Mabell Sena

• Over three years of hands-on experience managing long-term disability claims, ensuring timely and accurate decision-making.
• Investigate, analyze, and validate medical and occupational data to determine claim eligibility, and ensure proper liability management.
• Develop and execute claims management strategies to meet policyholder and claimant needs, while mitigating risk.
• Resolve discrepancies by securing additional documentation and applying policy provisions to align with company standards.
• Communicate disability decisions and benefits promptly, and empathetically, to claimants, policyholders, and stakeholders.
• Perform quality checks to maintain accurate, up-to-date claims records.

• 4 years of experience supporting eligibility and enrollment for health care plans, with a focus on long and short-term disability benefits, including navigating complex policy provisions.

• Screened and assessed prospective members for plan eligibility, ensuring compliance with guidelines, particularly in the context of disability-related claims.

• Delivered exceptional service to Spanish-speaking clients, facilitating clear communication and resolving issues efficiently.

• Handled escalated cases, providing in-depth, timely assistance to resolve complex eligibility and enrollment issues related to both short-term and long-term disability coverage.