Thomasina Ayon
Watauga,TX
Summary
Motivated team member eager to support new initiatives. Demonstrates strong work ethic, flexibility, and excellent communication abilities. Capable of working independently and rapidly acquiring new competencies.
Overview
9
9
years of professional experience
Work History
Disability Examiner
Sedgwick Claims Management
Irving, TX
02.2024 - Current
- Makes independent claim determinations, based on the information received, to approve complex disability claims or makes a recommendation to team lead to deny claims based on the disability plan.
- Reviews and analyzes complex medical information (i.e. attending physician statements, office notes, operative reports, etc.) to determine if the claimant is disabled as defined by the disability plan.
- Oversees additional facets of complex claims including but not limited to comorbidities, concurrent plans, complex ADA accommodations, and claims outside of typical guidelines.
- Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-house clinicians), as needed.
- Determines benefits due pursuant to a disability plan, makes timely claims payments/approvals and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.
- Informs claimants of documentation required to process claims, required time frames, payment information and claims status by phone, written correspondence and/or claims system.
- Communicates with the claimants’ providers to set expectations regarding return to work.
- Medically manages complex disability claims ensuring compliance with duration control guidelines and plan provisions.
- Communicates clearly and timely with claimant and client on all aspects of claims process by phone, written correspondence and/or claims system.
- Coordinates investigative efforts ensuring appropriateness; provides thorough review of contested claims.
- Evaluates and arranges appropriate referral of claims to outside vendors or physician advisor reviews, surveillance, independent medical evaluation, functional capability evaluation, and/or related disability activities.
- Negotiates return to work with or without job accommodations via the claimant’s physician and employer.
- Refers cases to team lead and clinical case management for additional review when appropriate.
- Maintains professional client relationships and provides excellent customer service.
- Meets the organization’s quality program(s) minimum requirements.
Human Resources Administrator
Sam's Club
Fort Worth, TX
11.2021 - 02.2024
- Communicate with (or to) individuals or groups verbally and/or in writing (e.g
- Customers, suppliers, associates)
- Processes payroll documentation for pay adjustments by researching, verifying and filing daily time reports, time and pay adjustments, and payroll edits; assisting with human resource functions (e.g., payroll, benefits, employment, etc.) including preparing, reviewing, analyzing and processing reports documents and logs to ensure compliance with applicable laws; responding to issues and questions related to payroll, benefits and employment; and reporting deficiencies to management
- Provides administrative and human resource function support by performing general clerical duties (e.g., filing, keying, faxing, answering phones); entering data in multiple systems; scheduling appointments and maintaining logs; and preparing, reviewing, and analyzing reports and other paperwork; processing human resources (HR) reports and documents; processing paperwork; and preparing, reviewing, and analyzing reports
- Provides assistance with multiple human resources functions by assisting with transfer orientation; preparing, reviewing, analyzing, and processing human resources (HR) reports and documents; and processing terminations and transfers
- Provides support for the hiring process by scheduling interviews and drug screens; completing reference checks; processing new hires, terminations and transfer paper and data entry work; and assisting with new hire and transfer orientation
- Assists with employment related paperwork and data entry work by processing information; completing required forms (e.g., Leave of Absence, Worker's Compensation, Occupational Safety and Health Administration (OSHA) log).
Quality Assurance Associate
Sam's Club
Fort Worth, TX
03.2021 - 11.2021
- Perform daily 2% outbound audits on orders starting from receiving to shipping
- Investigating correct inventory placement through receiving, cycle counting and proper slot procedure
- Consolidating materials and replenishing material for order filling throughout warehouse
- Increase quality expectation by identifying weakness in order filling procedure.
On-Site Manager
Sovereign Staffing Group
Fort Worth, TX
03.2020 - 03.2021
- Managed five production leads and one asset protection lead
- Reported daily attendance rate of 85% or higher
- Ensured proper compliance procedures for equipment operators, and material handler's was followed daily
- Conducted orientations for five separate shifts, helped recruiters onboard associates
- Assigned trainers for each department to execute safe training procedure
- Worked closely with clients' management to address production, conversion and discipline
- Managed 30-130 employees within each warehouse function
- Assisted payroll with 90 day pay raises for all on site associates
- Reported incident reports by following clients safety procedure.
Team Lead
J C Penney Logistics
Haslet, TX
03.2017 - 02.2020
- Cross trained in three production areas to help support business need
- Assigned to Special Projects department, working closely with Inventory Control and Receiving department to fix problem inventory
- Performed duties using Distribution Management System and Dematic System
- Staffed picking areas at beginning of shift and throughout to meet company needs
- Ensured conveyors ran without issue in picking areas by following Dematic system movement
- Maintained communication with maintenance department to identify weaknesses in conveyor system or operating system
- Managed 24 associates by following standard operating procedure and safety protocol
- Reported production data to managers throughout the day
- Reported attendance to attendance clerks daily
- Prepared detailed reports on updates to project specifications, progress, identified conflicts and team activities.
Shift Leader/Cashier
CVS Health Retail
Keller, TX
12.2018 - 01.2020
- Implemented small projects to drive sales and promotions
- Performed closing store duties
- Resolved customer complaints and issues and offered thoughtful solutions to maintain customer satisfaction
- Trained new employees and delegated daily tasks and responsibilities
- Regulated pricing, inventory count and supply during shift hours.
Education
General Studies -
Lincoln High School
Lincoln, NE06.1999
Skills
- Achieved efficient claims processing, resulting in improved turnaround times
- Delivered high-quality work through meticulous attention to detail
- Enhanced team communication, fostering a collaborative environment
- Utilized analytical skills to uncover actionable insights
- Promoted team collaboration, leading to successful project completions
- Executed precise data entry, ensuring data integrity
- Elevated customer service experiences, increasing overall satisfaction
Timeline
Disability Examiner
Sedgwick Claims Management
02.2024 - Current
Human Resources Administrator
Sam's Club
11.2021 - 02.2024
Quality Assurance Associate
Sam's Club
03.2021 - 11.2021
On-Site Manager
Sovereign Staffing Group
03.2020 - 03.2021
Shift Leader/Cashier
CVS Health Retail
12.2018 - 01.2020
Team Lead
J C Penney Logistics
03.2017 - 02.2020
General Studies -
Lincoln High School