Summary
Overview
Work History
Education
Skills
Affiliations
Certification
References
Languages
Timeline
Generic

Diberka Talavera

Orlando,FL

Summary

Dynamic professional with extensive experience at Sedgwick, specializing in claims adjudication and team leadership. Results-driven colleague known for productivity and efficiently completing tasks. Skilled in client communication, problem resolution, and process optimization. Excel in negotiation, strategy development, and customer relationship management. Leverage active listening, empathy, and persuasive speaking to achieve objectives and exceed goals.

Overview

20
20
years of professional experience
1
1
Certification

Work History

Sr. Disability Representative

Sedgwick
Orlando, FL
04.2025 - Current
  • Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
  • Reviews and analyzes complex medical information (i.e. attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.
  • Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines.
  • Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians), as needed.
  • Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
  • Informs claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system.
  • Communicates with the claimants' providers to set expectations regarding return to work.
  • Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions.
  • Communicates clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system.
  • Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.

Teacher

Orange County Schools
Orlando, FL
08.2024 - 04.2025
  • Follow lesson plans provided by the regular Teacher or Instructional Coach to create a cohesive and consistent learning experience for students.
  • Implement existing lesson plans in a manner that ensures the integrity of academic time and motivates students to learn and participate.
  • Manage the classroom effectively to encourage student participation, minimize distractions and maintain a positive learning environment.
  • Maintain and/or assist in maintaining classroom control that fosters a safe, positive environment for all students and staff in accordance with school district and state applicable laws and regulations.
  • Adapt teaching methods to fit the needs of each individual student.
  • Supervise students in and out of the classroom, including in the halls, on the playground and in the cafeteria.
  • Provide in-class and at-home assignments based on the available lesson plan.
  • For long-term assignments, develop lesson plans and assignments consistent with the regular teacher's past lesson plans.
  • Assign reasonable tasks and homework to students in accordance with the School/District lesson plans.

Workforce Absence Team Lead

Sedgwick
Memphis, TN
05.2018 - 07.2024
  • Supervises a team of 30+ examiners and/or several technical operations colleagues for a wide span of control; may delegate some duties to others within the unit.
  • Identified and advised operations of trends, problems, and issues as well as recommended course of action, implementation of new procedures and processes.
  • Provided technical/jurisdictional direction to examiner reports on claims adjudication.
  • Provided guidance in proper claim allocation; FMLA, ADA, STD and/or Worker's Compensation.
  • Monitored claims examiners processed for STD to ensure correct payout.
  • Compiled, reviewed, and analyzed management reports and takes appropriate action.
  • Performed quality review on claims in compliance with audit requirements, service contract requirements, and quality standards.
  • Acts as second level of appeal for client and claimant issues regarding claim specific, procedural or special requests; implements final disposition of the appeal.
  • Reviewed and managed reserve amounts on high-cost claims and claims over the authority of the individual examiner.
  • Monitored third party claims; maintains periodical review of litigated claims, serious vocational rehabilitation claims, questionable claims and sensitive claims as determined by client, including worker's compensation.
  • Ensured claims filed were coded correctly, and adequate documentation was made by claims examiners.
  • Facilitated new hires onboarding, classroom training, orientation and transition to work independently.
  • Attended and lead daily meetings for the new hires.
  • Worked directly with operations, quality coaches and trainers to determine additional training, coaching, or performance planning needed for claims examiners.
  • Tracked trends and areas of opportunity from each examiner. Provided feedback during one-on-one meetings.
  • Trained new examiners to handle claims for the Salaried/Driver and eCommerce colleagues.
  • Assisted with developing and reviewing ongoing communications to the Service Center.
  • Assisted with updating client policies, resources and training materials for the leave department.
  • Developed Spanish training material, resources and aids for better quality service.
  • Attended weekly team meeting with the Quality Group and Trainers to review Quality Monthly Recaps.
  • Attended implementation meetings with Client, Project Management Team and leaders.
  • Trained of new managers.
  • Tracked and verified employee timekeeping data along with attendance and payroll accuracy via WorkDay.

Multicultural & Family Support Specialist - Racine Urban Outreach Specialist

WI FACETS
Milwaukee, WI
02.2011 - 08.2011
  • Assist families with information and referral regarding special education and other community-based services.
  • Provide advocacy services to participants.
  • Facilitate trainings and workshops monthly to parents/caregivers and professionals.
  • Grant writing and collaborating with other community agencies.

CPRC Project Director/ Agency Director

A.L.A.S.
Milwaukee, WI
01.2007 - 04.2010
  • Completed all required forms to become a recognized entity in the state, originated all forms currently used by the organization.
  • Created and designed the original website, payroll system, Employee Manual, Policies and Procedures, Board of Directors and sub-committees.
  • Oversee all operations of the entire organization which had one federal grant, and five others local grants awarded by the state and private organizations.
  • Implemented goals and objectives for each of the grants awarded to meet the specific needs of participants.
  • Formed collaboration with other community organizations to improve services provided to families.
  • Conducted all public appearances and representations throughout the city, state, and at nation level that pertained to the organization.
  • Set fundraising goals and events every year to guarantee grant matches.
  • Generated materials distributed at bulletins and newsletters; also updated website monthly.
  • Created presentations and other materials use at workshops and trainings.
  • All materials were formulated in both English and Spanish.
  • Created and developed the Spanish version of the medical home program in partnership with the Children's Hospital of WI.
  • Created and developed the Parent-to-Parent Latino of WI in partnership with P2P of WI.

Assistant Manager and Interpreter

Language Source
Wawautosa, WI
03.2005 - 08.2008
  • Verbal interpretation and written translation for a full knowledge and understanding of all procedures between all parties in the medical, commercial and legal areas.
  • Process work orders including trouble shooting any problems our clients and employees might have to provide the highest level of service.
  • Supervise and train all interpreters on all state guidelines, codes of ethics and HIPPA.

Education

Master of Arts - Psychology

University of Arizona Global
Chandler, AZ

Bachelor of Science - Criminal Justice

Florida Technical College
Orlando, FL

Associate of Liberal Arts - Legal Studies

Kaplan University

Skills

  • Managerial skills
  • Report writing
  • Record and file maintenance
  • Time management
  • Verbal and written communication
  • Interpersonal skills
  • Public relations
  • Program development
  • Financial management
  • Budgeting
  • FMLA, ADA, and STD knowledge
  • Statutory benefits administration
  • Workers' compensation processes
  • Workday proficiency
  • OSHA compliance and guidelines
  • Data organization and analysis
  • Negotiation skills
  • Conceptual thinking
  • Legal terminology proficiency
  • Criminology and court systems expertise

Affiliations

  • IMIA
  • American Translators Association
  • Notary Association of America

Certification

  • Operation Management
  • Temporary Teaching Certificate
  • Grant and Proposal Writing
  • Strategic Planning
  • Evaluation for Program Improvement
  • Performance Development through Logic Models
  • Homeland Security
  • Florida State 215, Life and Health
  • Florida Notary Public

References

  • Candida Talavera, Racine, WI, 53402, 262-412-5962
  • Preston Brown, Columbus, OH, 43054, 614-556-1482
  • Javitza Galarza, Kissimmee, FL, 34741, 407-680-4960

Languages

Spanish, Certified Interpreter and Translator

Timeline

Sr. Disability Representative

Sedgwick
04.2025 - Current

Teacher

Orange County Schools
08.2024 - 04.2025

Workforce Absence Team Lead

Sedgwick
05.2018 - 07.2024

Multicultural & Family Support Specialist - Racine Urban Outreach Specialist

WI FACETS
02.2011 - 08.2011

CPRC Project Director/ Agency Director

A.L.A.S.
01.2007 - 04.2010

Assistant Manager and Interpreter

Language Source
03.2005 - 08.2008

Master of Arts - Psychology

University of Arizona Global

Bachelor of Science - Criminal Justice

Florida Technical College

Associate of Liberal Arts - Legal Studies

Kaplan University

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