Sr. Compliance Specialist

PROFESSIONAL EXPERIENCE
Disability Procedural Specialist/Compliance Specialist September ••••• - present
CIGNA Group Insurance, Pittsburgh, PA•••••X Creation and implementation of a new Policies & Procedures Department.
X Prioritize, research, write, & distribute procedures monthly to ••••• staff members.
X Legal liaison for staff and management.
X Coordinate and provide responses to Market Conduct Studies for CIGNA
X Draft external auditor and vendor Confidentiality & Privacy Agreements.
X Assess legislative and regulatory changes for impact on claim processes.
X Interact frequently with and present to all levels of management and divisions, including Sales, Underwriting, Legal, Tax Compliance, Vendors, Financial, and Compliance to resolve policy issues.
X Assess the cost and time requirements for compliance, provide recommendations, and modify processes accordingly.
X Update system and releases online monthly using FrontPage •••••
X Develop detailed action plans for project management.
X Track project progression and implement appropriate steps when action plan targets are not met.
X Document claim procedures & guidelines appropriately (verbal, written, and internet media).
X Serve as the Group Insurance Disability Compliance Representative.
X Disability Forms Developer & Coordinator.
X Analyze and document existing processes for multiple products administered by CIGNA Group Insurance.
X Responsible for issue escalation with respect to change in process.
X Develop varied communication vehicles for timely delivery of changes.
X Research Disability claim process issues/problems, conduct detailed analysis of alternatives, and recommend solutions to management in partnership with the Quality Performance Service Team.
X Manage complex product related projects such as the ERISA changes and Gramm-Leech Bliley Privacy legislation and conduct training sessions when required.
X Maintain direct responsibility for research/development of procedures, workflow, productivity, and quality control measures to support claims operation.
X Prioritize and identify critical tasks with maximum impact. •••••Quality Auditor August ••••• - September •••••
CIGNA Group Insurance, Pittsburgh, PA•••••X Created a Quality Review Process and tracking mechanism for CIGNA Group Insurance.
X Performed Quality Reviews of Short Term and Long Term Disability claims as well as Waiver of Premium claims.
X Worked with Sales and Claims Management staff to review and track Performance Guarantee Accounts.
X Traveled to other claims offices to perform consistent quality reviews.
X Provided monthly, quarterly, and annual quality reports to management staff.
X Collaborated with other network Quality Auditors and Trainers to track trends.•••••Case Management Team Member November ••••• V August •••••
CIGNA Group Insurance, Pittsburgh, PA•••••X Selected as one of the pilot team members to initiate a cohesive team of STD, LTD, Medical, Vocational, and Economic Consultants.
X Managed disability claims in a team-oriented environment.
X Aggressively managed claims telephonically for a faster resolution.
X Piloted innovative methods for obtaining information to serve the customer better.
X This team and its results served as the model for the existing structure of teams in all DMS offices.•••••Benefit Analyst February •••••November •••••
CIGNA Group Insurance, Pittsburgh, PA•••••X Investigated medical, vocational, and economic aspects of Disability claims to determine liability.
X Made high-level disability determinations in a timely manner.
X Ensured that claim actions were compliant, and were paid in a timely manner.
X Provided exceptional customer service to claimants in financial hardship.
EDUCATION
University of Pittsburgh ••••••••••X B.S. in Urban Studies
X Minor in Womens Studies•••••Life Office Management Association ••••• present
X Associate, Customer Service
X 8 credits toward Fellow, Life Management Institute•••••Penn State University October •••••
Privacy Officer Certification•••••Six Sigma May •••••
X Yellow Belt Certification
ACHIEVEMENTS
X X•••••X Responsible for creation and maintenance of two entirely new departments and workflows (Quality Assurance and Policies & Procedures).
X ••••• CIGNA Group Insurance Compliance Department Award winner
COMPUTER KNOWLEDGE
Proficient in the following software applications:
X Microsoft Word and Word Perfect
X Microsoft FrontPage •••••
X Microsoft Power Point
X Microsoft Excel
X Microsoft Outlook X Microsoft Picture It!
X Adobe Acrobat
X Microsoft Project Certified