Experience

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  Sedgwick cms

  Mar 2001 - Nov 2012

  Disability specialist ii (promoted from a i to a ii)

  Independently reviewed, analyzed, adjudicated, and managed short-term disability claims:Responsible for approving and authorizing payment for 200-300 claims per month, and their associated federal and state leaves of absence based on review, and analysis of medical records, to ensure compliance with claim and ERISA guidelines.Proactively managed claims to ensure timely referral to LTD to avoid lapse in benefits, and reduce the duplicate efforts in obtaining medical records. This resulted in positive employee relations for clients.Accountable for performing the two point contact that built positive relationships with claimants, advising them of the required documentation for claim processing, and ensuring a smooth claims experience.Key player in the decision for referring claimants for Independent Medical Examinations (IME) and Functional Capacity Evaluation (FCE) evaluations to alleviate claim cost, and reduce the number of fraudulent claims. Show less

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  Advantage solutions: sales, marketing, technology

  Nov 2012 - Apr 2016

  Managed all compliance issues related to disability, leave of absence, and reasonable accommodations.Responsible for independently reviewing, analyzing, and identifying all leave of absence and workplace accommodations to ensure a safe workplace, appropriate leave usage, and compliance.Independently reviewed accommodation undue hardship requests to help ensure compliance, consistency, and to follow legal guidelines, resulting in reduced liability, and increased compliance.Successfully provided leave of absence management, education, and training to all levels of employees, resulting in reduced inconsistent practices and thus risk.Effectively managed the entire operational relationship with third party vendor related leave of absence issues, ensuring all contractual terms were consistently met and that any policy or operational changes where fully and completely implemented. This resulted in higher quality, and increased employee satisfaction, loyalty, and retention. Show less Effectively handled a wide range of day to day benefits transactions and escalated benefit issues.Responsible for administrating benefit programs, including medical, dental, vision, life, 401k, flexible spending, HSA, COBRA, and voluntary, supplemental plans, successfully resolving escalated issues, including issues related leave of absence and disability.Key participant in the review, analysis, and selection of new vendor carriers, and third party administrators, for employee benefit plans. Selections provided reduced premium cost and enhanced employee choice. Independently responsible for managing employee communications regarding new benefit offerings, including the introduction of a tax favored health plan. Show less

  • Workforce Compliance Specialist (Promotion)

    Jul 2015 - Apr 2016

  • Benefits Specialist

    Nov 2012 - Jul 2015
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  Providence st. joseph health

  Apr 2016 - Oct 2020

  Integrated absence management (iam) analyst

  Proactively research and identify absence related inquiries/service tickets and exception reports from third-party administrator regarding worked hours, usage of paid time off (PTO), historical data, and eligibility feed issues that may impact employee’s benefits, pay, or leave eligibility. This eliminates compliance issues, employee relations and grievance issues; decreases employee dissatisfaction; and, ensures correct data. Work with other shared services entities to correct errors (Payroll, Benefits, etc.).Data analytics, utilizing discrete systems, including customizing high level standard and ad-hoc reports utilizing pivot tables and V-Lookup on multiple platforms of data, devise complex formulas, and prepare complex reports and make recommendations for policy and other actions.Audit cases of employee absenteeism lacking proper approval or notification, referring cases as appropriate to the applicable HR Business Partners to determine next steps and reducing costs related to unauthorized absence. Ensure that employees with multiple roles have consistent leave status to eliminate pay, benefits, accrual and other related errors.Check the ERP system on a regular schedule for employees on or transitioning to an unpaid leave of absence to ensure that benefit premiums are properly charged, resulting in less expense in lost premiums to the organization.Develop and manage COBRA audits that identify employees on leave that need to be moved to COBRA, eliminating benefit cost for the organization. In addition, this often results in employees returning to work faster, where clinically appropriate due to the cost of COBRA, which decreases temporary staffing costs and increases productivity. Provide extensive consultative assistance, including training, to the Benefits & Payroll Departments on matters of STD, LTD, and CA SDI. Show less

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  City of hope

  Oct 2020 - now

  Leave & disability program manager

  CITY OF HOPE, Duarte, CAOctober 2020 - PresentCity of Hope is a leading healthcare enterprise with approximately 13,000 employees across multiple states, including California, Chicago, Atlanta, and Phoenix.Subject Matter Expert for leave and disability programs, ensuring compliance with FMLA, CFRA, PDL, ADA, USERRA, and other related state leave laws.Provide guidance and consultation to employees and managers on leave policies and benefits, resolving disputes and grievances as needed.Manage all aspects of short- and long-term disability claims, ensuring timely resolutions and coordinating Return to Work processes.Develop and recommend improvements to leave policies and procedures to enhance efficiency and compliance.Collaborate with Payroll, Benefits, HRIM, and Employee Health Services to ensure accurate leave processing and resolve claims issues.Oversee vendor relationships for STD, LTD, and leave management, ensuring high-quality claims handling and policy compliance.Produce and analyze reporting metrics for leave and disability cases, identifying trends and presenting recommendations to leadership.Provide ongoing training and support for managers and employees on leave policies, disability management, and related processes.Represent the Total Rewards/Benefits Team during New Hire Orientation, Benefits and Wellness Fairs, and annual open enrollment.Expertise in ensuring workplace compliance with Fairness for Pregnant Workers Act (FPWA) Show less