Regina McColley

* Manage a caseload of 90–100 Long Term Disability (LTD) claims, ensuring timely and accurate benefit determinations.
* Communicate with claimants, employers, and medical professionals to obtain information for eligibility assessment, benefit authorization, and ongoing claim management.
* Apply contractual provisions, clinical guidance, and established claim processes to ensure accurate liability and eligibility decisions.
* Provide high‑quality customer service by meeting determination deadlines and responding promptly to inquiries.
* Independently manage complex disability claims, incorporating clinical review findings and specialized resources as appropriate.
* Verify ongoing disability status and participate in multidisciplinary reviews with nurses, physicians, and vocational rehabilitation specialists to evaluate return‑to‑work opportunities.
* Calculate monthly LTD benefits after the elimination period and ensure correct application of offsets and deductions in compliance with ERISA regulations.
* Use claim administration systems (Fineos, Compass, GSAP) to manage claim progression, document activity, and authorize payments while meeting service and production standards.
* Ensure seamless transitions throughout the claim lifecycle to support a positive claimant experience.
* Analyze claim activity and prepare reports for clients, carriers, and internal leadership.
* Demonstrate strong analytical and problem‑solving skills to gather information, identify issues, and implement effective action plans.
* Apply knowledge of FMLA and state leave programs, medical terminology, disability duration guidelines, and Social Security procedures.
* Proficient in Microsoft Excel and Word, with a strong ability to learn new systems and tools.
* Maintain excellent verbal and written communication skills and effective nterpersonal abilities with both internal and external stakeholders.

* Answer incoming phone calls from life insurance members and provide clear, accurate assistance.
* Process Premium Billing Business Events and Billing Business Event workflows accurately and within required timelines.
* Draft member correspondence and official communications using eCorr.
* Lead daily huddles to support team alignment, communication, and productivity.
* Maintain all call standards, including quality metrics, accuracy requirements, and professionalism.
* Train team members on Premium Billing Business Event processes and system navigation.
* Promote a superior customer experience by addressing member concerns with empathy and resolving issues promptly.
* Meet all call guidelines for service levels, handle time, accuracy, and productivity expectations.
* Educate customers on billing procedures, payment processing, and related support policies.

* Take calls from healthcare providers to troubleshoot denied or incorrectly paid medical claims using system knowledge and claims databases.
* Perform quality assurance reviews for agents and provide coaching both during and after training.
* Work across multiple stations to ensure optimal coverage and consistently meet production goals.
* Coach team members on the techniques and processes required to successfully complete job tasks.
* Train new team members by explaining company procedures, workflow expectations, and compliance requirements.
* Evaluate employee skills and knowledge regularly, providing mentoring and additional training to support performance improvement.

* Operated standard kitchen equipment with a strong focus on safety and sanitation procedures.
* Maintained clean, trash‑free work areas to maximize productivity and ensure a safe environment.
* Inspected equipment, refrigerators, and warming lamps to ensure compliance with safe operating standards.
* Distributed food efficiently during peak periods to support customer satisfaction and smooth service flow.
* Inspected culinary areas for proper employee hygiene, productivity, sanitation practices, and cleanliness.
* Used proper storage bins to organize and transport kitchen equipment to the stewarding room for storage.
* Restocked supplies and prepared additional ingredients during downtime to support upcoming busy periods.
* Washed, peeled, and cut fruits and vegetables in advance to improve kitchen preparation efficiency.

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