Siobhan Foley
UNUM
PORTLAND,ME
6
years of professional experience
Detail-oriented professional with a strong background in claims processing and compliance communication. Proven ability to manage health leave and evaluate eligibility effectively, ensuring timely and accurate claims adjudication.
Work History
Life Event Specialist
3 Years 9 Months- Manually processed and adjudicated diverse STD claims, ensuring accuracy and timeliness.
- Processed leaves related to employees’ own health conditions, ensuring compliance with internal policies and regulatory requirements.
- Applied detailed contractual knowledge, including policy provisions, eligibility rules, and liability criteria, to make sound claim decisions.
- Verified ongoing liability, monitored medical status, and identified return‑to‑work opportunities.
- Delivered high‑quality customer service by processing eligible claims promptly and responding independently to inquiries within Benefits service guidelines.
- Coordinated claim strategies with cross‑functional specialists, including nurses, physicians, and vocational rehabilitation professionals.
Eligibility Specialist
2 Years 8 Months- Reviewed applications to assess eligibility for benefits and services.
- Collaborated with team members to resolve complex eligibility challenges.
- Analyzed client documentation to ensure adherence to company policies.
- Mentored eligibility specialists and led daily team meetings to enhance performance.
- Collaborated with Client Liaisons on dedicated accounts to troubleshoot and ensure exceptional customer experience.
- Successfully exceeded required metrics and was awarded KPI Leader and Employee of The Month multiple times throughout the role.
Education
Bachelor of Science - Business Administration
Associate of Science - Business Administration And Management
High School Diploma
Skills
Claims processing
Compliance communication
Contract assessment
Eligibility evaluation
Policy implementation
Health leave management
Effective communication
Problem solving
Attention to detail
Team collaboration
Conflict resolution
Customer relationship management
Timeline
Life Event Specialist
UNUM
11.2022 - CurrentRead More
Eligibility Specialist
UNUM
03.2020 - 11.2022Read More
Westbrook High School
High School Diploma
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Southern Maine Community College
Associate of Science from Business Administration And Management
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University of Southern Maine
Bachelor of Science from Business Administration
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