Enthusiastic creative team player with a consistent track record of success through personal and team efforts. Diversified experience in the insurance and health industry.
South Forsyth County Volunteer and Certified Substitute Teacher (Contractor
July 2008 to Present
●Provide excellent administrative support to office staff, teachers, media center, and students.
●Implement teacher's plans on all academics.
●Para-pro special educational students-teach living skill, and learning fundamentals.
Realtor Assistant (Contractor)
January 2011 to December 2012
●Enter new Listing Agreements, Seller’s Disclosures, Dual Entry Sheets, Tax Records, and MLS Sheets into various communication media websites (FMLS, GAMLS, Pro Agent, and Realtor.Com). Communicate with agency, prospective buyers, sellers, and realtors.
●Assist bank operations with back-ground and credit checks, collect earnest deposits.
●Request warranty deeds. Oversee Agents files and organize data.
●Market the property (Create Flyers, Property Disclosure Book, and Buyer Agent Packet).
●General Office Support (Reception, Telephones, Mail, Supply Orders, Assemble Files)
January 2009 to December 2011
● First point of contact and claim intake for a broad base of customers. Assist with compliance of the Medicare Set-aside (MSA) and Medicare Secondary Payer Statue (MSP) services. Determine if threshold meets Medicare or SSDIB guidelines.
●Assist broad base of customers with compliance of the Medicare Set-aside (MSA) and Medicare Secondary Payer Statue (MSP) services. Determine if threshold meets Medicare or SSDIB guidelines.
●Provide excellent customer service to insured’s, employers, brokers, attorneys and various business units of healthcare providers and document activity in diaries and claim notes.
●Aggressively manage assigned accounts on an active diary system while communicating to management team. Review data and identify discrepancies, including reconciliations.
●Intervene with Complex Care Management Nurses, Attorneys, State Workers Compensation Departments, Hospitals, Treating and Non-Treating Physician’s.
●Request medical records, pay histories, rated ages and court orders.
●Ability deliver on-the-job training to staff. Assist in the preparation and maintenance of training material.
2009 to 2011
Achievement: Supervised team's new claim intakes; system test changes to applications; prepare training materials to team and train new hiree's.
Senior Claims Representative
January 2005 to December 2006
●Setup/Intake of new claims with 3-point contact aggressively managing inventory to resolution opportunities, (i.e.) return to work, structured settlement, and discontinuance of income benefits with or without litigation. Service the accounts including claimant/witness statements, review of medical documentation, request pre-existing medical and determine if SITF eligible, and determine compensability of claim within jurisdiction guidelines until settlement reached.
●Managed a claim load of 200 bodily injury cases demonstrated ability to handle medical only to mid exposure claims.
●Established appropriate accounting financial reserves to reflect claim exposure and document rationale in claim notes, payment of indemnity, medical and litigation expense.
●Aggressively manage inventory to ensure timely file closing or timely reassignment if necessary while conferring with management team inconsistent with company guidelines.
●Making collection calls to accounts with outstanding balances and resolve billing issues.
Senior Case Management Specialist
January 2003 to December 2004
●First point of contact for managing high volume claim load of Short Term Disability, Medical Leave of Absence, Family Leave of Absence, Medical Only and Long Term Disability accounts on an active diary.
●Coordinate with vocational consultants for eligibility determination while reviewing statute guidelines for varying disability plans with knowledge of legal processes.
●Honored to Train new hiree's in Utica, NY for 200 newly hired employees for National Accounts.
Long Term Disability Case Manager for National Account
January 2001 to December 2003
●Managed STD and LTD claim load of 150-200; demonstrated ability to handle mid-to high exposure claims including catastrophic claims. Established appropriate accounting financial reserves to reflect claim exposure and document rationale in claim notes, payment of indemnity, medical, and litigation expenses.
●Provide customer service to insured’s, brokers, business units of healthcare providers on a regular basis with prominent self insured national client and its’ employees during transition of claims to Long-Term Disability.
●Worked independently and on a team to achieve daily goals with client performance agreements.
●Proficient in interpreting policy language - obtained Medical Reports Certification.
System Tester/ EOB Reviewer
January 1995 to December 2000
●Provided client and carrier excellent customer service support, system and report customization.
●Coordinate the development and testing of multi-state medical policies and procedures for workers compensation laws, fee schedules, pharmacy pricing and DRG's and DME's.
●Maintain problem log spreadsheet for debugging clients system database for new and existing programs.
Early Medical Intervention
January 1993 to December 1994
●Setup/Intake of new claims with 3-point contacts with aggressively managing inventory to resolution opportunities for multi-state workers' compensation, general liability and auto liability claims,
●Responsible for account maintenance, insurance and rehab billing. Provided strong interpersonal customer service support daily.
●Aggressively managed inventory to ensure timely reassignment whether a claim requires the involvement of a lost time claim representative or closure if necessary while conferring with management team.
●Ensure the claims/files are handled in such a manner that is consistent with industry and company guidelines and requirements.
Associates Degree in Business Administration
Medical Terminology Certification
Substitute Teaching Certification
Proficient in use of most major computer systems, information systems, spreadsheet applications,presentation applications, and word processing applications, including but not limited to: Windows / Microsoft WordPerfect; Microsoft Office Suite: MS Word, MS Excel, PowerPoint; MS Publisher; Internet Explore; Lotus 123; 60 wpm typing.