Alicia Hurd

Dedicated insurance professional with 10+ years of experience in the insurance field with my last 5 years of insurance being in short term disability. Skilled in FMLA, ADA, STD/LTD, Workers Compensation and multi—state leave administration with a proven track record of reducing claim resolution times and ensuring compliance with federal and state regulations. Recognized as a subject matter expert and mentor to peers, with strong leadership and vendor management.

Seeking to leverage expertise into a management or an administrator role in disability or leave of absence. Proven ability to mentor staff, streamline workflows and maintain regulatory compliance.

SENIOR STD CASE MANAGER - METLIFE

(2024-03 - 2026-04)

• Assisted in developing and implementing process improvements for case management workflow.
• Managed 100+ concurrent short-term disability cases, applying policy, medical documentation, and regulatory standards to determine eligibility and benefits.
• Ensured full compliance with FMLA, ADA, and state-specific leave laws across multiple states.
• Act as subject matter expert for the team, mentoring new hires, training peers, and providing guidance on escalated/complex cases.
• Partnered with external vendors, physicians, and HR professionals to coordinate return-to-work programs and ADA accommodations to facilitate smooth leave processes.
• Streamlined case processing workflow, reducing claim turnaround time by 15% and improving employee satisfaction scores.
• Assisted leadership in quality audits and case reviews to ensure accuracy, consistency, and adherence to company standards.
• Compliance with employees, HR, and vendors
• Skilled with Medical Terminology and ICD9/10 knowledge.

STD ABSENCE CLAIMS MANAGER II - GUARDIAN LIFE

(2022-03 - 2024-03)

• Provided effective knowledge on contract language and plan design for group disability.
• Initiated communications with the claimant, physician, and plan holder to assess and facilitate job accommodation opportunities.
• Initiative-taking outreach to claimants, plan holders, and physicians via telephone. for information needed for initial and ongoing claim management (e.g., current earnings, other income benefits, medical information, etc.); notify claimants. When claims are pending for missing information.
• Proactively developed and executed an appropriate plan of action for pending and ongoing disability claims assigned by utilizing, managing, and directing appropriate resources. Conduct timely and accurate benefit determination in accordance with policy provisions and regulatory and internal standards while providing sound customer service to all internal and external customers.
• Investigated and analyzed claim information in conjunction with contract provisions to determine coverage and benefit eligibility.
• Communicated claim status and decisions via telephone and in writing.
• Escalated unusual situations, investigated suspected fraud and contestable claims as assigned by Management and provided information to the Legal Department when necessary.

SENIOR CASE MANAGER - STATE OF OHIO BUREAU OF WORKERS COMPENSATION

(2019-01 - 2022-02)

• Managed a self-insured case load of moderate to complex medical/lost-time disability claims for payment, investigation, adjustment, and resolution.
• Managed Percentage of Permanent Partial Disability applications for self-insured claims
• Processed family support orders received from the local county Child Support Enforcement Agencies (CSEA)
• Provided research to identify employers and verify workers’ compensation coverage on incoming claim applications.
• Assigned risk manual classifications on medical workers’ compensation claims filed
• Responded to customer inquiries & communicating with legal representatives, employers, claimants, etc.
• Knowledge of workers' compensation laws, policies & procedures
• Ability to define problems, collect data, establish facts, & draw valid conclusions; make proper referrals (within agency & external sources); diffuse potentially volatile situations; present information to others; work with a team; use International Classification of Diseases (ICD) coding manuals/system; generate properly formatted business correspondence; read and understand compensation payment plan screens, interpret Cognos reports.

DEATH CLAIMS REPRESENTATIVE II - NY LIFE INSURANCE

(2016-09 - 2018-12)

• Adjudicated Life, Annuity, Waiver and Accelerated Death Claims within the established speed of service and accuracy guidelines.
• Established high quality customer relationships using claim resources and my own technical knowledge to respond to external and internal inquiries.
• Active involvement in enhancing claims knowledge through e-learning’s and classroom led training to manage more involved death, waiver and annuity claims.
• Experienced in reviewing medical claim records and forms while making decisions based on documents received.
• Taking appropriate action on waiver claims and referring documents/policies for further action
• Developed and maintained a working knowledge of administrative and mainframe systems needed to process service functions at a fast-paced speed with high accuracy.

COMPLETED COLLEGE COURSEWORK - BUSINESS ADMINISTRATION - UNIVERSITY OF PHOENIX, INDEPENDENCE, OH (2024-01)

HIGH SCHOOL DIPLOMA - CLEVELAND HEIGHTS HIGH, CLEVE. HTS, OHIO (1998-06)