Jessica Diles
Southington,OH
Summary
Detail-oriented Claims Analyst with expertise in claims processing, data analysis, and regulatory compliance. Skilled in ensuring accurate and fast resolutions through effective communication and negotiation. Known for navigating complex claim scenarios to deliver optimal outcomes and maintain stakeholder satisfaction.
Overview
15
15
years of professional experience
Work History
Claims Analyst (Paid Family Medical Leave)
Principal Financial Group
10.2023 - 09.2024
- Oversaw paid family medical leave claims for multiple states, ensuring smooth processing from start to finish.
Reviewed medical documents to determine eligibility and make informed leave approval decisions efficiently.
Communicated effectively with HR teams and claimants to clarify leave requirements, and facilitate modified work schedules.
Maintained complete and accurate records of leave requests, ensuring compliance with state laws.
Collaborated with cross-functional teams to resolve issues and improve claims processing.
FMLA Specialist
Unum
03.2022 - 03.2023
- Processed FMLA claims for multiple companies, ensuring timely and accurate handling from start to finish.
- Made eligibility decisions based on medical information and communicated with employees to obtain additional documentation when necessary.
- Selected to test and implement a new company-wide processing system to improve claim management efficiency.
Owner/Manager
Diles Market & Café
09.2009 - 03.2022
- Managed all aspects of business operations, including new employee onboarding, training, and terminations.
- Handled human resources responsibilities such as payroll, tax filings, accounting, and vendor relations.
- Oversaw inventory management and financial transactions, including accounts payable and receivable.
- Utilized Toast Point of Sale, QuickBooks Online, QuickBooks Payroll, and Eagle Browser software to streamline business functions.
- Implemented successful business strategies to increase revenue and target new markets.
Education
H.S. Diploma -
LaBrae High School
01.2007
Skills
- Customer service
- Claims processing
- Regulatory compliance
- Eligibility determination
- Document management
- Data analysis
- Effective communication
- Problem solving
- Attention to detail
- Time Management
Timeline
Claims Analyst (Paid Family Medical Leave)
Principal Financial Group
10.2023 - 09.2024
FMLA Specialist
Unum
03.2022 - 03.2023
Owner/Manager
Diles Market & Café
09.2009 - 03.2022
H.S. Diploma -
LaBrae High School
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