Janet Crowder
Riverdale,GA
Summary
Accomplished case manager efficiently manages high caseloads while maintaining a high standard of care. Thrives in high-pressure environments and consistently recommends the best resources and courses of action to meet patient needs and improve their quality of life. Highly motivated and eager to take on new challenges, with a strong work ethic, adaptability, and exceptional interpersonal skills. Demonstrates the ability to work effectively without supervision and quickly acquire new skills.
Overview
18
18
years of professional experience
Work History
UI Claims Examiner I
Georgia Department of Labor
07.2024 - Current
- Review 60 unemployment insurance claims for overpayment
- Establishes and investigate fraud and non-fraud overpayments.
- Handle sensitive information with discretion, ensuring confidentiality of personal and financial details for claimants throughout the claim's examination process.
- Utilized analytical skills to evaluate accuracy and appropriateness of charges before establishing payments as part of the claims process.
- Reduce claim processing time by implementing efficient workflow strategies and prioritizing tasks effectively.
- Mitigate fraud risks by identifying suspicious patterns in claims data and escalating concerns to appropriate teams for further investigation.
Medical & Health Management Manager
Georgia Power
06.2018 - 03.2024
- Responsible for the proactive management of assigned disability claims (STD, LTD , FMLA and ADAA) by determining the length of disability through an evaluation of medical information and job duties
- Managed approximately 40 incoming calls, emails and faxes per day from customers.
- Evaluate the extent of the disability by interviewing or writing to the applicant and the employer, and ongoing update
- Conduct medical investigation by phone or in writing to the applicant, employer, physicians and other medical service providers
- Write letters to inform all affected parties of decisions regarding disability cases;
- Implement return-to-work programs and negotiate with the employer;
- Evaluate health care coordination programs and rehabilitation programs to ensure they have positive effects;
- Adhere to service level agreements associated with policy holder claims;
- Respond to all telephone inquiries made by the applicant, physicians, lawyers, regarding the assessment of the claims.
- Managed onboarding process for new hires, ensuring all documentation was completed accurately and in a timely manner.
- Promoted high customer satisfaction by resolving problems with knowledgeable and friendly service.
- Worked successfully with diverse group of coworkers to accomplish goals and address issues related to our products and services.
- Managed and motivated employees to be productive and engaged in work.
Risk Management Legal Specialist
Staffing One/Georgia Power
04.2007 - 08.2017
- Reviewed and prepared legal documents, including contracts, pleadings, appeals and motions.
- Conducted investigations into potential violations of laws or regulations.
- Provided administrative support to 6 attorneys in the preparation of legal documents and pleadings.
- Maintained electronic databases for 600 relevant legal records.
- Provided advice on procedural matters such as filing requirements or time limits for actions.
- Collaborated with other departments within the organization to ensure compliance with all applicable laws and regulations.
- Supported management of litigation cases and preparation for court presentation.
Education
Master of Science - Compliance Law
National Paralegal College
Phoenix, AZ12-2021
Skills
- Records Management
- Health History Documentation
- Case Management
- MS Office
- Legal Research
- Legal writing
- Contract Review
- Drafting memoranda
- Claims processing
- Disability claims process
- Policy interpretation
- Investigative skills
- Claims evaluation
- Litigation support
- Time management
Timeline
UI Claims Examiner I
Georgia Department of Labor
07.2024 - Current
Medical & Health Management Manager
Georgia Power
06.2018 - 03.2024
Risk Management Legal Specialist
Staffing One/Georgia Power
04.2007 - 08.2017
Master of Science - Compliance Law
National Paralegal College
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