Pauline RN, SS-YB, ACS, ALMI

Experience

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  LexisNexis

  Jul 2012 - Oct 2015

  Senior Online Fulfillment Specialist

   Provided training and development, assisted with quality assessment and escalation inquiries, and collaborated with sigma projects in hand with quality and training teams for process improvement and innovation.

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  QBE Insurance

  Nov 2015 - Sept 2017

   Risk assessment of medical-financial background for underwriting insurance policies  Highest ranking analyst cross trained for both property and liability insurance administrative functions, calculated financial risk, and prepared policy contract and offers to be sent directly to clients and brokers.

  • Underwriter

    Nov 2016 - Sept 2017

  • Assistant Underwriter

    Nov 2015 - Nov 2016
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  Sun Life

  Jan 2018 - now

   Adjudicates disability for eligibility of short and long-term benefits. This includes reviewing and analyzing contractual, medical, functional, and occupational information. Coordinates appropriate interventions including, but not limited to: Independent Medical Evaluations, Functional Capacity Evaluations, Ergonomic assessments, Medical Consultant Opinions, Rehabilitation Consultant resources, and Consulting Mental Health Experts Works collaboratively with insured employees, clients, lawyers, health care practitioners and other stakeholders to obtain information, provide claim status, create action plans, and communicate verbal and written decisions while maintaining confidentiality and privacy. Conducts telephone interviews to obtain information to develop and maintain outcome-focused case management plans to support employees in their recovery and return to work. Identifies and assess medical and non-medical influencing factors, functional capability, restrictions, and limitations. Builds strong relationships with clients: employers and their employees. Participates in face to face (virtual) client meetings. Engages in continuous learning about disability practices and tools. Show less

  • Disability Case Manager

    May 2023 - now

  • Reinsurance Analyst

    Dec 2021 - May 2023

  • Administrative Support for Tele-Interview

    May 2021 - Dec 2021

  • Senior Tele Interviewer II

    Apr 2020 - May 2021

  • Senior APS Analyst II - Attending Physician Statement

    Jan 2018 - Apr 2020