Kash-Monia Ross
Chino Hills,CA
Summary
Results-driven disability claims professional with over five years of experience in reviewing ERISA-governed long-term disability claims and analyzing complex administrative records. Expertise includes thorough medical documentation review, evaluation of denial rationales, and compliance oversight. Proven ability to organize claim files, identify procedural issues, and coordinate effectively with claimants and medical providers. Aiming to leverage carrier-side insights to enhance disability case development and facilitate comprehensive legal file reviews.
Overview
6
6
years of professional experience
Work History
Long-Term Disability Claims Specialist
United Healthcare Group
Remote
12.2023 - 11.2025
- Reviewed and adjudicated ERISA-governed Long-Term Disability claims in accordance with plan provisions.
- Evaluated medical, vocational, and financial documentation to determine eligibility.
- Rendered liability determinations and documented rationale clearly.
- Maintained organized administrative records for appeal-level review.
- Ensured confidentiality of PHI in compliance with HIPAA standards.
- Demonstrated attention to detail when reviewing medical records, enabling accurate assessment of functional limitations caused by disabilities.
Disability Compliance Claims Manager
United Healthcare Group
Remote
01.2021 - 11.2023
- Conducted audits of disability claim files to ensure procedural and regulatory compliance.
- Reviewed denial letters for consistency with policy language and ERISA notice requirements.
- Identified documentation gaps and prepared concise file summaries for review.
- Collaborated with legal teams on high-stakes claims, mitigating potential risks and liabilities.
- Streamlined communication between adjusters and clients, expediting claim resolution times.
- Established strong relationships with external partners such as medical providers and legal professionals for efficient case management.
Disability Client Services / Medical Coordination Specialist
United Healthcare Group
Remote
02.2020 - 01.2021
- Gathered medical and occupational information directly from claimants.
- Coordinated with physician offices to obtain and organize medical records.
- Assisted claimants in understanding policy provisions and required documentation.
- Maintained secure handling of protected health information.
- Supported cross-functional teams in executing project tasks and meeting deadlines.
- Facilitated communication between departments to support project alignment and collaboration.
Education
High School Diploma -
Hamilton High School
Los Angeles, CA06.2007
Skills
- ERISA compliance review
- Disability claims assessment
- Analytical skills in denial rationale
- Medical & Vocational Record Review
- Proficient in appeals-level documentation
- HIPAA & PHI Compliance
- Client & Physician Communication
- Skilled in Microsoft productivity tools
- Strong organizational skills
- Understanding of disability laws
Timeline
Long-Term Disability Claims Specialist
United Healthcare Group
12.2023 - 11.2025
Disability Compliance Claims Manager
United Healthcare Group
01.2021 - 11.2023
Disability Client Services / Medical Coordination Specialist
United Healthcare Group
02.2020 - 01.2021
High School Diploma -
Hamilton High School