Creative, hardworking, Customer focused Manager successful in building and motivating dynamic teams. Creating a positive work environment in which staff members feel comfortable voicing questions and concerns, as well as contributing new ideas that drive company growth. With a strong Customer Service & Medical Insurance background, willing and excited to take on new challenges.
Management and administration of Workers Compensation and General Liability claims. Participate in and coordinate event investigations, assist Workers Compensation TPA adjusters in claims adjustment and reviews, coordination of the Workers Compensation process, tracking of C-1, C3 and C4 forms, management of the employee light duty return to work program. Create and foster positive relationships and team environment. Responsible for meeting OSHA and governmental agencies reporting. Independently prioritize work; make decisions without supervision. Record keeping, data processing requirements such as generating standard and custom reports pertaining to specific injuries, lost time, claims frequency, Data analysis
Duties included management of a team of individuals which advised & assisted Attorney's, Claims Adjusters & Structured Settlement Brokers' in the submission of MSA's & Future Medical Cost projections to CMS (Medicare) for negotiation & settlement of Workers Compensation cases according to CMS guidelines. Calculation of life expectancy's based on rated age & annuities to fund the MSA, CMS rebuttals, monitor Social Security/Medicare verification process, delivery of Medicare Set-Asides, Drug Utilization reviews & other medical products.
Continued staff education on daily progress, case management, motivating and creating a positive work environment, feedback provided in several capacities for staff challenges and achievements. Meeting daily objectives for production and contractual goals, resolution of escalated issues for clients, coordinators and outside vendors, ongoing training / education, annual performance reviews.
Responsibilities included building positive long-term client relationships, management of client accounts & issues, meeting all TAT & statistical reporting objectives; all lab results & testing requirements, education of specimen submissions for molecular testing, resolving specimen submission issues, insurance billing, inventory and client medical supplies, overseeing courier routes, client site visits and education to build and retain business.
Experience with multiple applications including Word, Word Perfect, Excel, Access, Understanding of: ICD-9, CPT, HCPCS~ Medical, Dental, Vision & Hospital Claims, Accounts receivable, payables, budgets, spreadsheets, third party liability, benefits management, oversee departmental restructures, staffing, reviews, time & attendance and other personnel related duties.
Experience on various systems: AS-400, Yardi, Mult-billing software, TXEN, Insurdata, Rims, Electronic Claims, Occurence Insight, iVOS, Attask/Allegro, KRONO's
The Keys to Leadership
Employee Development and Leadership Training
Writing effective focal reviews
Coaching for Performance
Unlawful Harassment for Managers and Employees
Fraud, Waste and Abuse Training
Compliance and Ethics Training
Rapid Decision Making
Positive Employee Relationships
Seminar Urology & Womans Health
Community Association Management Classes,
Common Interest Community~ Pre-Certification Law,
New Construction, Project Management & Real Estate Classes
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