Kimberly Saylor
Sedgwick Claims Management Services Inc.
Gonzales,LA
18
years of professional experience
Benefits and disability professional with progressive experience administering complex leave and disability programs, interpreting plan provisions and statutory requirements, and guiding employees through benefit processes. Skilled in benefit eligibility determinations, medical documentation review, escalations, payment issue resolution, and return-to-work coordination. Trusted for translating complex benefit information into clear next steps for employees, providers, clients, and internal teams.
Work History
Senior Disability Representative
1 Year 1 Month- Managed a high volume of claims weekly ensuring timely and accurate claim determinations in a high-volume environment
- Conduct claim investigations by reviewing documentation, identifying gaps, and gathering required information
- Analyze medical and supporting documentation to determine coverage, liability, and claim outcomes
- Apply policy provisions and regulatory guidelines to support decisions and maintain compliance
- Identify and resolve payment discrepancies, overpayments, and claim errors.
- Communicate with claimants, providers, and employers to obtain information and resolve claim issues
- Handle escalated and complex claims, providing clear explanations and manage difficult conversations
- Maintained detailed claim documentation in systems (TAMS, Juris) to support decisions and audit readiness
- Recognized as a resource for team members on complex claims, multi-state requirements, and claim handling processes
- Managed claims across multiple state jurisdictions, including statutory requirements and compliance deadlines
Leave of Absence Representative
1 Year 11 Months- Administered continuous and intermittent leave and Paid Family Leave (PFL) benefits, including FMLA and employer-sponsored leave programs, from intake through closure.
- Reviewed benefit eligibility, payment calculations, benefit periods, offsets, and payment discrepancies to support accurate and timely paid leave benefits.
- Guided employees through certification, designation, recertification, extensions, payment expectations, and return-to-work requirements while coordinating with providers and internal/client teams to resolve complex leave issues.
Leave of Absence Coordinator
6 Months- Opened and maintained leave cases, verified eligibility, issued required correspondence, and monitored documentation due dates and case milestones.
- Assisted employees with forms, provider certification requirements, and leave process questions while maintaining accurate case records.
- Developed training materials for staff on leave management procedures and best practices.
- Implemented process improvements to reduce turnaround time for leave approvals and communications.
Healthcare Specialist
3 Years 4 Months- Assisted patients and providers while ensuring compliance with healthcare regulations and HIPAA standards
- Coordinated care and resolved issues by communicating with multiple parties in a fast-paced environment
- Delivered patient care through telehealth consultations, ensuring adherence to clinical protocols.
- Collaborated with multidisciplinary teams to enhance patient outcomes and streamline communication processes.
Claims Processor
10 Years 8 Months- Processed claims, verified eligibility, and ensured documentation accuracy for compliance
- Reviewed claim details and resolved discrepancies to maintain quality and efficiency
- Medical terminology application for claim evaluation
- Payment analysis, offsets, and financial accuracy
- Investigation and documentation review
Education
Bachelor of Science - Health Information Management
Skills
Benefits Administration
Leave of Absence Administration
Paid Family Leave (PFL)
Short-Term Disability (STD)
FMLA Administration
Benefit Eligibility Determination
Plan & Policy Interpretation
Employee Relations / Employee Support
Escalation Resolution
Regulatory Compliance
Multi-State Statutory Benefits Administration
Accomplishments
- Louisiana Property & Casualty Adjuster License - Active, Designated Home State
- New York Independent Adjuster License - Active
- Additional states available through reciprocity upon request
Timeline
Senior Disability Representative
Sedgwick Claims Management Services Inc.
07.2025 - CurrentRead More
Leave of Absence Representative
Sedgwick Claims Management Services Inc.
08.2023 - 07.2025Read More
Leave of Absence Coordinator
Sedgwick Claims Management Services Inc.
02.2023 - 08.2023Read More
Healthcare Specialist
MDLIVE Telehealth
07.2019 - 11.2022Read More
Claims Processor
Modivcare
10.2008 - 06.2019Read More
University of Arizona Global Campus
Bachelor of Science from Health Information Management
Read More