JUJUAN JOHNSON
Deerfield Beach,FL
Summary
Experienced Professional Case Manager looking to obtain a challenging and fulfilling position that will allow an immediate contribution to develop and promote the organization's mission, vision, values and strategic goals.
Overview
17
17
years of professional experience
1
1
Certification
Work History
SUPPLEMENTAL CLAIMS ANALYST
UnitedHealth Group
05.2022 - Current
- Analyzed and processed a range of supplemental insurance claims, ensuring adherence to company policies and regulatory guidelines
- Collaborated with underwriters to assess risks and recommend coverage for critical illness and hospital indemnity plans
- Analyzed and processed life insurance claims and benefits
- Managed a portfolio of accident claims, ensuring timely settlement and accurate documentation
- Developed a streamlined process to handle wellness claims, resulting in a 15% increase in claim processing speed
- Provide mentorship for new team members on supplemental insurance products and best practices
- Managed end-to-end processing of insurance claims, ensuring accurate and timely resolution
- Conducted detailed investigations into complex accident claims, collaborating with legal teams and other stakeholders
- Advised clients on the nuances of their policies, especially concerning critical illness and hospital indemnity claims.
Insurance Claims Analyst
Professional Disability Associates
03.2021 - 05.2022
- Collaborated with claims department and industry anti-fraud organizations to resolve claims
- Evaluated and settled complex insurance claims in strict timeframes
- Worked with claims adjusters and examiners to expedite processing in alignment with procedures
- Managed large volume of medical claims on daily basis
- Paid or denied medical claims based upon established claims processing criteria
- Reviewed provider coding information to report services and verify treatment.
Disability Specialist II (Case Manager)
Matrix Absence Management / Reliance Standard
01.2017 - 03.2021
- Determine eligibility under federal and state requirements for leaves submitted and determines eligibility under client's plan/policy
- Provide exemplary customer service by processing group disability income insurance claims in a timely and accurate manner
- Proactively communicates decisions within Best Practice guidelines, and consistently meet Performance Guarantee requirements
- Makes determinations to approve, deny or delay and or reach out to additional resources for review, based on medical certification review and management
- Determine duration associated with leave and or disability based on information given by the healthcare provider
- Communicate approvals, denials, leave extensions, return to work plans and other important information regarding leave to employee and client
- Knowledge of ERISA, HIPPA, FMLA, SSA, USERRA regulations, required offsets and deductions, disability duration and medical management practices and Social Security, and Military leave programs.
CLAIMS EXAMINER, York Risk Management Work Comp
01.2014 - 01.2017
- Analyzes and processes complex or technically difficult workers’ compensation claims by investigating and gathering information to determination the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution
- Negotiates settlement of claims within the designated authority
- Calculated and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim
- Calculate and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level
- Prepares necessary state filings within statutory limits
- Manage claim recoveries, including but not limited to: subrogation, Social Security and Medicaid offsets
- Communicates claim activity and processing with the claimant and the client relationships
- Ensures claim files are properly documented and claims coding is correct
- Refers cases as appropriate to Supervisor and management.
Training and Development Specialist
FARMERS INSURANCE GROUP
06.2006 - 12.2013
- Contributes on project teams in designing learning for all levels of complexity
- Leads projects of medium complexity to design learning solutions for audiences up to and including supervisory/professional level learners, using adult learning practices and technologies appropriate to needed outcome
- Delivers and maintains established learning and performance improvement solutions as designed for content of intermediate complexity for audiences
- Provides feedback to participants during application of knowledge, skills and attitudes
- Provide feedback monthly obtained from automated auditing system NICE, listen to calls and provide constructive feedback that helps to build confidence and kept audience within company quality guidelines
- Selected to train a group of 50 new hires for clear harbor project in Grenada and provided continual coaching and instruction when needed.
Education
BACHELOR of ARTS - Business
Florida Atlantic University
Boca Raton, FL06.2024
ASSOCIATE OF ARTS - BUSINESS MANAGEMENT
Broward College
Skills
- Coaching and mentoring
- Improvement initiatives
- Claims Adjustments
- Claims review
- HIPAA, ERISA
- Transactions reconciliation
- Insurance industry experience
- FMLA, STD, PFL, ADA, CFRA
Certification
ALL LINES ADJUSTER 620 And 440 | BUSINESS OPERATIONS, ACCOUNTING TECHNOLOGY SPECIALIST
Timeline
SUPPLEMENTAL CLAIMS ANALYST
UnitedHealth Group
05.2022 - Current
Insurance Claims Analyst
Professional Disability Associates
03.2021 - 05.2022
Disability Specialist II (Case Manager)
Matrix Absence Management / Reliance Standard
01.2017 - 03.2021
CLAIMS EXAMINER, York Risk Management Work Comp
01.2014 - 01.2017
Training and Development Specialist
FARMERS INSURANCE GROUP
06.2006 - 12.2013
BACHELOR of ARTS - Business
Florida Atlantic University
ASSOCIATE OF ARTS - BUSINESS MANAGEMENT
Broward College
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