1. Catherine M. Harris, ALHC
3114 Sherry Lane
Balch Springs, TX 75180
(Cell) 440-227-0302
Email: Catyat2012@gmail.com
MEDICAL, LIFE AND DISABILITY CLAIMS
Experience in multiple aspects of claims functions, including Management, Special
Investigations, Training, Appeals and Customer Service. Ability to work from entry level
to management through teamwork, strong ethics, eagerness to learn and adaptability to
change. Strong desire to build and maintain customer relationships with continued trust,
efficiency, experience, passion and empathy.
Areas of expertise and special skillsets, encompassing Medical, Disability and Life claims:
 Claim Management
 Appeal/DOI Review
 Auditing
 Special Investigations/High-Risk Claims
 Customer Service
 Training
 Supervision
PROFESSIONAL EXPERIENCE
CIGNA GROUP INSURANCE 2014-Present
Senior Long Term Disability Case Manager
Responsibilities include procuring and analyzing medical documentation, eligibility
information, reports and policies to determine approval or denial of Long Term Disability
claims. Handle special accounts that require additional attention, reporting claim issues
and implementing efficient and cost-effective solutions. Provides excellent customer service
to all internal and external customers, including, but not limited to employers, claimants,
medical providers, attorneys, brokers and agents. Maintaining and/or exceeding
production and quality standards on a consistent basis. Provides training and mentoring to
new team members, as well as support to existing staff.
DEARBORN NATIONAL/HEALTH CARE SERVICE CORPORATION 2008-2014

2. Supervisor, Short Term and Long Term Disability Claims
December, 2010 – Present
Responsibilities include the planning and distributing of assignments to team members,
implementing and devising work-flows and service strategies, incorporating extensive
medical review experience in order to make critical decisions in regards to high risk claims
determinations, hiring and training new claims staff, performing audit reviews during
probationary period, performing the work of the department in peak periods, and handling
customer service escalations. Regular performance review and feedback to claims staff,
adhering to the claims department standards of excellence. Additional duties included the
handling and response of disability, life and accidental death & dismemberment appeals
and Department of Insurance inquiries, creating new claims processes and procedures and
creating a reporting system for quality, time-service and production. Ability to effectively
assist with inquiries from many sources, including account management, sales, agents,
brokers, group (employer) benefit representatives, employees, attorneys and medical
providers on a daily basis.
Unit Coordinator, Short Term and Long Term Disability Claims
April, 2008 – December, 2010
Claims team leader, supportive directly to the claims supervisor. Responsibilities included
daily monitoring of new claims received, and appropriately distributing assignments to the
claims team. Assisted in implementing work-flow strategies and producing reporting and
metrics reflecting the responsibilities and production of the claims team and forwarding
this information to claims management. Other responsibilities included random quality
review of claims staff, appeals review and response, Department of Insurance responses,
mentoring of claims staff and providing detailed review of the most complex claims and
advising the claims department of appropriate action based on documentation and policy
language.
CERES GROUP/CENTRAL RESERVE LIFE 1993-2007
Sr. Special Investigations, Medical Claims
November, 2001 – February, 2007
Conduct Pre-Existing and misrepresentation investigations to determine the eligibility of
catastrophic and complex claims. Collected all pertinent health information needed for the
investigation such as medical records from various health care providers and information
from the insured. Also conducted investigation into accident claims of high severity,
requesting records, accident reports and critical information from law enforcement
agencies, hospitals and physicians. Evaluated all documentation, and determined payment
or denial of these claims. Indentified potential issues of fraud and medical necessity and
reported information to appropriate personnel.

3. Sr. Claims Processor, Medical Claims
December, 1998 – November 2001
Handled the manual processing of high-dollar claims while maintaining a high degree of
accuracy. Analyzed and handled claims of high severity such as transplant, complex, high-
dollar treatment and case managed claims. Identified claims with coordination of benefits
with Workers Compensation, Medicaid, Medicare and other Third-Party Payers and
adjudicated these claims based on policy provisions. Expedited payment of Disability
benefits to claimants eligible for the Weekly Income Benefit.
Jr. Claims Examiner, Medical Claims
October, 1994 – December 1998
Examined and processed claims of basic and intermediate severity. Processed prescription
drug, vision and dental claims. Conducted pre-existing investigations as needed. Evaluated
refunds from providers and claimants, posting to accounts accordingly. Performed
administrative duties such as maintaining procedure manuals and memos, as well as
preparing statistical reports and records.
EDUCATION AND TRAINING:
High School Diploma, Medical Terminology I and II
Health Insurance Association of America (HIAA), Life Office Management Association
(LOMA) and International Claims Association (ICA) designations completed.