Taylor Scott
Chicago,IL
Summary
Enthusiastic Claims Representative motivated to maintain customer satisfaction and contribute to company success. Proven ability to establish rapport with clients and claimants. Resolute and driven, with strong time management and prioritization abilities. Committed to training and mentoring new colleagues.
Overview
5
5
years of professional experience
Work History
Senior Disability Representative
Sedgwick Claims Management
10.2019 - Current
- Manages 150-200 claims per day
- Maintains contact with claimants, medical provider, and employer to determine treatment and claim status
- Verifies eligibility and determines fair compensation
- Review medical treatment records and determine the impact of one’s condition
- Read over benefit policies to ascertain levels of coverage and determine whether claims would receive approvals or denials
- Organizes, plans, and documents materials for Short Term Disability claims
- Identified and forwarded claims to specialized internal and external resources in areas such as medical review, investigations, appeals, SSI, ADA Specialist, and clients
- Applies fundamental liability concepts, practices, and procedures of state or federal laws and requirements
- Reviews new files to determine status of injury claim and to develop a plan of action
- Reviewed and analyzed suspicious and potentially fraudulent claims
- Mentor/trainer to onboarding colleagues
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Greeted customers warmly to set tone of customer experience and provide welcoming and friendly atmosphere.
- Developed and maintained positive customer relations and coordinated with team members to properly handle requests and questions.
- Communicated with clients and customers to gather, provide and share updated information on products and services.
- Learned and followed all organizational policies and procedures to maintain safe and professional working environments.
- Responded to customer questions via telephone and written correspondence regarding insurance benefits, provider contracts, eligibility, and claims.
- Collected, arranged, and input information into database system.
- Helped meet changing demands by recommending improvements to business systems or procedures.
Leave of Absence Coordinator
Sedgwick Claims Management
08.2018 - 10.2019
- Service employees by interpreting and administering leave of absences under Family and Medical Leave Act (FMLA) according to Federal and State guidelines and client specifications which included approving and/or denying leave cases based on relevant medical information
- Also ensures that HIPPA and employee privacy guidelines were closely monitored and executed
- Manages a workload of over 150 claim-count and reviews claims daily for appropriate and timely decision making as well as ensuring all correspondences were provided to the proper recipients
- Provides additional support to other team members as needed
- Interfaces with other claim examiners and customer service representatives daily
- Provides ongoing communication via verbal and outgoing correspondences between the client and claimants
- Handles inbound and outbound calls from claimants, clients and other individuals who were pertinent to the claim.
- Improved office efficiency by effectively managing internal communications and correspondence.
- Administered employee benefits programs and assisted with open enrollment.
- Advocated for staff members, helping to identify and resolve conflicts.
- Conducted performance reviews and provided feedback to managers on employee performance.
Education
Associates of Arts - Business Administration
South Suburban College
05.2018
Certificate - Project Management
Coursera
11.2023
Google Project Management Certificate -
Skills
- Project management
- Customer service
- Microsoft Office
- Training Development and Execution
- Attention to detail
- Adaptability and flexibility
- Effective communication
- Empathy and understanding
- Process Improvement
- Analytical Thinking
- Organizational skills
- Medical terminology
Timeline
Senior Disability Representative
Sedgwick Claims Management
10.2019 - Current
Leave of Absence Coordinator
Sedgwick Claims Management
08.2018 - 10.2019
Associates of Arts - Business Administration
South Suburban College
Certificate - Project Management
Coursera
Google Project Management Certificate -
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