Summary
Overview
Work History
Education
Skills
Timeline
Generic

Valencia Gopaul

Orlando,FL

Summary

Skilled Absence Management Specialist with broad experience in managing employee leaves and absences. Strengths include knowledge of federal, state, and local leave laws, strong interpersonal skills for effective communication with employees and management, as well as efficient problem-solving abilities for handling complex cases. Previous work focus on reducing unplanned absences by implementing proactive absence management strategies that align with company objectives.

Overview

10
10
years of professional experience

Work History

Absence Management Specialist

Insight Global
06.2024 - Current
  • Managed case management services, including reviewing medical documentation to adjudicate leaves in compliance with corresponding leave plans, federal and state laws, and benefit plans as defined by Amazon.
  • Initiated and responded to inquiries about leave and disability events, benefits, and options available to employees.
  • Leveraged duration guidelines, best practice tools, and Amazon resources to support oversight of leave event, as appropriate.
  • Critically assess and adjust the case management plan to the employee's changing needs.
  • Identified and solved problems that may arise throughout cases, ensuring all documentation is in place to approve claims accordingly.
  • Facilitated a smooth return to work and ramp-back plan for employees returning to the workplace. Communicated regular updates to employees and stakeholders, both verbally and in writing.
  • Ensured compliance with standard work, federal and state regulations, and company policy.
  • Maintained system records to ensure accurate and timely information/documentation.

Disability Claims Specialist

Brown and Brown Remote
09.2021 - 06.2024
  • Reviewed and analyzed disability claims to determine eligibility for benefits.
  • Provided assistance and guidance to claimants regarding the completion of paperwork and forms related to their claim.
  • Investigated medical records and gathered evidence in support of approved or denied claims.
  • Drafted letters of notification for approved or denied claims.
  • Assisted in developing strategies for resolving complex cases involving multiple disabilities, long-term illnesses, or conflicting medical opinions.
  • Ensured that all decisions were made in accordance with applicable laws, regulations, and policies.
  • Maintained accurate records and files containing detailed information on each claim processed.
  • Researched state and federal laws related to disability benefits eligibility requirements.
  • Provided education to claimants about their rights under various disability programs.
  • Assisted claimants, providers and clients with problems or questions regarding claims.
  • Researched issues regarding disability accommodation requests, Short Term Disability (STD), and Family Medical Leave of Absence (FMLA).
  • Planned and organized a large caseload, averaging 70-95 and more. Ensured that accuracy levels were maintained and that cases were processed within the specified timeframes set by federal and state regulations.

Absence Management Specialist

Insight Global remote
10.2021 - 11.2022
  • Managed case management services, including reviewing medical documentation to adjudicate leaves in compliance with corresponding leave plans, federal and state laws, and benefit plans as defined by Amazon.
  • Initiated and responded to inquiries about leave and disability events, benefits, and options available to employees.
  • Leveraged duration guidelines, best practice tools, and Amazon resources to support oversight of leave event, as appropriate.
  • Critically assess and adjust the case management plan to the employee's changing needs.
  • Identified and solved problems that may arise throughout cases, ensuring all documentation is in place to approve claims accordingly.
  • Facilitated a smooth return to work and ramp-back plan for employees returning to the workplace. Communicated regular updates to employees and stakeholders, both verbally and in writing.
  • Ensured compliance with standard work, federal and state regulations, and company policy.
  • Maintained system records to ensure accurate and timely information/documentation.
  • Planned and organized a large caseload averaging 70-95 and more, ensured that accuracy levels were maintained and that cases were processed within the specified timeframes set by federal and state regulations.

Short Term Disability Case Manager

Reed Group Ltd
Orlando, FL
03.2017 - 12.2020
  • Responsible for providing holistic case management services for 150- 250 employee or cases, including reviewing medical documentation to adjudicate leaves in compliance with the corresponding leave plans, federal and state laws and benefit plans.
  • Investigate and evaluate STD claims and manages FMLA .
  • Track all stand-alone leaves and those running concurrently with Workers Compensation and Short T erm Disability.
  • Provide guidance and mentoring to others and projects assigned at manager's discretion and provide outstanding support for Intake/Customer Service team as needed.
  • Communicates with claimants, employers, attorneys, and various medical professionals to gather information regarding the application for, payment of, and ongoing management of STD.

Patient Care Advocate

Express Scripts
Orlando, FL
02.2015 - 03.2017
  • Managed over 50 inbound and outbound members and providers a day.
  • •Answered questions related to pharmacy benefits.
  • •Researched and resolved mail and claim issues.
  • Maintained productivity standards and performances.

Education

Some College (No Degree) - Health Science

Keiser University
Fort Lauderdale, FL

Skills

  • Strong written and verbal communication
  • Proficient in Microsoft Office, including Word, Excel, and Outlook
  • Leadership and team development
  • Employee coaching and motivation
  • Issue and Conflict Resolution
  • Policy Management
  • Communication Strategy
  • Expert with disability and Absence products

Timeline

Absence Management Specialist

Insight Global
06.2024 - Current

Absence Management Specialist

Insight Global remote
10.2021 - 11.2022

Disability Claims Specialist

Brown and Brown Remote
09.2021 - 06.2024

Short Term Disability Case Manager

Reed Group Ltd
03.2017 - 12.2020

Patient Care Advocate

Express Scripts
02.2015 - 03.2017

Some College (No Degree) - Health Science

Keiser University

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Valencia Gopaul