Isis Montesino
North Brunswick,NJ
Summary
To obtain a position that will utilize my skills and enhance them. I am a very detail-oriented and technically skilled person. I am a hardworking administration/healthcare/customer service professional with over 10 years of experience providing support to multiple executives. Highly adaptable, rapidly learning new procedures and processes, and quickly adjusts to changes in schedule, team structure, assignment parameters, and manages data quickly and efficiently. I am a team player with strong organizational, interpersonal and communication skills. Extensive experience in positions involving a high degree of trust, sensitive materials, and confidentiality. Progressive experience in disability benefit administration processes, Skill and claimant eligibility. Highly organized and efficient in a fast-paced environment, communicating effectively at all organizational levels, with clients and stakeholders. Demonstrated to build trusting relationships. Thinks critically, solve problems, plan and organize activities and deliver excellent customer service.
Overview
23
23
years of professional experience
Work History
Integrated STD/Absence Claims Manager
Prudential
11.2021 - 02.2024
- Responsible for handling a claim block of disability / and or FMLA claims
- Accountable for ensuring optimal claims handling and timely, accurate decisions
- Managing assigned caseload of more complex FMLA and integrated FMLA and Disability cases
- Evaluate claimant eligibility
- Interact with internal and external customers including, but not limited to, claimants, employers, physicians, and attorneys etc., to gather the information to make the decision on the claim
- Provide technical direction to other claims personnel as needed
- Validate payment period, follow up and monitor payment accuracy and timeliness; follows plan to closure.
- Demonstrated strong organizational and time management skills while managing multiple projects.
- Self-motivated, with a strong sense of personal responsibility.
Integrated Leave Coordinator
AbSolve
08.2019 - 03.2020
- Working in a team environment to ensure all timeframes regarding claim submission are met
- Receives and triage incoming communications to determine the nature of callers’ request
- Assist employees in navigating through the disability/leave of absence initiation process and facilitates transfers to other areas when appropriate
- Understand and respect the confidential nature of issues handled
- Exercises careful discretion when collecting, discussing, and documenting information
- Collects pertinent information from employees, initiates disability/leave cases in the appropriate tracking tool, documents leave comments concisely, requests employee leave policy kits Serves as the first point of contact to initiate the disability claim evaluation process
- Redirects quality of care/service complaints, requests for information, explanation of benefits, to the correct operational area
- Verify member eligibility and coverage from the related computer system and enters all information into the appropriate computer system
- Obtain and document clear, concise, objective, and significant information from a claimant
- Sends acknowledgement and authorization correspondence timely
- Ensures incoming cases are processed in accordance with corporate and regulatory requirements and adheres to mandated compliance timeframes
- Performs other duties as assigned.
Claims Support Specialist
M.I.G Inc.
11.2015 - 06.2018
- Filing workman's compensation Froi's & Sroi's electronically to the state, file & serve's, subpoena’s, files to attorney's
- Sort, document, distribute, match, file, and post documents
- Process incoming faxes and route to appropriate claim analyst and corresponding claim
- Responsible for entering all new notices of claims into the computer system and maintaining files for cases reported
- Research, compile, and interpret information to prepare various reports
- Maintain file folders, diaries, and correspondence
- Pull files for closures, reopens, audits, special requests, diaries, priority searches, etc
- File claim files were returned from file handlers and performed searches for misfiled and out-of-file materials
- Reassign files and transfer diaries as necessary
- Check files for accuracy and remove closed files or obsolete material as directed by the file-handlers or management
- Verifies all payments and distributes them to appropriate parties
- Transcribe letters and documents for claims professional staff
- Prepare all required state forms such as Workers Compensation state reporting forms, index bureau requests, etc
- Research IR temporary file report for missed claims or file documentation per SOX Stays current with insurance practices through continuing education.
STD/ LTD Disability Claims Manager
Prudential
07.2001 - 03.2014
- Managing a caseload of more complex disability claims, evaluating claimant's eligibility
- Responsible for documentation of case management
- Activities and follow-up of the case to assure timely case resolution
- Interacting with internal and external customers including, but not limiting to, claimants, employers, physicians, and attorneys to gather information to decide on a claim
- Other responsibilities included inputting new claims into the Disability Claim Management system
- This includes gathering information on first notices of claims for all coverages
- Coordination of Airborne; void requests; check copy request; voucher preparation and processing change request
- Formulating correspondence and questions to all responsible parties including claimants, providers, and Independent Medical Examiners.
Office Coordinator
Bartky Healthcare
02.2011 - 02.2013
- Filing, Scanning documents Answering and handling multiple phones lines
- Scheduling patient appointments / Intakes / Payments Checking patients in and out, Confirming and Scheduling appointments
- Scoring Psych Testing, Filing charts
- Calling in Prescriptions
Office Manager
Main St Counseling Center
08.2010 - 02.2011
- Greeting clients as they arrive for their appointments and advising therapist clients arrived
- Billing and posting payments received from clients
- Answering phones, updating client information, from inputting a new client's information, to a new time client will come in for treatment
- Inputting and confirming client's insurance information
- Make sure that all information is in the file to terminate the file
Education
Associates in Business Management -
Union County College
Skills
- Claims analysis
- Claims investigation and research
- Policy Interpretation
- Procedure Implementation
- Investigation techniques
- Planning and Organization
- Team motivation
- Claims Processing
- Team Management
- Quality Assurance
- Performance monitoring
- Legal Compliance
- Customer Expectations Management
- Disability claims process
- Insurance policy review
- Claims
- Critical Thinking
- Team Collaboration
- Decision-Making
- Relationship Building
- Coaching and Mentoring
- Coverage Determination
- Payment Processing
- Risk Management
- Fraudulent Claims Investigation
- Underwriting knowledge
- File and Record Management
- Regulatory Compliance
Languages
Spanish
Limited Working
English
Native or Bilingual
Timeline
Integrated STD/Absence Claims Manager
Prudential
11.2021 - 02.2024
Integrated Leave Coordinator
AbSolve
08.2019 - 03.2020
Claims Support Specialist
M.I.G Inc.
11.2015 - 06.2018
Office Coordinator
Bartky Healthcare
02.2011 - 02.2013
Office Manager
Main St Counseling Center
08.2010 - 02.2011
STD/ LTD Disability Claims Manager
Prudential
07.2001 - 03.2014
Associates in Business Management -
Union County College
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