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Medical Management

Location:
Harvey, LA, 70058
Posted:
January 08, 2013

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Resume:

Clara Rivera

**** ******* **. ******, ** *****

Mobile: 504-***-****

Email: ablpmv@r.postjobfree.com

Professional Profile

Fluent in English and Spanish, proficient in a fast-paced environment

demanding strong technical, organizational, and interpersonal skills.

Ability to work with minimal supervision.

Professional Education

LOYOLA UNIVERSITY

New Orleans, Louisiana

Bachelor of Arts Degree in Criminal Justice

December 2003

DELGADO COMMUNITY COLLEGE

New Orleans, Louisiana

Associate of Arts Degree in Criminal Justice

May 2001

Professional Experience

Brown Greer PLC

New Orleans, Louisiana

Claims Reviewer August 2012-

current

Responsible for complex review of documents in order to evaluate and assign

values to claims while maintaining confidential claim data.

. Review claims submissions to determine completeness of required

documentation.

. Review financial records in order to evaluate claims.

. Data enter claim information in order to generate correspondence and

report related to claim status.

. Review claims in order to provide information to the client and other

counsel outside the firm.

. Prepare correspondence to communicate benefit determination.

. Perform financial document categorization in data system.

National Automotive Insurance Company

Metairie, Louisiana

Fast Track Adjuster

April 2011- September 2011

Use claims knowledge I order to determine liability and settle property

damage claims with clients.

. Handle translations for Spanish speaking customers.

. Settle total loss claims.

. Order police reports.

. Handle multi line telephone.

. Determine liability.

. Took client's statements.

. Prepare inbound and outbound correspondence.

. Issue property damage settlement payments.

. Set up rental vehicles for customers

BI INC.

Atlanta, Georgia

Case Specialist

August 2009 - March 2011

Received U.S. Federal Government Clearance in order to develop, implement,

and coordinate case management and individual service plans for ISAP

Program Participants in conformance with state and federal regulations and

program requirements.

. Meet with participants face to face as required by contractual

obligations.

. Serve as a translator for Spanish- speaking program participants.

. Conduct intake interviews and orientation sessions with each ISAP

Program Participant within contractual timeframes.

. Install electronic monitoring equipment on ISAP Program Participants

as necessary and monitor compliance with electronic monitoring

program.

. Assist program participants with acquiring travel documents from their

countries of citizenship.

. Establish schedules for ISAP program participants that include,

counseling as needed, immigration court appearances and access to

legal services.

. Conduct home visits to verify ISAP program participants' places of

residence are in compliance with contractual obligations.

. Review individual service plans, conducts risk/needs assessments and

write progress reports on a regular basis in compliance with

contractual obligations.

CONRY & ASSOCIATES LLC Metairie,

Louisiana

Secretary

September 2008 - April 2009

Served as an assistant to attorney.

. Serve as interpreter and translator for Spanish speaking clients for

depositions and conferences.

. Review documents from interns and Attorney.

. Maintain files and access filed material in a timely manner when

requested.

. Assist Attorney with calendar management by coordinating meetings,

appointments and conference calls and depositions.

. Answer and handle Attorney calls as requested.

. Assist Attorney with hiring.

. Reviewed mail as and draft responses where necessary.

GEICO INSURANCE COMPANY Metairie,

Louisiana

LA Licensed Claims Adjuster II March 2005

- August 2008

Use medical knowledge and negotiation training to evaluate and settle

injury claims with attorney represented and unrepresented clients.

. Handle translations for Spanish speaking customers.

. Settle injury claims with attorneys.

. Evaluate injury claims.

. Answer multiple phone lines and returned voice mails.

. Order and reviewed medical records for accident related injuries.

. Prepare inbound and outbound correspondence.

. Maintained client injury files

. Issue injury and property damage settlement payments.

. Meet with clients to settle injury claims.

. Prepare releases for attorney represented and unrepresented clients.

. Handle uninsured and under insured motorist injury claims.

. Set up rental vehicles for customers

. Handle recorded statements for customers.



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