Kenyetta Flemming
Hampton,GA
Summary
Experienced absence management and benefits specialist with 4+ years in FMLA and multi-state paid family and medical leave administration, as well as disability claims in remote environments. Recognized for exceeding service level agreements and maintaining compliance with audit standards while delivering high-quality claim outcomes. Skilled in analyzing medical certifications, interpreting regulations, and mitigating risks, with a strong focus on customer communication. Background includes fraud analysis and legal support, improving compliance and investigative accuracy.
Overview
26
26
years of professional experience
Work History
Remote Leave of Absence Representative
Sedgwick
10.2021 - Current
- Manage a high-volume caseload of FMLA and multi-state PFML claims while consistently meeting productivity and quality benchmarks.
- Interpret federal and state leave laws to issue accurate, compliant approval, denial, or pending determinations, minimizing compliance risk.
- Review and analyze complex medical certifications to ensure eligibility alignment with regulatory requirements.
- Maintain 100% audit-ready documentation standards, reducing rework and minimizing escalations.
- Consistently meet or exceed established SLAs for claim processing and payment accuracy.
- Serve as a subject matter resource for employees regarding leave eligibility, documentation requirements, and employer policies.
- Strengthened claimant communication processes by delivering clear written determinations, reducing follow-up inquiries and delays.
- Impact: Improved claim turnaround efficiency while maintaining regulatory accuracy and high customer satisfaction in a fully remote, high-demand environment.
Remote Benefit Verification Specialist
Talent Bridge
11.2020 - 02.2021
- Verified insurance eligibility, benefits, and coverage details to ensure accurate reimbursement and minimize claim denials.
- Researched payer portals and insurance databases to validate policy information with precision.
- Processed prior authorization requests in compliance with payer and HIPAA standards.
- Maintained detailed documentation to support billing accuracy and regulatory compliance.
- Delivered responsive service via phone and email, contributing to improved patient satisfaction and streamlined revenue cycle processes.
- Impact: Reduced billing discrepancies and prevented reimbursement delays through proactive verification and documentation accuracy.
Remote Fraud Specialist
TTEC
04.2020 - 11.2020
- Monitored high-volume financial transactions to detect suspicious activity and mitigate fraud risk.
- Applied analytical review techniques to identify irregular patterns and escalate confirmed fraud cases.
- Documented investigative findings to support regulatory audits and compliance reporting.
- Collaborated cross-functionally to strengthen fraud prevention controls and reduce organizational risk exposure.
- Impact: Contributed to loss prevention efforts by identifying fraudulent activity and supporting improved internal control processes.
Litigation Paralegal
Law Office of Johnny Phillips
04.2018 - 08.2019
- Managed complex case files and maintained organized litigation documentation systems.
- Conducted legal research using LexisNexis and Westlaw to support case strategy development.
- Drafted pleadings, motions, and discovery documents in compliance with court rules and deadlines.
- Coordinated service of process and maintained professional client communications.
- Impact: Strengthened case preparation efficiency and ensured strict adherence to procedural requirements and court deadlines.
Legal Administrative Assistant
King & Spalding
02.2000 - 08.2017
- Provided executive-level administrative support in a high-volume litigation environment.
- Prepared case summaries, chronologies, and trial exhibits to support attorney strategy.
- Managed complex legal calendars, depositions, and court filings with zero missed deadlines.
- Maintained extensive legal databases and documentation systems.
- Impact: Supported litigation teams in maintaining operational efficiency, deadline compliance, and organized case management over a 17-year tenure.
Education
Bachelor of Arts - Business Administration
The University of Arizona Global Campus
12.2028
Skills
- Absence Management & Leave Administration
- Medical Certification & Eligibility Analysis
- Claims Adjudication & Determination Writing
- SLA & Productivity Management
- HRIS & Claims Management Systems
- Legal Research (LexisNexis, Westlaw)
- Data Entry (55 WPM)
- FMLA & Multi-State PFML Compliance (MA, CT, DE)
- ADA & Regulatory Interpretation
- Audit Readiness & Documentation Control
- Fraud Detection & Risk Mitigation
- Insurance Verification & Prior Authorization
- Microsoft Office Suite (Excel, Word, Outlook)
Timeline
Remote Leave of Absence Representative
Sedgwick
10.2021 - Current
Remote Benefit Verification Specialist
Talent Bridge
11.2020 - 02.2021
Remote Fraud Specialist
TTEC
04.2020 - 11.2020
Litigation Paralegal
Law Office of Johnny Phillips
04.2018 - 08.2019
Legal Administrative Assistant
King & Spalding
02.2000 - 08.2017
Bachelor of Arts - Business Administration
The University of Arizona Global Campus