ShaRon Blackmon
Ruskin,FL
Summary
Highly skilled case management professional with comprehensive experience in handling short-term disability claims. Expertise in assessing medical documentation, coordinating with healthcare providers, and ensuring compliance with policies. Strong focus on team collaboration and achieving results, consistently delivering reliable support and adapting to changing needs. Known for effective communication, critical thinking, and empathy.
Overview
22
22
years of professional experience
Work History
Short Term Disability Case Manager
MetLife
2022.08 - Current
- Managed 50-150 STD block of claims and possible companion claims to include Statutory plans,
- Federal, company, state and other leave types as required by group customers or other Federal, State, local laws.
- Managed complex short-term disability claims while ensuring compliance with regulatory requirements.
- Assessed medical documentation to determine eligibility for benefits and appropriate case outcomes.
- Reviewed new files to determine current status of injury claim and to develop plan for return to work.
Leave of Absence Case Manager
Chrysalis Health
2019.08 - 2022.08
- Processes complex claims that pend for various hold reasons to assist in the final determination on claim disposition
- Managed approximately 100 leave of absence processes, ensuring compliance with company policies and regulations.
- Coordinated communication between employees and management regarding leave entitlements and status updates.
- Served as a point of contact for employees seeking information about their leave options, providing knowledgeable assistance in navigating complex situations.
- Provided compassionate support to employees experiencing personal or family medical issues, easing the stress of navigating leave processes.
Sr. Claims Analyst
Humana
2018.08 - 2019.08
- Processes Institutional, Professional claims that pend for various hold reasons to assist in the final determination on claim disposition
- Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing referrals and adjusting claims, DME for Medicaid community and state programs
- Consistently meet established productivity, schedule adherence and quality standards
- Facets system process contact with hospitals and medical system for claims
- Review critical errors from EDI submissions, research and correct data in system.
Workers' Compensation Claims Adjuster
Aetna, a CVS Health
2015.06 - 2018.08
- Evaluated and processed 50-200 high volume of workers' compensation claims to ensure timely and accurate resolutions.
- Collaborated with medical professionals to assess treatment plans and validate claim legitimacy.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Analyzed information gathered by investigation and reported findings and recommendations.
Child Protective Services Caseworker Supervisor
State of Ohio
2004.06 - 2015.12
- Assessed child safety and well-being through comprehensive home visits and interviews with families.
- Supervised 6-12 caseworkers in collaboration with families, creating case plans that align with state regulations and best practices.
- Monitored performance metrics and implemented process improvements to increase case efficiency and service outcomes.
- Coordinated multidisciplinary team meetings to review case progress and strategize interventions for complex cases.
- Contributed to court proceedings, advocating for family's best interests and recommending balanced solutions.
Education
MBA - Business Administration
University of Phoenix
Phoenix, AZ2004-05
Bachelor of Arts - Sociology
College of Mt St Joseph
Tampa, FL2023-09
Skills
- Documentation skills
- Written and verbal communication
- Teamwork and Collaboration
- Analytical and Critical Thinking
- Flexible and Adaptable
- ADA Compliance
- Physician Collaboration
- Medical terminology
- Great mathematical skills
- State and federal leave laws
- Client relationship management
- Multitasking Abilities
Timeline
Short Term Disability Case Manager
MetLife
2022.08 - Current
Leave of Absence Case Manager
Chrysalis Health
2019.08 - 2022.08
Sr. Claims Analyst
Humana
2018.08 - 2019.08
Workers' Compensation Claims Adjuster
Aetna, a CVS Health
2015.06 - 2018.08
Child Protective Services Caseworker Supervisor
State of Ohio
2004.06 - 2015.12
MBA - Business Administration
University of Phoenix
Bachelor of Arts - Sociology
College of Mt St Joseph