Denise Dennie
Rosedale,USA
Summary
Dedicated and resourceful professional with extensive experience administering all benefits and retirement programs, including medical, dental, vision, life insurance, and short- and long-term disability. Committed to meeting company needs with consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Workers Compensation Benefit Examiner
New York City Housing Authority
New York, NY
02.2023 - Current
- Investigate and evaluate workers' compensation claims to determine compensability and liability.
- Review accident reports and other documents related to claims to determine workers' compensation coverage. Run reports to manage, monitor, and provide HR/Benefits metrics.
- Review cases for correction of awards or decisions and process payments resulting from hearings by New York State Workers’ Compensation Board.
- Review employee job duties to determine eligibility for benefits under applicable laws.
- Investigate disability claims by contacting pertinent parties.
- Perform complex technical and financial functions related to Workers’ Compensation.
- Draft correspondence regarding claim status changes, benefit calculations, settlement offers, denials.
- Prepare cases for Workers’ Compensation Board and arbitration hearings.
- Coordinate the return-to-work process between employers, employees and medical providers to ensure compliance with statutory requirements.
- Maintain accurate documentation of all activities related to assigned claims files in a timely manner.
- Process awards/decisions and medical invoices; reviews complex cases involving multiple injuries to determine requirements for surveillance, liens, subrogation and case management action plans.
- Conduct investigations into potential fraud or abuse of workers' compensation benefits by claimants or employers.
- Act as a liaison between insurance carriers, employers, claimants, attorneys during dispute resolution proceedings. Review and forward medical reports to insurance carrier for continuation of benefits.
- Participate in internal meetings focused on improving processes related to adjudication of workers' compensation claims.
- Ensure compliance with all relevant federal and state laws governing workers' compensation programs.
- Review cases for compliance with NYCHA policies and procedures.
- Enter and maintain electronic records of cases.
- Determine liability, compensability and benefits due on each claim.
- Comply with Audits from Insurance Carrier.
- Deliver exceptional customer service to clients by communicating information and actively listening to concerns.
- Gather information from case files or computer records and prepare written material and forms for distribution.
- Communicate with insurance carrier via email, telephone and on-line system. Respond to inquiries and/or discuss injured employee’s obligations and entitlements under
NYCHA’s policies. - Implement the pro-rated benefits for compensable claims in accordance with contractual agreements.
- Compute benefit payments accruing to prospective recipients.
- Input claim information and payments into company database.
- Review policies to determine appropriate levels of coverage and assist with approval or denial decisions.
- Investigate potentially fraudulent claims with focus on thoroughness, quality and cost control.
- Check into questionable claims, interviewing agents and claimants to resolve errors and omissions.
- Gather and documented evidence to support court proceedings.
- Communicate with reinsurance brokers to obtain claim information for processing.
- Maintain highly confidential information.
- Assist in the processing of claims utilizing manual and/or automated office systems.
- Prepare and file workers’ compensation documents.
- Prepare personnel Actions through Movaris.
Benefit Counselor
Employee Family Protection
New York, NY
06.2021 - 02.2023
- Assisted clients with the completion of applications for various public benefits programs and provided follow-up support throughout the application process.
- Maintained accurate records of all client interactions including initial assessment forms, individualized plans of service, progress notes, referrals.
- Provided case management services by developing action plans tailored to each client's needs and monitoring ongoing progress through regular contact with clients.
- Attended trainings on new policies or procedures related to public benefits programs; kept abreast of changes in relevant legislation.
- Compiled data from various sources regarding client outcomes within specific public benefits programs and presented findings at agency meetings.
- Performed periodic quality assurance reviews of benefit files to identify any discrepancies or errors that may have occurred during the application process.
- Responded promptly to inquiries from government representatives regarding specific cases; maintained open lines of communication between agency staff and external partners.
- Coordinated benefits processing, including enrollments, terminations and claims. Reviewed employee enrollments to verify accuracy, inputting information into company database.
- Communicated effectively via email, phone and face-to-face with plan participants to resolve issues pertaining to health and welfare benefits. Oversaw enrollment of new employees and company-wide yearly enrollment period.
- Mastered state and Federal benefit laws Including ERISA, FMLA, COBRA, HIPPA and 401k administration.
- Administered employee insurance, pension and savings plans, working with insurance brokers and plan carriers.
- Conducted benefit eligibility assessments and developed customized benefit plans for clients. Conduct in person and/or virtual Open Enrollment sessions.
- Worked as a contract Liaison for MTA buses Staten Island. Working alongside Union leaders to construct Supplemental Benefits for bus operators in all five operating Depot. Complying with MTA policies, practices, and procedures.
Insurance Agent/Workplace Benefit Enroller Special
Allstate Insurance Company/Chubb Insurance Tri-Sta
New York, NY
06.2012 - 06.2021
- Investigated and evaluated workers' compensation claims to determine compensability and liability.
- Reviewed employee job duties to determine eligibility for benefits under applicable laws.
- Provided guidance on complex coverage issues to adjusters or other staff members as needed.
- Maintained accurate documentation of all activities related to assigned claims files in a timely manner.
- Identified trends in claim activity that could result in cost savings opportunities for the organization.
- Acted as a liaison between insurance carriers, employers, claimants, attorneys during dispute resolution proceedings.
- Participated in internal meetings focused on improving processes related to adjudication of workers' compensation claims.
- Determined liability, compensability and benefits due on each claim.
- Input claim information and payments into company database.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Communicated with reinsurance brokers to obtain claim information for processing.
Education
Social Work - Bachelor of Science
York CUNY
New York, NY06.2014
Corporate Communications/ Minor: Sociology & Law - Bachelor of Arts
Baruch College
New York, NY06.2000
Skills
- Policy Analysis
- Allocating Claims
- Coverage Assessment
- Active Listening
- Legal Documentation and Reporting
- Decision-Making
- Client Interviewing
- Personnel Relations
- Case Reporting
- Customer Service and Support
- Critical Thinking
- Fraud Identification
- Relationship Building
- Verbal and Written Communication
- Public Speaking
- Fraudulent Claims Investigation
- Complex Problem Solving
- Report Writing
- Liability Determination
- Benefit Explanation
- Coverage Determination
- Human Relations
- Social Services
- Team Collaboration
- Records Review
- Payment Processing
- Workers' Compensation Claims
- Claim Processing
- Team Leadership
- Employee Benefits
- Staff Development
Licenses
Licensed Real Estate Agent | Licensed Health and Life Agent | Certified EKG Technician
Phlebotomist and Nursing Assistant | Certified Anti-Fraud | Certified Regulation 187 |
Certified Long Term Care Benefit Counselor
Certification
- Insurance License - 2014- current
- Civil Service Tentative Score: Customer Service Representative-93%
- Civil Service Tentative Score: Staff Analyst-83%
- Civil Service Tentative Score: New York City Bridge Exam(Analyst Trainee)- 82%
Software
- Sedgwick
- Kronos
- UCM (Content Management)
- Ecase
- C11, C-240 Forms
- Movaris Dashboard
- HRdbx, NYCAPS, PRISE, PMS, CHRMS, RMDS, and CityTime
- Selerix
- Microsoft Office Suite (Word, Excel, Access)
Timeline
Workers Compensation Benefit Examiner
New York City Housing Authority
02.2023 - Current
Benefit Counselor
Employee Family Protection
06.2021 - 02.2023
Insurance Agent/Workplace Benefit Enroller Special
Allstate Insurance Company/Chubb Insurance Tri-Sta
06.2012 - 06.2021
Social Work - Bachelor of Science
York CUNY
Corporate Communications/ Minor: Sociology & Law - Bachelor of Arts
Baruch College
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