Denice Martin

Experience

• 

  Intracorp

  Jan 2005 - Apr 2007

  Claims Customer Service Representative III

  • Examines and processes paper claims and/or electronic claims. • Follows established departmental policies and procedures, operating memos and corporate policies to resolve claims and claims issues. • Settles claims with claimants in accordance with policy provisions. • Interacts with agents and claimants by mail or phone to correct claim form errors or omissions and to investigate questionable entries.

• 

  Sedgwick

  Apr 2007 - Jan 2020

  Disability Operation Manager ​​Responsibilities include but not limited to:• Collaborate, communicate and foster alignment with other Operation managers as well as departments such as service, product and practices to provide value added service to clients.• Builds cooperation and collaboration with the business units to realize revenue growth, client value and satisfaction.• Provide the highest level of technical support as an expert in all aspects of claim management by demonstrating an intimate understanding of all aspects of STD, LTD, FMLA and ADA claim management/adjudication.• Assist with the submission of request for proposals (RFP’s) and client presentations.• Maintains current client-specific instructions to drive quality outcomes.• Implement, communicate and manage policies and procedures to comply with federal, state and client requirement and enable organization to successfully deliver on the strategic priorities.• Foster a spirit of teamwork and unity among department members that allows for disagreement over ideas, conflict and expeditious conflict resolution, and the appreciation of diversity as well as cohesiveness, supportiveness, and working effectively together to enable each employee and the department to succeed. Show less • Identifies and advises management of trends, problems, and issues as well as recommended course of action; informs management of new procedures and ideas for continuous process improvement; and coordinates with management projects for the office.• Provides technical/jurisdictional direction to examiner reports on claims adjudication.• Monitor and ensure direct reports are meeting and exceeding monthly audits.• Monitor and ensure financial specialists are updating accurate information.Managed and monitor average durations of absences.Managed and monitor total absence management for a Fortune 500 client. Show less • Determines benefits due, makes timely claims payments and adjustments for workers compensation, Social Security Disability Income (SSDI), and other disability offsets.• Communicates clearly with claimant and client on all aspects of claims process either by phone and/or written correspondence.• Informs claimants of documentation required to process claims, required time frames, payment information and claims status either by phone, written correspondence and/or claims system.• Refers cases as appropriate to supervisor and management. Show less

  • Disability Operation Manager

    Oct 2018 - Jan 2020

  • Absence Management Team Lead

    Sept 2013 - Oct 2018

  • Integrated Disability Manager II

    Oct 2010 - Sept 2013

  • Assistant Unit Manager

    Oct 2008 - Oct 2010

  • Senior Disability Specialist

    Apr 2007 - Oct 2008
• 

  DART (Dallas Area Rapid Transit)

  Jan 2020 - now

  Directs and oversees the agency-wide Short-Term Disability (STD) and Long-Term Disability (LTD) programs including development of policies and procedures to ensure compliance and coordination with applicable laws including Americans with Disabilities (ADA) and Family and Medical Leave Act (FMLA). Oversees and ensures the coordination of DART policies that support the STD Administrators performance, insures compliance with stated objectives, contract requirements, internal expectations, and applicable laws.Develops and implements audit procedures to insure TPAs adherence to statutory performance measures. Identifies statutory noncompliance, develops and implements performance improvement plans to promote observance of mandatory performance goals.Conducts periodic disability and leave claim reviews between TPA, Risk Management and DART Management using agreed upon protocols. Directs and oversees the agency-wide Family and Medical Leave Act (FMLA) program. Works closely with management and legal counsel to develop policies and procedures in accordance with federal mandates for compliance. Stays current with applicable laws and modifies policies as needed. Serves as a liaison with the Department of Labor for dispute resolution and input regarding FMLA issues.Works collaboratively to promote the utilization of the Alternative Duty return-to-work program. Responsible for promoting policies that maximize coordination, reduce unscheduled absences, and utilization of human capital to support the attainment of all departmental strategic goals.Performs a variety of complex analyses of internal costs; reviews and evaluates incurred costs, prepares budget estimates, schedules, and financial and statistical information. Provides concise on-point reports to support management decision-making.Performs supervisory duties including, but not limited to, hiring, counseling, evaluation, staff development and similar functions in support of lost time programs. Show less

  • Senior Manager, Integrated Disability and Leave Programs

    Apr 2024 - now

  • Manager, Disability and Leave Programs

    Jan 2020 - Apr 2024