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Click here or scroll down to respond to this candidateCandidate's Name , B.A.Street Address
PHONE NUMBER AVAILABLEEMAIL AVAILABLESUMMARYSEEKING A POSITION TO FURTHER KNOWLEDGE IN PIP, BUSINESS IMPLEMENTATION AND/OR QUALITY ASSURANCECOMPUTER SKILLSSoftware: Microsoft TEAMS, Word, Excel, Outlook, ONE NOTE, Power Point and Publisher; EKOS, KYNECT, KADAP PORTAL, KAMES, KASES, KEWES, Focus Career Suite, CRM, SQL, KOR, Medi-Tech, Care Ware, Claim Station, Mitchell Decision Point (MDP), Zoom, Claim Pro, Accurint and varied social media.EXPERIENCE*08/01/2018-Present Medical Claims Adjuster Progressive Insurance CompanyImplementation and management of Auto Injury claim of moderate complexity.Review of exposures, policy and procedures, medical records and order IMEs as necessary.Research of mechanism of injury, economic loss, transportation cost, wage loss and payment.Investigates coverage, injury causation and subrogation possibilities per policy guidelines.Responds to the insured, colleagues, providers, attorney representatives and management with urgency through phone calls, mail and electronic correspondence.Payment of claims, economic loss and wage loss through pay management system Mitchell Decision Point.*10/01/2016-07/15/2018 Resource Management Analyst III Commonwealth of KYWorkforce Dev.Provided direction in planning, organizing and managing information resources; other duties as assigned.Acted as a liaison between the business/programmatic functions of the agency and the information systems function as they related to the Employ Kentucky Operating System (EKOS), Focus Career Suite and Kentucky Electronic Workplace for Employment Services (KEWES) program.Coordinated agency information resources activities to ensure that information and technology requirements are met. Coordinated and disseminated information to assigned local workforce area development areas and central office staff to keep abreast of policies and performance set forth by US Dept. of Labor.Coordinated agency information resources activities to ensure that information and technology requirements are met. Coordinated and disseminated information to assigned local workforce area development areas and central office staff to keep abreast of policies and performance set forth by US Dept. of Labor.Provided technical assistance to assigned local area as needed.Monitors WIOA and Wagner-Peyser programs to verify programmatic and fiscal compliance per DOL regulations.Reviewed EKOS and local area files for compliance as well as monitor grants and contracts.Advised staff to ensure data accuracy as needed.Advised management of impact of federal and regulatory changes. Promoted the use of statewide information resource management guideline(s) and technology standards. Recommended to cabinet information resource manager opportunities for sharing information resources through the development of inter-departmental systems and participation in state level systems.Participated in Dept. of Labor and local workforce area performance negotiations. Reviewed local areas drawdown requests to ensure accuracy. Worked with local workforce area finance and certified public accountant personnel to solve erroneous draw issues. Performed other duties as assigned.* 10/01/2015-09/30/2016 Ryan White Program Coordinator KY Dept. of Public HealthCoordinated all inter- or intra-unit administrative functions of a specific program(s) on a statewide basis; and performed other duties as required.Interpreted laws, regulations, policies and procedures for a program(s) to program implementation staff and program recipients on a statewide basis.Requested and collected program data, edited and analyzed data, and wrote comprehensive program status reports for executive and managerial superiors.Performed in-depth analysis of program support needs and recommended policy and procedural modifications.Reviewed records and reports submitted by program recipients or agency staff for compliance with legal, regulatory or policy standards.Responded to programmatic inquiries from the general public, governmental officials, or other jurisdictions.Prepared, reviewed, processed and/or recommended approval of contracts, grants and other program implementation.Reviewed, analyzed and reported impact of legislative, financial or policy changes in respect to the program(s).Communicated procedural or program changes to program staff, contractors, recipients, and other interested parties.Attended professional meetings, civic meetings or other meetings to gather or distribute program or technical information.*10/08/14-06/30/15 Subject Matter Expert/Consultant Tek SystemsImplementation, testing and bug fixes for the KYNECT, Family Medicaid and Adult Medicaid Program.Adhered to HIPPA Guidelines and CHFS Policy and Procedure for Medicaid.Used CRM to resolve tickets regarding possible bugs and tested until able to provide work around if needed and sent to programmers for fix.Worked as part of the team that worked to resolve and responded to Governors complaints in regard to KYNECT cases and issues.Communicated with clients, listened to their needs, calculated coverage and plan costs, suggested plans within their health need and cost range, made recommendations for solutions to other issues according to CHFS Policy and entered the relevant information into the database to keep client records up to date and accurate for others to view.*11/16/10-10/07/14 Family Support Specialist II Commonwealth of KY CHFS/DCBSDetermined initial and ongoing eligibility for public assistance programs including SNAP and Medicaid.Interviewed clients for SNAP and Medicaid. Prepares and maintains case records.Participates in in-service training to enhance various public assistance program requirements, forms, policies and procedures.Determined with use of Federal Guidelines, the program benefit award amount.Identified additional needs, identified other resources and made appropriate referrals.Explained work requirements and encouraged the exploration of work opportunities.Tracked processing deadlines for timely redeterminations and case hearings.Testified in hearings.Gathered information to be used in responding to inquiries about cases.Prepared monthly reports.*EDUCATIONEastern Kentucky University Masters In ProcessKentucky State University (Deans List) Bachelor of Arts 2017Maysville Community & Technical College Associate of Applied Science 2010*REFERENCESJIM BEYEA PHONE NUMBER AVAILABLE ASSISTANT DIRECTOR, DEPARTMENT OF WORKFORCE DEV.DIVISION OF TECHNICAL ASSISTANCE, STATE OF KYPROFESSIONAL REFERENCECARIE MCGEE PHONE NUMBER AVAILABLE APRNPERSONAL REFERENCE |
