Selina Stevenson Campbell
Allentown,PA
Summary
Detail-oriented Disability Case Manager with over 15 years of experience in case management and compliance. Skilled in resolving complex issues through effective communication and collaboration, ensuring timely and accurate processing of short-term disability claims.
Overview
25
25
years of professional experience
Work History
Disability Case Manager III
Alight Solutions
Lincolnshire, Illinois
10.2019 - Current
- Manage and adjudicate Short-term disability claims, ensuring accurate and timely processing.
- Manage STD claims and coordinated leave processes for employees across multiple plans.
- Gather and review medical documentation for clinical evaluation and decision-making.
- Utilized MDGuidelines to determine leave durations and clarify medical conditions for informed decision-making.
- Ensure compliance with FMLA, Target Leave Plans, Paid Family Leave, and Pregnancy Fairness Workers Act.
- Resolved complex issues and customer inquiries, enhancing service quality and client satisfaction.
- Maintain high daily accuracy and productivity while meeting service-level goals.
- Collaborated with team members to meet project deadlines and achieve operational objectives.
- Maintain up-to-date knowledge of CPT and ICD-10 Coding and billing regulations
Short-Term Disability Case Manager
1199 SEIU National Benefit Fund
New York, New York
03.2007 - 08.2018
- Determined eligibility for short-term disability and facilitated transitions to long-term disability.
- Responded to member inquiries regarding disability benefits, eligibility, and claims status.
- Processed and updated claims data to ensure accurate payment outcomes.
- Adjusted claim payments based on updated information and rate modifications.
- Investigated workers compensation claims by coordinating with members, providers, and employers.
- Generated wage verification letters and processed stop-payment requests.
Medical Claims Processor
MetroPlus Health Plan
New York, New York
11.2005 - 08.2018
- Entered and processed hospital and medical claims for payment, denial, or investigation.
- Researched unpaid claims involving coordination of benefits and Medicare Secondary Payer rules.
- Maintained high accuracy and productivity in daily claims review.
- Maintained high accuracy and productivity in daily claims review.
- Stayed current with CPT and ICD-10 coding and billing requirements.
Medical Claims Processor
Promed Staffing
New York, New York
08.2005 - 09.2005
- Adjudicated claims for payment, denial, and investigation.
- Cleared backlog to bring accounts up to current processing dates.
- Maintained high accuracy and compliance with coding regulations.
Medical Claims Processor
Amalgamated Life Insurance
New York, New York
04.2001 - 06.2004
- Processed EPO, POS, and PPO claims across multiple employer groups.
- Handled hospital and professional claims, including Beech Street repricing.
- Streamlined workflows to reduce backlog and improve service efficiency.
- Maintained strong accuracy and compliance with CPT and ICD-9 coding standards.
Education
License For State of NY - NY Accident And Health Claims
New York, NY08-2021
Associate of Science - Health Administration
University of Phoenix
Tempe, AZ01-2010
Some College (No Degree) - Medical Billing
Kingsborough Community College
Brooklyn, NYSome College (No Degree) - Nursing Assistant
Travel Institute
New York, NYSkills
- Disability regulations
- Case management
- Claims processing
- Leave administration
- Compliance management
- Medical coding
- Customer service
Timeline
Disability Case Manager III
Alight Solutions
10.2019 - Current
Short-Term Disability Case Manager
1199 SEIU National Benefit Fund
03.2007 - 08.2018
Medical Claims Processor
MetroPlus Health Plan
11.2005 - 08.2018
Medical Claims Processor
Promed Staffing
08.2005 - 09.2005
Medical Claims Processor
Amalgamated Life Insurance
04.2001 - 06.2004
License For State of NY - NY Accident And Health Claims
Associate of Science - Health Administration
University of Phoenix
Some College (No Degree) - Medical Billing
Kingsborough Community College
Some College (No Degree) - Nursing Assistant
Travel Institute