MARINA RUSS
Lewisville,TX
Overview
5
5
years of professional experience
Work History
Absence Integrated Management
New York Life Group Benefit Solutions
06.2024 - Current
- Review insurance policies, coverage and claim handling practices. Ensuring compliance with government regulations related to employee leaves of absence and mitigating potential legal risks.
- Effectively communicate with claimants, employers, and various medical professionals both verbally and in writing to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits and applicable leave plans.
- Manage up to 200 complex cases involving multiple overlapping leave types, ensuring all relevant laws were properly applied and adhered to throughout the duration of each case.
- Own and review assigned cases while effectively managing work through task driven queues and multi-tasking in a fast-paced call center environment.
- Assist the network with overdue tasks to meet compliance goals and maintain company metrics while ensuring quality work.
Claims Senior Representative
New York Life Benefit Solutions formerly Cigna Group Operation
04.2021 - 05.2024
- Manage new and ongoing Short Term Disability claims within metric goals of 5-10 days
- Process and calculated Short Term, State Disability and policy offsets payments accurately within the 5-10 day deadline
- Determine customer eligibility by reviewing contractual language, monitor policy offsets, medical documentation, interpreted the information and made decisions based on the facts presented
- Work directly with clients and Vocational Rehabilitation counselors to facilitate return to work in capacity
- Communicate with customers as well as physician offices to medically manage claims from initial medical request to reviewing and evaluating medical information
- Social security, worker compensations, other disability income benefits, etc.) to ensure accurate and timely payments
- Resolve customer escalation calls with a positive approach dispelling tension when there is a difference in opinion.
Concierge
Inspired Living Lewisville
01.2020 - 04.2021
- Greeted guest/clients determined nature and purpose of visit as well as directed or escorted them to specific destination(s).
- Reviewed documents medical data regarding residents into the system and filed and maintained resident records
- Recorded guest comments or complaints, referred customers to managers as necessary
- Provided information about establishment, such as location of departments or offices, employees within the organization, or services provided.
- Managed 30-60 calls a day in regards to facility inquires and scheduling.
Education
Bachelor of Science - Clinical Psychology- Candidate
Texas Woman's University
Denton, TXAssociate of Arts - General Studies
North Central Texas College
Gainesville, TX01.2021
High School Diploma -
Lewisville High School
Lewisville, TX06.2018
Skills
- Microsoft Office (Outlook, Word, Excel, etc)
- Excellent communication and interpersonal skills to effectively interact with clients, agents, and other stakeholders
- Detail-oriented with strong organizational, analytical thinking and decision-making skills
- Organizational Management
- Records and Information Management
- Excellent Customer Service with successful problem resolution
- ICD 9/ICD 10
- MDGuidelines, Adminsuite, Acclaim
- Claim Auditing
- Call Center
- Bazinger
Timeline
Absence Integrated Management
New York Life Group Benefit Solutions
06.2024 - Current
Claims Senior Representative
New York Life Benefit Solutions formerly Cigna Group Operation
04.2021 - 05.2024
Concierge
Inspired Living Lewisville
01.2020 - 04.2021
Bachelor of Science - Clinical Psychology- Candidate
Texas Woman's University
Associate of Arts - General Studies
North Central Texas College
High School Diploma -
Lewisville High School
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