Julissa Lundy
New Albany,OH
Summary
Claims professional well-versed in claim assessment and resolution strategies, bringing proven track record of managing diverse caseloads. Recognized for achieving high levels of client satisfaction through effective communication and comprehensive claim evaluations. Known for strong collaboration skills and adapting to dynamic environments.
Experienced with claim evaluation, dispute resolution, and policy interpretation, ensuring accurate and timely claim processing. Utilizes analytical thinking and effective communication to resolve complex claims efficiently. Knowledge of company policies to maintain compliance and uphold high standards in claim processing.
Overview
11
11
years of professional experience
Work History
Sr. Disability claim rep
Sedgwick
12.2023 - Current
- Company Overview: (waste management program)
- Makes claim determinations to approve non-complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan
- Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets
- Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system
- Handles complex claims
- Benefit Liaison
- Assisted with training new hires
- (waste management program)
Disability claim rep
Sedgwick
08.2022 - 12.2023
- Company Overview: (Google program)
- Makes claim determinations to approve non-complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan
- Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets
- Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system
- Refers cases as appropriate to team lead; maintains professional client relationships
- Assisted with training new hires
- (Google program)
Leave of Absence claim rep
Sedgwick
06.2021 - 08.2022
- Company Overview: (Honda program)
- Establishes FMLA claims; tracks and codes documentation in accordance with internal workflow processes
- Analyzes FMLA claims to determine eligibility and certification in compliance with state and federal regulations
- Identifies action plan; determines benefits due; and makes timely case decisions based on service expectations as established by the client
- Communicates decisions and on-going expectations with claimants and clients
- Assisted with training new hires and assigning work
- (Honda program)
Customer service representative
Sedgwick
03.2020 - 06.2021
- Liaison for employee's
- Follow client guidelines to file claims and problem solve any questions or concerns the employee may have
- Informs employee of payments, claim status and paperwork details
- Properly notate the claim with any updates or concerns the employee expressed and relay correct information to the employee
- Escalate any ongoing concern the employee has so it can be resolved efficiently
- Submits any request the employee may have to the claim handler
- Apart of mentor/ training program
Team Lead
Candid
01.2018 - 01.2020
- Performed Coaching
- Conduct Interviews
- Career Development for employee who wanted to enhance their skills
- Phones- Making inbound and outbound calls
- Handled Escalations- chats, emails or phone calls
- Assisted with the chat queue
- Assisted with email queue
- Supervises Operations Support Services colleagues
- Defines and establishes quality assurance procedures, standards, metrics reporting and auditing
- Reviews quality data, conducts audits, tracks quality metrics, and reports on findings
- Tracks non-compliance issues and monitors through resolution
- Manages staffing schedules to assure appropriate department coverage
Dispute specialist
JP Morgan Chase
10.2016 - 12.2017
- Regulation Z codes for Visa/Mastercard- Be knowledgeable and up to date on dispute codes
- Filled out fast track forms for a chargeback- Input data into a system to chargeback a charge from the merchant, that a customer deems to be made in error
- Data entry - Input information into the system
- Handle inbound high call volume
Customer service rep
Safelite Autoglass
10.2013 - 09.2016
- Data Entry- Input information in to the system
- Filed insurance glass claims- Gather information such as policy number and year make and model of a vehicle to file an insurance claim
- Inbound high volume calls- Have taken back to back phone calls
- Verified insurance coverage- Would use the insurance companies system to verify a policyholder's insurance coverage or for State Farm contact their third party company, who would provide the information for us
- Scheduled appointments-Schedule commercial companies along with residential customers auto glass installments
- Maintain SLA- For our commercial companies, like enterprise, JBHunt, Waste management, and many more, we make sure we get a technician out to install the glass no matter how busy their schedules are
Education
BS - Psychology
University of Arizona
Chandler, AZ07-2027
AAS - Registered Nurse
Columbus State Community College
Columbus, OH01-2026
Skills
- Oral communication
- Management
- Motivational skills
Written/verbal communication
- Analytical/problem solving skills
- Organizational skills
- Time management
- Teamwork
References
- Paris Roten, 614-313-3334
- Angela Moore, 614-813-4000
Timeline
Sr. Disability claim rep
Sedgwick
12.2023 - Current
Disability claim rep
Sedgwick
08.2022 - 12.2023
Leave of Absence claim rep
Sedgwick
06.2021 - 08.2022
Customer service representative
Sedgwick
03.2020 - 06.2021
Team Lead
Candid
01.2018 - 01.2020
Dispute specialist
JP Morgan Chase
10.2016 - 12.2017
Customer service rep
Safelite Autoglass
10.2013 - 09.2016
BS - Psychology
University of Arizona
AAS - Registered Nurse
Columbus State Community College
Similar Profiles
Nora OrosNora Oros
Customer Service Representative at SedgwickCustomer Service Representative at Sedgwick
Christina TurnerChristina Turner
Complex Pharmacy Management Nurse at SedgwickComplex Pharmacy Management Nurse at Sedgwick
Leah StarrLeah Starr
Absence Management Team Lead at SedgwickAbsence Management Team Lead at Sedgwick