Teran Parris
Dallas
Summary
While maintaining a balance between corporate, client, and team best practices, for me I also think relationships, empathy, and trust are important concepts when you are helping people in possibly the worst time of their lives. I am passionate about my clients and believe that claims management is a team approach. Working with my teams, clients, claimants, and their provider's we have a proven track record of reduction in lost time days, and in ensuring a sustainable return to work.
Overview
17
17
years of professional experience
Work History
Operations Manager
Sedgwick CMS
11.2023 - Current
- I oversee the operations of multiple leadership teams responsible for managing diverse client disability and leave claims
- My role involves driving performance, ensuring teams meet client requirements, and delivering the highest levels of customer care, quality, and service
- I actively engage with the teams, conducting frequent reviews of complex or high-exposure cases and providing support, guidance, and motivation to ensure teams meet expected standards
- Additionally, I ensure that high-impact tasks, such as month-end billing and client bordereaux management, are appropriately and timely handled through proper planning and coordination
- I also maintain client relationships, ensuring ongoing partnerships, and oversee the implementation of new accounts and processes
- Moreover, I develop new processes in response to changing client needs and identify opportunities to enhance overall team performance, actively engaging leadership in discussions and change management while making recommendations for mitigation plans
- Supervise and coordinate the multiple team's activities to ensure tasks are prioritized and completed efficiently, in collaboration with team leads input when necessary
- Confirm compliance with company policies together with client and regulatory requirements
- Resolves all major customer service issues
- Identifies and solicits cross-selling opportunities
- Negotiates changes or improvements to service plan
- Reviews and identifies areas of potential dissatisfaction
- Ensure high-impact tasks, such as month-end billing and client bordereaux management, are handled appropriately and timely, with proper planning and coordination
- Review monthly payment reconciliations to ensure compliance before sending them over to the client, verifying accuracy and resolving any discrepancies
- Administers company personnel policies in all areas and follows company staffing standards and training recommendations
- Conducts regular reviews of operational activities – ensuring team maintains accurate and up-to-date records in the claims management system, compliant to agreed processes and meeting internal KPIs and client’s SLAs
- Reinforce a culture of continuous improvement by identifying areas for attention, develop efficient workflow that maximizes productivity and implementing changes
- Establish quantitative and qualitative metrics, guidelines, and standards by which efficiency and effectiveness can be evaluated
- Identify and advise of trends, problems, and issues as well as recommended course of action; informs new procedures and ideas for continuous process improvement; and coordinate with other management projects for the office
Workforce Absence Management Team Lead
Sedgwick CMS
03.2023 - 11.2023
- I was responsible for overseeing the operations of multiple teams of examiners responsible for disability and leave claims for our clients
- My responsibilities encompassed providing training, monitoring individual claim activities, and offering technical and jurisdictional guidance to examiner reports on claims adjudication
- I maintained a proactive involvement in claims within the teams and conducted frequent reviews on complex or high-exposure claims
- Additionally, I undertook the compilation, review, and analysis of management reports and took appropriate actions based on the findings
- Supervisory duties extended to multiple teams of examiners and several technical operations colleagues, with the delegation of specific responsibilities within the unit
- The performance of quality reviews on claims was carried out in line with audit requirements, service contract stipulations, and quality standards
- Furthermore, my role encompassed the administration of company personnel policies, adherence to company staffing standards, and compliance with client internal controls, audit, and service agreement requirements
- I provided comprehensive support, guidance, leadership, and motivation to foster maximum performance within the teams
Sr. Absence Management Team Coordinator
Sedgwick CMS
08.2020 - 07.2021
- I was responsible for managing a reduced caseload of intricate claims and maintaining accurate diaries for the assigned files
- In addition, I provided assistance to the team lead in the development and analysis of reports and account trends and contributed to establishing account contact information and cultivating customer service relationships with clients
- Moreover, I conducted training sessions for team members in disability and leave across multiple accounts, fostering strong colleague engagement and retention
- I also identified trends across the team and took an active role in engaging leadership in discussions pertaining to training and development needs, all the while identifying opportunities for enhancing the overall team performance in work and caseload management
SR Disability Specialist
Sedgwick CMS
06.2017 - 08.2020
- I was to analyze complex claims, determine benefits due and make timely payments and adjustments; medically manage complex disability claims; coordinate investigative efforts and thoroughly review contested claims; evaluate and arrange appropriate referral of claims to outside vendors; and to negotiate settlement of claims up to the designated authority level
Disability Specialist
Sedgwick CMS
11.2015 - 05.2017
- I was responsible for the analysis of reported claims, determination of benefits owed, facilitation of timely payments and adjustments, medical management of disability claims, coordination of investigative efforts, comprehensive review of contested claims, evaluation and organization of appropriate referral of claims to external vendors, and negotiation of settlements up to the prescribed authority level
Return to Work Associate
Sedgwick CMS
07.2015 - 11.2015
- I was responsible for assisting the Return to Work and ADA Specialist in overseeing and managing the client's programs, policies, and procedures regarding a claimant's request for medical accommodations
- This involved analyzing reported Family Medical Leave (FMLA) requests that run concurrently with workers' compensation claims, making determinations based on state, federal, and worker's compensation claims status
- Additionally, I reviewed open and closed workers' compensation claims to determine the necessity of leave, as well as reviewed medical information to approve a claimant's request for concurrent personal accommodation leave for a period of out-of-work over six months to support their return-to-work and stay-at-home efforts
- I also identified needs, developed long-range plans and initiatives, provided advice, and recommended appropriate practices, while assisting clients with the determination of return-to-work expectations and outcomes
Leave of Absence Coordinator
Sedgwick CMS
07.2014 - 07.2015
- I was responsible for analyzing reported Family Medical Leave (FMLA) requests and adjudicating them in accordance with state and federal regulations
- I oversaw ongoing claim management to ensure alignment with company service standards and industry best practices
- My responsibilities also included establishing FMLA and state leave claims, and meticulously tracking and coding documentation in adherence to internal workflow processes
- Additionally, I analyzed FMLA claims to determine eligibility and certification, ensuring full compliance with state and federal regulations
Customer Service Representative
Sedgwick CMS
05.2012 - 07.2014
- I was to conduct operational audit reviews of new incident reports, expedite the claims application process, ensure correct case assignment, and act as a customer liaison, assisting the customer with the proper contact person to resolve problems and/or questions
- Reviewed new incident and statistical reports and communicated quality issues using application software
- Educate and inform the customer by telephone, written correspondence and/or the claims system about the documentation required to process a claim, required time frames, payment information and claim status
- Process escalated calls within the guidelines and timelines established in the client customer service instructions
Front Desk Clerk
Marriott Solana
02.2009 - 01.2010
- I worked as front desk customer service and night audit, managing customer satisfaction and accounting of days’ end
Cook Children’s Hospital
05.2008 - 01.2009
- At Cook’s I performed both Chart Analysis and medical records management
- My job duties included auditing ongoing and completed charts to ensure all hospital, state, and federal guidelines were met
- I memorized the hospitalists’ signatures to obtain provider completion when a chart was missing a required summary, and/or the wrong clinician signed off on a procedure or chart note
- I also pulled records, completed chart link into the hospital system, and determined medical information release based on guidelines and best practice
Education
NY Health Accident and Health Adjuster License -
Insurance Schools
Skills
- Claims management
- Regulatory compliance
- Process improvement
- Team leadership
- Client relationship management
- Performance metrics
- Training development
- Data analysis
- Cross-functional collaboration
- Change management
- Strategic planning
- Problem resolution
- Employee relations
- Performance measurement
- Program administration
- High-pressure environments
- Effective leader
- Process flows
Timeline
Operations Manager
Sedgwick CMS
11.2023 - Current
Workforce Absence Management Team Lead
Sedgwick CMS
03.2023 - 11.2023
Sr. Absence Management Team Coordinator
Sedgwick CMS
08.2020 - 07.2021
SR Disability Specialist
Sedgwick CMS
06.2017 - 08.2020
Disability Specialist
Sedgwick CMS
11.2015 - 05.2017
Return to Work Associate
Sedgwick CMS
07.2015 - 11.2015
Leave of Absence Coordinator
Sedgwick CMS
07.2014 - 07.2015
Customer Service Representative
Sedgwick CMS
05.2012 - 07.2014
Front Desk Clerk
Marriott Solana
02.2009 - 01.2010
Cook Children’s Hospital
05.2008 - 01.2009
NY Health Accident and Health Adjuster License -
Insurance Schools