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Click here or scroll down to respond to this candidateCandidate's Name
Street Address Willow Spring Dr.Dayton, Ohio Street Address
EMAIL AVAILABLEPHONE NUMBER AVAILABLESUMMARYA Customer Services Professional recognized for handling several duties simultaneously in a fast paced environment. Highly organized, detail oriented with ethical character.PROFESSIONAL EXPERIENCENew Elizabeth New Life Feb 2020- August 2021ConsultantExplain to recipients their available options to services that are designed to support life.Assist daily with routine inquires, maintain, and prepare recipients records.Scheduling and greeting recipientsAssisting with phone lines, incoming and outgoing lines to respond to inside or outside clients.Premier Home Health Care Aug2019- Feb 2020Non Medical CaregiverEnsure proper nutrition by planning and preparing their meals, Assist with bathing and toileting as needed. Housekeeping tasks, such as laundry, dusting, making beds, organizing mail and keeping a calendar of appointments.Montgomery Country Dept. Jobs & Family Services Dayton Jan 2018 to Feb 2019JFS Specialist/ ESSInterview applicants to determine eligibility for public assistance programs; compute budgets; verify documents submitted to support public assistance requests; approve or deny applications for public assistance.Explain to recipients their rights, procedures, programs, policies and available services customers conduct in-house and field investigations relative to public assistance.Provide follow-up; produce relative correspondence; receive and investigate complaints related to services provided.Prepare and maintain case records; review and retain all relevant documents; prepare notification letters to recipients of suspension, reduction or termination of assistance; prepare documentsAnswer routine inquiries, complete special assignments; cooperate with law enforcement agencies; judicial and governmental officials and agencies; testify in court when necessary; maintain investigative records and prepare reports on findings.Heartland Health& Wellness Jan 28 to April 11, 2017Claims ExaminerProcess claims in accordance with the SPD/PlanVerify benefit eligibility-Independent Caregiver, Dayton Feb 2013 to Jan 2014Non Medical CaregiverEnsure proper nutrition by planning and preparing their meals, performing grocery shopping. Assist with bathing and toileting as needed. Housekeeping tasks, such as laundry, dusting, making beds, running errands, organizing mail and keeping a calendar of appointments.Medical Evaluators, LLC-Dayton July 2012-Feb 2013QA- Office ManagerReviewing and editing Independent Medical Evaluations from doctors to ensure product quality.Ensuring customer relationships and satisfactionScheduling and greeting claimants.Supported team members with complex customer services issues to ensure a continued working relationship with the customerAssisting with phone lines, incoming and outgoing lines to respond to inside or outside clients.Catholic Health Partners, (HealthSpan) 2011- July 2012Senior Account SpecialistEmployer Account SupportCoordination of information to and from employer group to ensure product quality.Support to utilization management process including queue line, managing incoming faxes.Entering Pre-Certification request into database for medical necessity.Assisting with ACD lines, incoming and outgoing lines to respond to member, provider and TPA questions.Support team members with daily requests for utilization management services.Process MD and claims reviews for all products purchased.Catholic Health Initiatives, (Erlanger, KY) 2002-2009Claim CoordinatorManaged lost time workers compensation claims.Identified lost prevention opportunities which resulted in decrease of company premiums.Maintained working relationships with internal Risk and Insurance staff that decreased lost time days per full time employee.Analyzed disability claims to determine benefits due.Assigned reserve values to claims to determine liability exposure.Supported team members with complex claims resolution.Directed and collaborated with Defense Counsel on litigated claims that resulted in fair compensation settlements up to the designated authority level.Ensured file documentation with state agency that resulted in prevention of state penalties.Communicated claims actions and processes with clients and appropriate parties to ensure a smooth transition of lost time benefits.Led fraud investigation and used surveillance to help reduce claim exposure.Coordinated all aspect of medical treatment with providers to ensure compliance with state treatment guidelines and standards.Claim RepresentativeManaged medical-only workers compensation claims.Developed and maintained effective working relationships to manage claims.Communicated plan of action and monitored progress through resolution.Comp Management Health Systems (formally Integrated Managed Comp) 1997-2002(Cincinnati, OH)Senior Case ExaminerManaged Ohio workers compensation claims.Facilitated and maintained developed successful return to work plans of care for injured workers.Claims Management SupervisorSupervised 5-10 claims representatives in daily processes of medical claims.Worked with HR and Manger to address hiring, termination and promotions which resulted in ensuring the highest quality to meet the needs of those served.Developed and implemented team training of state law changes to achieve departmental goals.EDUCATION/TRAININGSouthern Ohio College Cincinnati, OHAssociate Degree in Science, 2001 |
