Monica Shelby
Prosper,TX
Summary
Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
6
6
years of professional experience
Work History
Short Term Disability Claims Manager
New York Life Insurance Co
07.2022 - Current
- Make claim / customer eligibility determinations and manage on-going claims for an assigned caseload of short-term disability claims, through capturing medical information, applying appropriate contractual provisions, following legal guidelines, and leveraging expert resources.
- Communicate with claimants, employers, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits.
- Support and promote all integration initiatives (including Family Medical Leave, Life Assistance Programs, Integrated Personal Health Team, Your Health First, Healthcare Connect, etc.)
- Ability to handle potentially high levels of call volume from customers and clients. Respond to various written and telephone inquiries, including eligibility, approval/denial determinations, status and continuation or closure of benefits.
- Work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis
- Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information
- Pay all covered claims accurately and timely
- Execute on all customer performance guarantees
- Adhere to standard timeframes for processing mail, tasks and outliers
- Understand Group Operations and Corporate Compliance, Polices and Procedures and best practices
- Stay abreast of ongoing trainings associated with role and business unit objectives
- Respond to all telephonic and email inquiries within customer service protocols in a clear, concise and timely manner
Insurance Coordinator
Dr. James Dean Jensen
07.2020 - 07.2022
- Verified insurance and communicated coverage to staff and patients.
- Obtained data such as patient, insurance ID, insurance provider and medical codes to properly file insurance claims.
- Obtained prior authorization and precertification for outpatient procedures.
- Filed and tracked insurance claims and communicated claims status to patients.
Client Success Manager
Thomson Reuters
10.2017 - 12.2019
- Built constructive customer relationships to improve loyalty and recommendations.
- Utilized advanced skills in solving problems and making accurate decisions to implement strategies that brought about immediate results.
- Identified changing customer needs and adapted service strategies to meet them.
- Evaluated current customer retention strategies and recommended improvements.
- Utilized knowledge of customer experience to create specialized plans for customer retention.
Education
High School Diploma -
Dallas Lutheran School
Dallas, TXSkills
- Proficiency with MS Office applications (Word, Outlook)
- Proven track record of successfully driving results in a complex matrix environment
- Strong critical, analytical and investigative skills; ability to gather information, analyze facts, and draw conclusions
- Ability to work with a sense of urgency and be a self-starter with a customer focus mindset
- Ability to build and maintain effective relationships
- Effective interpersonal, written and verbal communication skills
- Excellent planning, time management and organizational skills
- Ability to manage multiple and changing priorities
- Strong negotiation skills
- Knowledge of legal liability, insurance coverage and medical terminology
- Technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously
Timeline
Short Term Disability Claims Manager
New York Life Insurance Co
07.2022 - Current
Insurance Coordinator
Dr. James Dean Jensen
07.2020 - 07.2022
Client Success Manager
Thomson Reuters
10.2017 - 12.2019
High School Diploma -
Dallas Lutheran School