Erica P. Sessions

Processed Wellness , Accident and Hospital Indemnity insurance claims and determined the nature and validity of claims by reviewing policy status, patient eligibility , and supporting medical documentation; key claims data while interpreting coding and medical terminology in relation to diagnoses and procedures; used multiple core administration databases , systems and subsystems to process and transmit claims for payment or further investigation.

• Processing of new leaves and all daily follow-ups assigned
• Determine eligibility and availability of leave time for each employee requesting leave for FMLA, State, and applicable Corporate protections
• Determine and generate appropriate communications to comply with FMLA regulations and customer procedures
• Review medical certifications and other documentation submitted; consult with Nurse Case Manager and IME unit if needed
• Determine the appropriate status of leave under FMLA and state leave regulations taking into consideration regulatory requirements, company-specific requirements, and analysis of documentation received (medical, legal, etc.)
• Communicate medical or absence information with other internal units (STD, Intake)
• Management of a leave through duration, reporting status to Employer, employee and other internal units
• Respond to leave questions and issues from employees or Employer contacts

• Provide accuracy and efficiency of new intake claims
• Responsible for identifying and supporting multiple products with a core/baseline proficiency of Short-Term Disability, Long Term Disability and various other volunteer benefits
• Support various project work as needed.

• Assist with quality monitoring, coaching, mentoring of reps, and handling of escalated calls
• Colonial Life- Customer Service Specialist I
• Exceed daily performance goals
• Provide critical and accurate information on benefits, claims, and policy issues
• Assist with complex issues, De-escalation of irate customers, resolving problems, billing and documenting issues for additional research
• Work with internal and external Business Partners to improve the customer service experience in the Contact Center Assist internal customer service specialist

• Verify receipt of HIPAA compliant electronic claim transactions submitted electronically via the Gateway Production Network
• Serve as Subject Matter Expert for Private Business, Medicare and Commercial electronic claim related inquiries
• Escalate necessary inquiries to Tier II support as needed
• Restore ANSI 837/835 response files to direct submitters for immediate download
• Research, resolve and respond to EDI inquiries in a timely manner and in accordance with departmental standards
• Perform self and peer ticket evaluation and analysis to ensure proper coding and documentation

• Researched commercial lines of credit and various asset accounts for accuracy
• Expedited credit references to third parties for proper assessment of account information
• Assisted with quality control re-verifications, social security validations and verifications of deposits
• Processed abandoned/unclaimed property for escheatment to various states
• Ensured Service Level Agreements were met and timely notifications were delivered to the customers
• Resolved complex transactions/issues
• Identified fraudulent documents to assist with fraud detection
• Assisted Safe box Abandoned Property/Unclaimed Contents for delinquency and unclaimed property for escheatment to various states
• Ensured excellent service levels were met and timely notifications to customers were delivered to claim contents
• Assisted customers with processing of deposits, money orders, cashier checks, wire transfers, ACH payments
• Advanced ability to identify fraudulent documents
• Maintained Vault responsibilities/daily cash balancing
• Upselling of new products/services related to individual needs