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3647 Ripley Trail Drive Pickerington, OH 43147 PHONE NUMBER AVAILABLEEMAIL AVAILABLEQualifications SummaryHighly personable Client Services Professional with experience in call-center operations within the healthcare industry.Talent for identifying client needs and presenting appropriate solutions.Demonstrated ability to gain client trust and provide exceptional follow-up.High degree of initiative and independent judgment.Ability to organize work and manage a variety of tasks simultaneously.Proficient with Microsoft Office System.Professional ExperienceStateFarm 2022-PresentClaim Specialist- Injury (June 2022-Present)Delivered a remarkable customer experience through handling claims involving injuryInvestigated, evaluates, negotiates, and settles auto claims in an assigned area to include verification of coverage, legal liability and extent of damage to persons and property, which may require contact by telephone, correspondence, in person, or various electronic mediaApplied knowledge of policies, procedures, laws, statutes, and insurance regulations when determining coverage, liability, damages of injury (first and third party) and property damageRecognized and reviews claims requiring specialized handling, including identifying issues that may require the use of independent experts or vendorsUsed various electronic resources for claim handlingWorked in partnership with and provides instruction to claim assocBureau of Workers Compensation 2016 to 2022Workers Compensation Specialist (August 2016 -June 2022)Managed processing of medical provider in-claim services through BWCs Cambridge billing systems.Charged and made determinations to pay, deny, and adjust in-claim medical charges associated with pre-Health Partnership (HPP) provider billing, Managed Care Organization (MCO) billing, settlement claims, and non-routine billing for non-HPP business.Completed research, bill payment, on adjustments on written and phone billing inquiries.Prepared comprehensive written responses.Assisted Management in planning, analysis and suggestions regarding the implementation of solutions to problems.Healthscope Benefits, Columbus Ohio 2014 to 2016Claims Analyst (June 2014- August 2016)Processed and evaluated medical and dental claimsObtained information by telephone as well as by hard copy and entering into the computer systemsPrioritization of individual work flow associated with the case assignmentsEstablished and maintaining professional rapport with clients and providers (physicians and hospitals)Maintained and assured accuracy of documentation.CareworksUsa., Dublin Ohio 2013 to 2014Absence Management Specialist (November 2013-June 2014)Processed disability/FMLA paperworkAnalyzed FMLA claims to determine eligibility and certification in compliance with state and federal regulationsCommunicated absence and return to work information to clientConsulted with nurse case manager regarding claim, as appropriateCoordinated certain types of leaves with client Human Resources DepartmentCommunicated decisions and on-going expectations with claimants and clientsAdhered to communication and workflow timeframesTracked FMLA absences, per client calendarTroubleshoot disability and absence issuesVerified return to work statusAccomplishmentsMember of Omega Psi Phi Fraternity Incorporated Upsilon ChapterParticipated on a community service project for Habitat for HumanityEducation and TrainingBachelor of Science Psychology  Wilberforce University  Wilberforce OH., May 2005Masters of Healthcare Administration-University of Phoenix-Online May 2019ReferencesUpon request