Medical Management Specialist Ii resume example

• Managed moderate to complex medical claims for customers injured in auto losses.

• Coordinated independent medical evaluations for causality of suspicious injuries.

• Made analytical decisions in determining medical action plans and setting reserves for monetary payouts on each claim.

• Placed outgoing calls to attorneys, providers and insureds to maintain communication throughput the claims process.

• Handled inbound calls for claim status and billing issues for PIP claim handling.

• Maintained empathy and customer care while monitoring the treatment for each party.

• Coordinated with service representatives, sales teams and clients to manage inventory, adjust reservations and handle logistics to meet customer needs at a flagship location.
• Optimized guest experience by inspecting vehicles prior to and post guest usage, coordinating repairs and upgrades.
• Resolved customer disputes to maintain positive relationships and increase customer base.
• Placed calls to confirm incoming appointments and handled sales for customers.
• Implemented rental asset processes, consistently complied with underwriting guidelines, met and exceeded cleanliness standards including Covid19 protocols.
• In the first month post training I became top 10 in sales for the region and have remained a consistent performer in all metrics.
• Learned to employ a flexible management style to objectively delegate tasks and effectively communicate to other team members.

• Duties in the Network shop included completing appraisals for damaged vehicles. Coordinating weekly shop walk throughs and continuous communication with customers and shop staff regarding repairs.
• Completion of weekly reports documenting the shops’ success and opportunities based on internal metrics consisting of network program goals for productivity and customer service.
• Worked at total loss yards and non network shops, completed repair supplements and managed repairs for the surrounding territories.
• Negotiated completed damage estimates and repair costs.
• Collaborated with repair workers to determine feasibility of repairs under constraints of coverage limits, time frame and customer finances.
• Helped customers obtain alternate transportation via rental car services according to their rental coverage or lack there of.

• Trained in both the collections and fraud department, learning handling procedures for each.
• Maintained a high quality level of professional customer service throughout high volume outgoing and incoming calls.
• Handled credit card/debit card red flags and fraud prevention including but not limited to blocking cards for security reasons, verifying card holders transactions and documenting fraud reports and claim/dispute follow up.
• Trained team members in successful strategies to meet operational targets.