Rogelio Gamon
Tiffin,IA
Summary
I am a dependable and personable teammate who is very dedicated to my work. I enjoy learning new aspects to my job which helps me further develop my career. I am always looking to expand my knowledge and advance to the next available opportunity within the company. Growing up in a Spanish speaking household, English was my second language. This has allowed me to communicate with a larger variety of clients. I enjoy keeping things up beat and fun.
Overview
11
11
years of professional experience
Work History
Short-Term Disability Case Manager
Symetra
Enfield, CT
10.2023 - Current
- Evaluated short-term disability claims to ensure compliance with policy guidelines and regulations.
- Collaborated with healthcare providers to gather necessary documentation for timely claim processing.
- Conducted thorough assessments of claimant eligibility and communicated decisions effectively.
- Managed state offsets per the determined contract directives
- Managed state disability benefits in conjunction with employer provided disability benefits for MA, NY, NJ, OR, and CO.
- assisted with onboarding new hires and was an assigned as a mentor
- Evaluated continuous, intermittent, and reduced work schedule claims for FMLA. Also reviewed for any employer specific leave policies if employees were not FMLA eligible
Senior Disability Coordinator
Sedgwick Claims Management
Coralville, IA
11.2021 - 10.2023
- Over my five years with Sedgwick, I held several positions with a variety of responsibilities including:
- Customer Service Representative November 2017 – April 2018
- Reviewed Family and Medical leave of absence claims
- Answered phone calls from clients and provided exceptional customer service on various questions regarding their personal claims.
- Processed new claims for multiple clients
- Leave of Absence Coordinator 2019 – 2020
- Managed Family and Medical leave of absence claims
- Composed decisions on claims in compliance with Federal and State guidelines
- Managed and tracked a workload of over 350 leave claims
- Analyzed medical documents derived from doctors
- Short-term Disability Coordinator 2021-2022 and became a senior disability coordinator 2022-2023
- Manages and handles a set claim load of up to 160 – 220 claims
- Examines medical information for approval of STD pay and leave of absence for clients. As well as composes decisions on claims in compliance with Federal and State guidelines.
- Gather clarification from health care providers if any additional information is needed for approval of benefits.
- Informs associates on clarification requests and final determinations of their claims
- Reviews benefits amount dispersed to associates for accurate pay
- Also use CPT, ICD10 and ICD9 code on medical paperwork.
- Manage a wide variety of clients with different policies and provisions depending on contract and claim type.
- Update pay using ASO ATP as well as manage statutory state offsets and deductions for pay depending on state location of clients.
Frame Builder
All Steel
Muscatine, IA
02.2016 - 06.2016
- Constructed high-quality steel frames using precision tools and welding techniques.
- Inspected finished products for structural integrity and compliance with safety standards.
- Collaborated with team members to optimize assembly workflows and reduce lead times.
- Trained new employees on safe operation of machinery and frame assembly processes.
Customer Service Representative
Thomas L. Cardella & Associates
Coralville, IA
02.2015 - 01.2016
- Reviewed accounts for Verizon Fios customer
- Assisted supervisor with answering questions on call floor when busy
- Called back customers and assisted supervisors with escalated calls
- Sold Verizon products for TV, Internet, and home phone
Education
High School Diploma -
West Liberty High School
West Liberty, IA05-2010
Associate in Arts - undefined
Kirkwood Community College
Iowa City, IASkills
- Bilingual- Spanish and English
- Proficient in Microsoft Word, Excel, and PowerPoint
- Ability to maintain composure in high-stress situations
- Case management expertise
- Policy interpretation
- Ability to review complex medical documentation
Timeline
Short-Term Disability Case Manager
Symetra
10.2023 - Current
Senior Disability Coordinator
Sedgwick Claims Management
11.2021 - 10.2023
Frame Builder
All Steel
02.2016 - 06.2016
Customer Service Representative
Thomas L. Cardella & Associates
02.2015 - 01.2016
Associate in Arts - undefined
Kirkwood Community College
High School Diploma -
West Liberty High School