducted criminal history verification with the Tennessee Bureau of Investigation.
- Maintained accurate inmate records and booking logs within the Jail Management System.
Contact Center Banker
REGIONS BANK (Randstad Contractor)
03.2020 - 09.2020
- Assisted customers with banking transactions and account inquiries, enhancing understanding of financial products.
- Identified customer needs and recommended suitable banking products, contributing to customer satisfaction.
- Resolved customer concerns and escalated complex issues, ensuring timely resolution and maintaining service quality.
- Resolved customer concerns and escalated complex issues to specialized departments.
- Worked remotely to assist customers with banking services.
Quality Assistant
VIEW, INC.
Olive Branch, MS
02.2018 - 03.2020
- Ensured calibration and operation of quality measurement equipment met compliance standards.
- Supported quality assurance initiatives through auditing, inspection, and data analysis.
- Trained and mentored quality technicians and new associates to enhance team skills and knowledge.
- Contributed to continuous improvement projects and process enhancement initiatives to optimize quality practices.
Center Consultant
FEDEX OFFICE
Germantown, TN
08.2016 - 02.2018
- Resolved customer concerns, fostering high levels of customer satisfaction and loyalty.
- Processed complex orders with accuracy, contributing to timely project completion and customer satisfaction.
- Delivered customer service by managing printing, copying, binding, and graphic service requests, ensuring positive client experiences.
Education
High School Diploma - Extension Program
Gateway Christian School
Memphis, TNSkills
- Disability Claims Management
- Disability administration
- Leave management
- Medical Documentation Review
- Claims Investigation & Analysis
- Regulatory Compliance
- Benefits Determination
- Case Management
- Data management
- Microsoft Office
- Issue resolution
- Task prioritization
- Teamwork
- Customer support
- Written & Verbal Communication
Timeline
Senior Disability Representative
SEDGWICK CLAIMS MANAGEMENT
11.2024 - Current
Disability Representative
SEDGWICK CLAIMS MANAGEMENT
05.2023 - 11.2024
Consumer Care Advocate
SEDGWICK CLAIMS MANAGEMENT
01.2022 - 05.2023
Jail Processing Assistant
SHELBY COUNTY SHERIFF'S OFFICE
10.2020 - 11.2021
Contact Center Banker
REGIONS BANK (Randstad Contractor)
03.2020 - 09.2020
Quality Assistant
VIEW, INC.
02.2018 - 03.2020
Center Consultant
FEDEX OFFICE
08.2016 - 02.2018
High School Diploma - Extension Program
Gateway Christian School