Summary
Overview
Work History
Education
Skills
Timeline
Generic

Lakeldrick Mcguire

Greenville,MS

Summary

Dedicated Disability Case Manager with extensive experience in coordinating and advocating for individuals with disabilities. Skilled in conducting comprehensive assessments, developing tailored care plans, and facilitating access to necessary resources and support services. Committed to empowering clients to achieve their maximum independence and quality of life. Seeking a challenging position where I can utilize my expertise to make a positive impact in the lives of individuals with disabilities.

Overview

8
8
years of professional experience

Work History

Disability Case Manager

St. Coletta's Of Illinois
01.2022 - 03.2024
  • Responsible for reviewing, investigating, or documenting Short Term Disability (STD) or Long-Term Disability (LTD) claims to determine eligibility for benefits
  • Compare claim materials against disability policy coverage to determine liabilities
  • Works with Disability Case Management Nurse and Physician Reviewers
  • Maintains up-to-date knowledge of company products and services, Fair Claims Practices, privacy regulations, and state and federal laws governing group insurance
  • Administer disability income payments on behalf of group policyholders
  • Obtain necessary agreements to determine FICA, and Federal and State income tax requirements
  • Monitors and acts on potential benefit reductions, contract fraud, and misrepresentation
  • Interpreting laws, regulations, or procedures to analyze evidence to make with recommendations; and following procedures to process eligibility claims for benefits such as but not limited to disability, worker and unemployment insurance compensation, insurance, loans, education, or retirement programs
  • Make determinations as to the eligibility for the type of benefit sought to include questions relating to adequacy of military service, medical evidence, and the evaluation of evidence of income, employability, dependence, and relationship.

Disability Case Manager | Claims Adjuster

Memorial Healthcare System- Remote
01.2019 - 01.2022
  • Evaluated account and service histories to identify trends, using data to mitigate future issues
  • Offered advice and assistance to customers, paying attention to special needs or wants
  • Answered constant flow of customer calls with up to 50 calls in queue per minute
  • Reviewed guest travel documents to meet government travel requirements and transferred the information accurately into computing systems
  • Respond to inquiries regarding healthcare benefits from providers, brokers, employers, and other customers
  • Review claims cases to assure all issues have been addressed, applies, and interprets laws, including patient case law, existing statutes and procedures, precedent rulings, and state law in the adjudication process
  • May conduct interviews in person or by phone with patients, representatives, and advocates to explain the full range of member benefits and related programs
  • Prepare and release correspondence for use by other federal, state, and local agencies
  • Utilize various electronic data processing (ALICS) systems to input data for processing claims and generating automated correspondence.

Healthcare Communications Agent Lead

Connexion Point
01.2016 - 01.2019
  • Respond to and resolve, on the first call, customer service inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, and correspondence
  • Help guide and educate customers about the fundamentals and benefits of consumer-driven health care topics to select the best benefit plan options, maximize the value of their health plan benefits and choose a quality care provider
  • Assist customers in navigating myuhc.com and other UnitedHealth Group websites and encourage and reassure them to become self-sufficient
  • Assists in maintaining a clean, organized, and efficient work area, including maintaining supplies necessary to perform job duties
  • Provide single point of contact for the member for highly designated or dedicated UHC national or key account insurance plans
  • Respond to and own consumer inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, financial spending accounts, correspondence, OptumRx Pharmacy, Optum Behavioral Health, and self-service options
  • Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member.

Education

Allied Health -

Calhoun Community College
Huntsville, AL
08.2021

General Studies -

Greenville High School
Greenville, MS
05.2016

Skills

  • Healthcare Benefits
  • Claim Billing
  • Documentation
  • Email & Fax
  • Process invoices
  • Legal Documentation
  • Processing Claims
  • Policies
  • Sales
  • Proficient Typing
  • Case Management
  • Customer Service
  • Call Center Management
  • Quality Assurance
  • Electronic Medical Records (EMR) Systems
  • Microsoft Office
  • Claims Adjuster

Timeline

Disability Case Manager

St. Coletta's Of Illinois
01.2022 - 03.2024

Disability Case Manager | Claims Adjuster

Memorial Healthcare System- Remote
01.2019 - 01.2022

Healthcare Communications Agent Lead

Connexion Point
01.2016 - 01.2019

Allied Health -

Calhoun Community College

General Studies -

Greenville High School

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