Laura Young
Fremont
Summary
Professional claims specialist with strong record in handling and resolving complex claims efficiently. Adept at analyzing data, identifying discrepancies, and providing solutions that drive positive outcomes. Effective team collaborator with focus on achieving results and adapting to evolving requirements. Skilled in negotiation, customer service, and regulatory compliance, consistently ensuring accuracy and fairness.
Overview
25
25
years of professional experience
Work History
Disability Claim Specialist-Microsoft Team
Prudential
01.2022 - Current
- Effective and timely management of a combined block of Complex STD/LTD/WOP claims
- Demonstrated risk management practices
- Collaboration and mentoring with Claims Resource Group (CRG) on claims identified that warrant investigation
- Mentoring DCM’s (through Pru’s mentorship program)
- Active coaching and resource for the team for Appeals and Litigation
- Release Point escalation liaison
- Daily LTD Metrics and P360 (WOP) Metric reporting to team.
- Collaborated with cross-functional teams to resolve complex claim issues promptly.
- Developed process improvements that enhanced workflow efficiency within the claims department.
- Enhanced customer satisfaction with timely communication, empathy, and clear explanations of claim outcomes.
- Developed strong working relationships with external partners such as adjusters, legal counsel, and medical professionals to facilitate efficient claim resolution processes.
- Handled high-pressure situations with professionalism and composure, consistently achieving positive outcomes for both clients and the organization.
- Achieved performance targets consistently through attention to detail, effective time management, and strong decision-making abilities.
- Improved team morale and productivity by fostering collaborative work environment.
Sr. Appeals Analyst
Prudential
01.2014 - 01.2022
- Project work including auditing of External File Reviews completed by independent physicians for quality, accuracy and consistency.
- Project work developing internal quality review (QTS) sheet for Appeal Review Unit.
- Project work involving Appeal Unit feedback tracking to core associates and leadership.
- Met and exceeded all productivity metrics
- Actively assist other appeal specialists when needed including STD appeals and coaching.
- Train and coach new hires on LTD, LCMS and Waiver of Premium handling.
- Accurate and timely determinations-99% quality of claim referrals
- Extensive knowledge of 2018 ERISA guidelines
- Knowledge of HIPPA regulations and applications
- Handle Waiver of Premium and Total Disability appeals including Non-ERISA, offset and overpayment appeals
- Streamlined and updated the STD/LTD job aid to incorporate overpayment appeals.
- Collaborate and identify claims for CRG involvement
Long Term Disability Manager
Matrix Absence Management
01.2013 - 01.2014
- Conducted reviews of claims files received on appeal
- Actively pursue and follow-up on key pieces of information pertinent to a timely and appropriate decision.
- Exceeded productivity goals every month
- Actively assisted other appeal specialists when needed
Appeals Unit Manager
Aon/Hewitt
01.2008 - 01.2012
- Manage daily activities of 6 team members
- Timely response to all insurance department and EEOC complaints.
- Conduct performance reviews, interviews, terminations and development of performance management plans.
- Generate and distribute weekly reporting tools to internal and external customers
- Perform quality audits on all team members
- Extensive knowledge of HIPPA, FMLA, and STD/LTD Disability products
- Created Ad Hoc reporting system in Microsoft Access which allowed effective management for the appeal team to improve decisional timeliness from 47.9 days to 36.5 days.
- Drafted and consulted on all Requests for Proposals and worked closely with leadership for implementation on all incoming new business.
LTD Appeals Specialist/Case Support Specialist/Client Services Consultant
MetLife
01.2001 - 01.2008
- Conducted reviews of claims files received on appeal
- Office liaison for Auto & Home recovery/SIU and SIU investigations
- Exceeded productivity goals every month
- Actively assisted other appeal specialists when needed
- Accurate and timely determinations
- Extensive knowledge of ERISA guidelines
- Handled all remanded litigation files.
- Compiled deliverables, ad hoc reporting, data gathering and root cause analysis
- Trained new hires in FMLA procedures and guidelines
- Trained associates in STD/LTD/FMLA
- Constant re-prioritization of objectives
- Job coaching/mentoring
- Office liaison for Auto & Home recovery/SIU and SIU investigations
- Co-ordinate assistance teams for backlog claims recovery
- Developed, implemented and coordinated Flight School/New Hire training for all new hires
- Interpret and conclude all incoming internal and external customer issues and escalations.
- Correctly reconciled and distributed monthly premiums
- Troubleshooting incorrect plan language and correcting for the claims unit.
- Drafting of Summary Plan Descriptions
- Drafting of LTD, STD, FMLA, Appeals template letters
- Compiled weekly appeals reports, deliverables charts, ad hoc reports
- Daily interaction with national customers and complaints.
- Assisted in production and presentation of Finalist Presentation demonstrations
Education
B.A. - Criminal Justice
Western Illinois University
Macomb, IL01.1999
Masters Certificate - Training and Development
Roosevelt University
Schaumburg, IL01.2007
Masters - Clinical Professional Psychology
Roosevelt University
Schaumburg, IL01.2006
B.A. - Psychology
Western Illinois University
Macomb, IL01.1999
Skills
- Claims processing/investigation
- Policy interpretation
- Claims analysis
- Complex claims consulting
- Coaching and mentoring
- Training and Development
- Teamwork
- Excellent verbal and written communication
Accomplishments
ADAPT BRG-Board of Directors
PRIDE, Generations, and Women Empowered BRG member
Timeline
Disability Claim Specialist-Microsoft Team
Prudential
01.2022 - Current
Sr. Appeals Analyst
Prudential
01.2014 - 01.2022
Long Term Disability Manager
Matrix Absence Management
01.2013 - 01.2014
Appeals Unit Manager
Aon/Hewitt
01.2008 - 01.2012
LTD Appeals Specialist/Case Support Specialist/Client Services Consultant
MetLife
01.2001 - 01.2008
Masters Certificate - Training and Development
Roosevelt University
Masters - Clinical Professional Psychology
Roosevelt University
B.A. - Psychology
Western Illinois University
B.A. - Criminal Justice
Western Illinois University
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