TABITHA BELL
Clover,SC
Summary
Versatile professional Case Manager with extensive knowledge of counseling principles and practices. Adept at creating individualized treatment plans and leading group therapy sessions. Committed to creating safe, supportive environment for all participants. Knowledgeable Proactive and resourceful with strong knowledge of community resources. Strong communicator with passion for helping others. Adept at handling high caseloads without sacrificing quality of care. Operates in high-pressure environments while recommending best resources and courses of action to benefit patient needs and return each to optimal quality of life.
Overview
9
9
years of professional experience
Work History
Long Term Disability Claims Examiner
New York Life
01.2023 - Current
- Investigate and processed medical insurance claims for policyholders.
- Conduct day-to-day administrative tasks to maintain information files and process paperwork.
- Interview claimants and treatment providers to gather factual information.
- Finalize medical documents for insurance claim approval and payment release.
- Research claims and incident information to deliver solutions and resolve problems.
- Handled complaints and grievances using negotiating and problem-solving skills.
- Review updated medical information to determine current status of ongoing eligibility claim and develop plan of action.
- Review and analyze suspicious and potentially fraudulent insurance claims.
- Collaborate with claims department and industry anti-fraud organizations to resolve claims.
- Examine disability forms and medical statements.
- Order medical records to complete claim files.
- Correct ICD-10 codes to properly classify medical diagnosis for claims.
Quality Auditor
Amazon
08.2022 - 12.2022
- Completed timely quality reports highlighting deficiencies and recommending corrective actions.
- Participated in compliance inquiries and provided interpretation of data to guide investigators in creation of Corrective and Preventive Actions.
- Evaluated cases and assigned grades based on factors such as approval and standard operating procedures.
- Performed continuous random spot reviews of daily logs, non-routine and case management contents for completeness, correct use of appropriate references and approved data.
- Monitored departmental forms for compliance to submissions rules and guidelines.
HR Specialist III
Amazon
01.2021 - 12.2022
- Coordinate refresher training for disability case managers by designing PowerPoint presentations while outlining key concepts and errors and elaborating policies and procedures, achieving a 95% score in audits and productivity
- Structure lesson plans and job aids to train a team of 12 members to upscale technical expertise and competency, elevating employee productivity
- Elevate performance productivity by delegating tasks and assigning project timelines to the competent members to enhance process improvement, exceeding outlined metrics by 20%
- Orchestrate workforce development by coordinating performance evaluations for 50 case managers and integrating training and succession planning to ensure 100% productivity is met along and maintain a 96% +audit rate
- Observe compliance to insurance policies and procedures by conducting audits and reviewing for accuracy and completion to verify if a case is denied or approved
- Implement process improvement by pulling complete reports to identify areas for improvement and track projects in time, ensuring timely completion
- Integrate cultural intelligence by collaborating with cross-functional remote teams comprising Indians to manage short-term disability claims eliminating language barriers and biases
- Spearhead the nesting of new case manager hires in India and onboarding by following the training map to enhance employee performance and caseload management
- Employ People portal, Salesforce, internal platforms, and Excel sheets to create pivot tables and prepare reports scaling operational efficiency and accuracy
- Administer projects by generating global and team reports and delegating to each case manager to ensure proper dispensing of reports.
Senior Long Term Disability Claims Examiner
Lincoln Financial Group
10.2019 - 01.2021
- Verify the accuracy and completeness of up to 15 submitted claims weekly for long-term and short-term disability, achieving 100% process implementation
- Escalate claim issues and concerns to senior team members or management and resolve them promptly and effectively, maintaining a 99% customer satisfaction rate
- Determined eligibility for complex Short-Term and Long-Term Disability Claims and managed claims to determine ongoing benefits by reviewing medical with internal physicians and nurses
- Referred claims to SIU (Surveillance Investigation Unit) to obtain additional information on claimants and determine if Disability is supported, increasing operational efficiency by 80%
- Managed claims through various case management systems to issue payments, stop payments, set follow-up tasks, review, and send documents
- Saved over 30k in reserves (money set aside to pay on the life of a claim) by helping individuals return to work by working with employers to make accommodations or referring claimants to the Vocational Rehabilitation department to find alternate occupations
- Facilitated and created reports for unit audits by reviewing open and closed claims to ensure correct coding and appropriate documentation and provided feedback to seniors and management on trends and training that may be needed
- Meet team and unit metrics by approving and closing claims for the current month, earning recognition from senior management for resourcefulness and productivity
- Achieved and sustained quality claim execution, supporting a culture of diligence and accuracy while applying appropriate claim management and documentation in day-to-day claim status and decision making to drive individual, team, and business unit results
- Support critical activities that drive appropriate inventory risk management, including resource utilization and initial and ongoing claim management
- Deliver 55-65% (Dover, Charlotte, Phoenix), and 80% (Omaha, Atlanta) of initial liability decisions are accepted, with 80% of initial decisions made by day and 45 Initial determinations made within 45 days.
Transformation Specialist I
The Harvest Center Of Charlotte
08.2019 - 10.2019
- Followed all company policies and procedures to deliver quality work.
- Listened and responded to families requests and forwarded necessary information to superiors.
- Interpreted clients' needs and introduced services to fit specific requirements.
- Communicated closely with other counselors to devise programs and activities based on developmental and academic levels.
- Identified risk and resiliency factors within individual youth, peer group, family, school and community and developed strategies for intervention
- Used cognitive behavior therapy to assist clients in recognizing and redirecting poor habits.
- Provided individual counseling services to individuals and families with adjustment issues and partnered to facilitate weekly support groups.
- Assessed clinical risk and danger to children and families and determined appropriate level of response and intervention.
- Developed service plans to maintain intact families and improve family functioning.
- Kept abreast of new and developing information in mental health field by attending professional conferences and workshops.
- Provided comprehensive case management services, created treatment plans and connected clients and families to appropriate resources.
Financial Aid Social Worker
Child Care Resources Inc
01.2019 - 08.2019
- Managed 5-15 cases monthly for recertification to determine ongoing monthly parent copay
- Excelled as an intake case manager to determine the appropriateness of requests for financial assistance with child care services in
- Mecklenburg County
- Oversaw caseloads of 200+ families while maintaining a 90% accuracy rate or better
- Spearheaded and monitored the visitation process for 35+ families weekly
- Completed monthly recertifications and processed cases promptly
- Coordinated with other case managers for weekly Work First client intake appointments
- Created and maintained monthly reports on intakes and productivity
- Determined eligibility within program policies and income guidelines
- Established placement of children in appropriate child care situations
- Periodically visited daycare centers and childcare homes while developing effective working relationships to foster positive relationships with clients and providers
- Communicated with local Department of Social Services staff and community partners
- Facilitated case managers and supervisors with audits and filing cases and oversaw audits and filing cases
- Analyzed and mentored other staff members on child development, state and local eligibility regulations of funding, childcare services, and child care licensing rules.
Family Support Specialist
Commonwealth of Kentucky
10.2016 - 11.2018
- Reviewed over 50+ eligibility documents weekly for families looking for government assistance
- Successfully helped transition 85% of caseload into stable home environments within 6 months
- Maintained a client approval rate of over 80%, according to quarterly surveys
- Met with families weekly, providing emotional and mental support for dire situations
- Organized and filed all documentation expeditiously, keeping errors
- Reviewed functional behavioral assessments and ensured the development and approval of behavioral support plans to meet 62 clients weekly
- Prepared financial summaries and maintained case records of making appropriate referrals as needed
- Completed investigative reports for cases of suspected fraud and referred to special programs for further investigation.
Social Service Aid II
Commonwealth Of Kentucky
01.2015 - 10.2016
- Spearheaded and monitored the visitation process for 35+ families weekly
- Overviewed privacy documents concerning medical and psychological states
- Analyzed and documented visitations, informing upper management of safety and wellness concerns, increasing and monitoring family’s care concerns
- Built meaningful relationships with parents, foster parents, and community partners, fostering a positive and trusting environment
- Referred clients to community resources for job placement, debt counseling, legal aid, housing, medical treatment, or financial assistance and provided factual information.
Substance Abuse Counselor Intern
Turning Point Youth
08.2014 - 12.2014
- Led supportive group discussions and education sessions with adolescents and families with chemical dependency disorders.
- Supported and assessed clients struggling with addiction or relationship issues and devised strategies based on client needs.
- Developed individual treatment goals based on history and diagnosis.
- Provided counseling and support to clients with drug and alcohol abuse issues.
- Provided comprehensive case management services, created treatment plans and connected clients and families to appropriate resources.
Education
Bachelor of Science - Psychology
Ashworth College
Norcross, GA05.2018
No Degree - Substance Abuse Counseling
Penn Foster
12.2014
Skills
- Project Management - Organizational Change - Training Facilitation - Team Leadership - Reporting & Analysis - Process Mapping -
- Human Resource Management - Process Improvement - Employee Engagement - Employee Benefits - Quality Control -
- Investigations - Compliance - Negotiation - Time & Attendance
- Case Notes
- Medical Records Management
- Corporate Policies and Procedures
- Claims Investigations
- Mood Disorders
- Crisis Response
- Social Work
- Suicide Risk Assessments
- Family Therapy
- Outreach Programming
Affiliations
Professional Memberships with the National Federation of Families for Children’s Mental Health and NAADAC
Ronald McDonald House of Charities of the Central Valley Volunteer.
Timeline
Long Term Disability Claims Examiner
New York Life
01.2023 - Current
Quality Auditor
Amazon
08.2022 - 12.2022
HR Specialist III
Amazon
01.2021 - 12.2022
Senior Long Term Disability Claims Examiner
Lincoln Financial Group
10.2019 - 01.2021
Transformation Specialist I
The Harvest Center Of Charlotte
08.2019 - 10.2019
Financial Aid Social Worker
Child Care Resources Inc
01.2019 - 08.2019
Family Support Specialist
Commonwealth of Kentucky
10.2016 - 11.2018
Social Service Aid II
Commonwealth Of Kentucky
01.2015 - 10.2016
Substance Abuse Counselor Intern
Turning Point Youth
08.2014 - 12.2014
Bachelor of Science - Psychology
Ashworth College
No Degree - Substance Abuse Counseling
Penn Foster
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