Summer Rock
Cambridge,ON
Summary
Dynamic professional specializing in disability case management, adept at leading cross-functional teams to enhance claims processing and client satisfaction. Proven track record in identifying process improvements that drive operational efficiency and reduce claim turnaround times. Committed to fostering strong relationships with stakeholders.
Overview
9
9
years of professional experience
Work History
Long-Term Disability Case Manager
Disability Management Institute
06.2022 - Current
- Handled new and ongoing long-term disability claims, determined eligibility, calculated earnings, and secured medical evidence within timelines.
- Collaborated with stakeholders to gather comprehensive claim information, ensuring informed decision-making.
- Prioritized claims based on rehabilitation needs, facilitating timely recovery and supporting return-to-work efforts.
- Work collaboratively with early intervention and the short-term disability team to minimize the duration of absence and return claimants to work.
- Utilize available resources to assess diagnoses and treatment plans.
- Liaised with insurance agencies, doctors, employees, management, and lawyers to protect sensitive information and ensure compliance with disclosure protocols.
- Draft and deliver written correspondence identifying claim activity and next steps.
- Maintain confidentiality over client and corporate records and medical claims information.
Disability Claims Auditor, Extended Health Claims Auditor & Technical Consultant
Orion Audit Limited
04.2021 - 06.2022
- Conduct high quality, detailed, disability and extended health claim audits; evaluate adjudication processes, error rate, test plan eligibility and adherence to the insurance contract.
- Analyze disability and health claim data and effectively detect and evaluate patterns, trends and anomalies.
- Identify opportunities and solutions, recommending improvements to claims administrative processes that enhanced cost savings and strengthened risk management.
- Prepare technical reports detailing observations and findings from claims audits to support data-driven decision-making.
- Participated in preparation and presentation of audit findings to clients, facilitating discussions that led to new business opportunities.
- Manage Post Audit Work for the client: Prepare post-audit documentation, including recommendations and next steps.
- Organized and ranked recommendations based on urgency and impact.
- Continuously strive to improve the overall audit process by looking for ways to expedite the report writing process and streamline the data analysis process.
- Provide disability management technical knowledge and support to the consultants on client specific projects.
- Review prepared documents (such as benchmarking reports) for clients and provide technical feedback.
Disability Case Manager – Group Disability
Sun Life Financial
01.2020 - 04.2021
- Managed short-term and long-term disability claims to resolution in a proactive manner, determining eligibility for benefits and implementing interventions to support recovery and return to work.
- Manage and resolve escalated cases.
- Documented case files and communicated with team members to strengthen partnerships and enhance collaborative outcomes.
- Maintained my working schedule, prioritizing tasks based on importance and deadlines.
- Identified continuous improvement opportunities and implemented end-to-end processing for sustainable long-term solutions.
- Adapted a client-centric outlook, taking ownership and responsibility to ensure client satisfaction by recommending best practices.
- Maintained a working schedule by prioritizing tasks based on importance and deadlines.
Plan Change Associate – Insurance Operations
Sun Life Financial
05.2017 - 01.2020
- Investigating and completing customer requests in accordance with established service standards, resulting in meeting and exceeding expectations for clients and advisors.
- Increased accuracy and efficiency through continuous improvement initiatives, establishing best practices.
- Contributed to department projects aimed at improving team outcomes and service delivery.
- Cultivated relationships with Sun Life Advisors, enhancing collaboration and communication.
- Lead social committee activities, including planning and organizing events.
Education
Certified Disability Management Professional -
National Institute of Disability Management And Research
Port Alberni, BC03-2026
Occupational Therapist Assistant/Physiotherapist Assistant Program -
Conestoga College
Kitchener, OntarioSkills
- Customer service
- Relationship management
- Problem solving
- Analytical thinking
- Prioritization
- Multitasking
- Leadership
- Adaptability
- Initiative
- Empathy
- Communication skills
- Microsoft Office
- Creativity
Timeline
Long-Term Disability Case Manager
Disability Management Institute
06.2022 - Current
Disability Claims Auditor, Extended Health Claims Auditor & Technical Consultant
Orion Audit Limited
04.2021 - 06.2022
Disability Case Manager – Group Disability
Sun Life Financial
01.2020 - 04.2021
Plan Change Associate – Insurance Operations
Sun Life Financial
05.2017 - 01.2020
Certified Disability Management Professional -
National Institute of Disability Management And Research
Occupational Therapist Assistant/Physiotherapist Assistant Program -
Conestoga College