Manager Medical
Resume:
O rient, OH ****6
Penny F. Nesbitt
Summary of
October 2009 - January 2010 WellPoint for Jacobson Group Worthington, OH
A uditor
D uties: Compare Patients names, date of birth and ICD codes on medical
charts, excel sheet. Corrections on the computer with incorrect data.
October 2008-January 2009 Anchor Hocking for THRD Dublin, OH
BWC Analys
D uties: Update the OSHA 300 log set up the new claim. Review the claim
for the mechanism of the injury. Fax medical & FROI to the 3rd party
administrator. Discuss the plan of action on the claim with the adjuster.
F iling. Answered employees questions & concerns in regards to their
claim. Review & follow up on paper work to the BWC to ensure they are
compliant with the state. Separated incoming correspondence & send to the
p roper department. Follow up calls made to the doctors office to get
medical treatment plan along with the medical records. Follow up with the
supervisors to get the proper paperwork for the claim.
J une 2007-May 2008 CCI Dublin, OH
C laims Examiner
D uties: Determine the compensability of the claims with the locations, 3
point contact with Employer, clmt, & the provider to get medical
t reatment notes. Calculate the wages, pre-pared file for hearing, set
claims up for I ME, review medical treatment, answered phones, paid
compensation, computer operations, referred claim files for telephonic or
f ield case management, pre-pare managed files for internal & external
audits, directed files to legal counsel for an appeal on orders, live &
well checks, surveillance, set reserves on all files.
November 2006-April 2007 SYGMA Columbus, OH
Qualifications Safety Manager
D uties: Investigate workers compensation claims, File workers
compensation & liability claims with the 3rd party administrator.
M aintained workers compensation claim files, Safety meetings with
supervisors to review the claims & the core cause of accidents. Monthly
claims review with the management team to discuss the open claims on
review & reserves set on claims. Daily contact with 3rd party
administrator on open claims, review & revise light duty jobs & implement
changes for current light duty jobs as needed, Report to the Vice
P resident/General Manager on a daily basis with the current status of all
operations, weekly reporting to the Vice President/General Manager on the
current bench mark reporting, Walk through all warehouses to review for
safety hazards, followed routes to ensure drivers were working in a safe
manner. Implement preferred work methods, Update all OHSA reports.
A ugust 2005-November 2006 Gallagher Bassett Dublin, OH
C laims Examiner
D uties: Decided claims adjuster for Ohio claims. Determine the
compensability of the claim, 3 point contact with location, clmt, & the
p rovider, recorded statement with the clmt. Calculate the wages,
p re-pared file for hearing, set claims for IME, reviewed medical
t reatment, answered phones, paid compensation, computer operations,
referred claim files for telephonic or field case management, pre-pare
managed files for internal & external audits, directed files to legal
counsel for an appeal on the orders, live & well checks, surveillance,
evaluated claims for settlement, set reserves on all files, approval from
Medicare & Medicaid.
J une 2002-June 2005 ESIS Dublin, OH
C laims Examiner
D uties: Process all claims for Ohio and West Virginia. Determine the
compensability of the claims, 3 point contact with location, clmt, & the
p rovider, recorded statement with the clmt. Calculate the wages,
p re-pared file for hearing, set claim for IME, reviewed medical
t reatment, answered phone, paid compensation, computer operations,
referred claim files for telephonic or field case management, pre-pare
managed files for internal & external audits, directing files to legal
counsel for an appeal on orders. live & well check, surveillance,
evaluate claims for settlement, set reserves all files, approval from
Medicare & Medicaid.
A ugust 1993-May 2002 GatesMcDonald Columbus, OH
C laims Examiner
D uties: filed appeals orders & motions, paid compensation, set clmt up
for IME, pre-pared file for hearing, requested medical from provider,
f iled claim with the BWC, answered phone, computer operations, reviewed
medical treatment, determine the compensability of the claim, calculate
wages, pre-pared file for internal & external audits, set reserves on all
claims, pre-pare & referred files to re-insurance, client meeting.
Education
1988-1990 Eastland Career Center Groveport, OH
Administrative Assist
G raduated June 1990, Intensive two year, hands-on training in the
Administrative Assistant Program. Vocational training highlights include:
I BM PC, WordPerfect, typing, shorthand, accounting, calculator, filing,
telephone techniques, and machine transcription.
1986-1990 Hamilton High School Columbus, OH Graduated June 1990. Required
course in Math, English, Science, and Health
References Upon request
Contact this candidate