Sierra Tiwari
Allentown,PA
Summary
Senior Claims Analyst with extensive experience in disability and life insurance, specializing in policy interpretation and accurate claims adjudication. Proven expertise processing state and short-term disability claims using FINEOS and other integrated claims management systems to ensure timely, compliant decisions. Skilled in developing and optimizing workflows to improve operational efficiency and turnaround times, while also supporting team growth through the creation of training materials and learning resources.
Overview
2027
2027
years of professional experience
Work History
Claims Analyst
Voya Financial
03.2026 - Current
- Experienced using FINEOS to process integrated disability claims.
- Managed multiple leave types, including ADA, FMLA, and state-specific plans like CA VDI, CO PMFML, NY DBL, NY PFL, and MN PFML. Assisted employees with navigating various leave options, ensuring compliance with ADA and FMLA regulations. Coordinated state leave programs to support employee needs and maintain organizational standards.
- Managed timely callbacks and proactive outreach to claimants and employers, enhancing overall service quality.
- Coordinated efforts with various departments to address and resolve complex claim issues in a timely manner.
- Resolved discrepancies in claim submissions through thorough investigation and communication.
- Educated claimants on processes, timelines, and required documentation for effective processing.
- Advised management on potential improvements to existing policies, contributing to the continuous refinement of company procedures and client outcomes.
- Identified and forwarded claims to specialized internal and external resources in areas such as medical review, investigations, tender of claim, claim subrogation or physical damage experts.
Short Term Disability Case Manager
Guardian Life Insurance
Bethlehem, PA
10 2024 - 03.2026
- Managed a high-volume caseload of short-term disability claims from intake through final determination, ensuring timely and accurate decisions.
- Trained and experienced in Minnesota, Delaware, New York, and New Jersey state disability products and regulatory requirements.
- Reviewed medical documentation, employment information, and policy provisions to adjudicate claims in accordance with plan guidelines and regulatory requirements.
- Interpreted disability and life insurance policies to determine eligibility, benefit calculations, and coverage determinations.
- Utilized FINEOS and other claims management systems to document claim activity, maintain accurate records, and track decision timelines.
- Communicated with claimants, employers, and medical providers to gather required documentation and provide status updates.
- Ensured compliance with state disability regulations, FMLA, ADA, and company policies.
- Maintained quality assurance standards while meeting productivity and turnaround time goals.
- Participated in workflow improvements and supported training initiatives to enhance team performance.
Customer Care II
Guardian Life Insurance
Bethlehem, PA
07 2023 - 10.2024
- Delivered high-volume customer support for LTD, STD, ADA, FMLA, state disability, and life insurance claims, ensuring accurate and timely resolution of inquiries.
- Interpreted policy provisions and explained eligibility, benefits, and claims processes to customers, employers, and internal stakeholders.
- Utilized FINEOS and multiple integrated systems to document interactions, research claim details, and resolve complex service issues.
- Collaborated with the FINEOS Early Adopters team to support system enhancements and workflow development, improving operational efficiency.
- Assisted in peer training and onboarding by facilitating job shadowing and sharing best practices.
- Applied strong problem-solving and conflict-resolution skills to de-escalate concerns and improve customer satisfaction.
- Consistently met or exceeded performance metrics, including quality assurance, call handling time, and service level standards.
Education
Integrated Biology - undefined
Cedar Crest College
Allentown, PA05-2023
Skills
- Short-Term Disability (STD) Claims Adjudication
- Long-Term Disability (LTD) Claims Knowledge
- State Disability (MN, DE, NY, NJ)
- Life Insurance Claims
- Policy Interpretation & Benefit Determination
- Medical Documentation Review
- FMLA & ADA Compliance
- ERISA & Regulatory Compliance
- FINEOS Claims Management System
- Claims Documentation & Case Management
- Benefit Calculations
- Workflow Development & Process Improvement
- Quality Assurance & Audit Readiness
- Customer Service & Conflict Resolution
- Training & Onboarding Support
- Cross-Functional Collaboration
- High-Volume Caseload Management
- Multi-System Navigation
Accomplishments
- While enrolled at Cedar Crest College, I mentored high school age girls interested in pursuing careers in STEM.
Timeline
Claims Analyst
Voya Financial
03.2026 - Current
Integrated Biology - undefined
Cedar Crest College
Short Term Disability Case Manager
Guardian Life Insurance
10 2024 - 03.2026
Customer Care II
Guardian Life Insurance
07 2023 - 10.2024