Rosaline Johnson

***** *********** **** ****

Houston, Texas 77049

Cell:832-***-****

acdmnv@r.postjobfree.com

Education

A&M Consolidated High School

College Station, TX

Graduated - May 1982

Objective

I am seeking a position offering advancement with an opportunity to utilize

the skills already obtained and offers the opportunity to learn new skills

Experience:

Texas Department of Insurance

Office of Injured Employee Counsel

Customer Service Rep./Ombudsman assoc

Houston, Texas 77060

September 2007 - present

-Contacts injured employees to explain Ombudsman services; explains rights

and responsibilities;

responds to complaints and questions; assists with referrals to social

service agencies; provides information about workers'

compensation

processes; and contacts insurance carriers and medical providers to

identify and resolve disputes.

-Documents all customer contact in the mainframe system. Answers general

customer service calls.

-Reviews claim files to determine if required forms and documents have been

received; explores avenues for resolving disputes;

-Requests information from others, including health care providers,

witnesses, and parties, as appropriate; prepares Ombudsman file and index.

-Prepares injured employees for proceedings through education about the

workers' compensation process and provisions of pertinent law and rules;

explores alternatives for resolution of disputes; assists with obtaining

supporting documentation; and initiates follow-up contacts about the

results of proceedings and assistance provided.

-Coordinates workflow with Ombudsmen to assure effective delivery of

service.

-Performs related work as assigned.

-Use mainframe system to enter, retrieve, and review workers' compensation

information;

-Provide administrative or customer service support on an as needed basis.

-Other duties as assigned

Texas Department of Insurance

Division of Worker's Compensation

Claim Service Officer

Houston, Texas 77060

March 2004 - September 1, 2007

-Review requests for Pre hearing/ Benefit Review Conferences and Contested

Case Hearings and attempts to resolve disputes between system participants

within requires timeframe, includes talking with all parties to a claim and

preparing correspondence

-Evaluates designated doctor requests and take appropriate action.

-Initiate the proceeding setting process when dispute resolution attempts

are no successful.

Provide guidance in completing TWCC forms and explained the complexities of

the TWCC law, policy & advisories to injured workers, attorney, employers,

healthcare providers and other participants

-Train new disability determination officers

Communicates, meets with and provides information and assistance to injured

workers, employer, insurance carrier, healthcare provider and other

participants

-Assist in resolving disputes through out the process, prepare and

organizes documentations and records information on contacts and case

action

-File proper documentation to support settlement of a claim between

interested parties, data entry all TWCC forms and any documentation

regarding claim

-Enter dispute, submit violation, documents all action taken

-Update and correct mainframe, ensure initial contact to injured worker

-Review documentation for formal and informal proceeding (BRC,CCH)

-Explain TWCC policies, procedures and regulations, Make recommendation to

other social services

Texas Worker's Compensation Commission

Administrative Technician III

Houston, Texas

February 1999 - March 2004

-Communicates, meets with and provides information and assistance to

injured workers, employer, insurance carrier, healthcare provider and other

participants

-Assist in resolving disputes through out the process, prepare and

organizes documentations and records information on contacts and case

action

-File proper documentation to support settlement of a claim between

interested parties, data entry all TWCC forms and any documentation

regarding claim

-Enter dispute, submit violation, documents all action taken

-Update and correct mainframe, ensure initial contact to injured worker

-Review documentation for formal and informal proceeding (BRC,CCH)

-Explain TWCC policies, procedures and regulations, Make recommendation to

other social services

-Provide guidance in completing TWCC forms and explained the complexities

of the TWCC law, policy & advisories to injured workers, attorney,

employers, healthcare providers and other participants

-Train new customer service reps

Texas Worker's Compensation Commission

Administrative Technician II

Houston, Texas

September 1997 - February 1999

Communicates, meets with and provides information and assistance to injured

workers, employer, insurance carrier, healthcare provider and other

participants

-Assist in resolving disputes through out the process, prepare and

organizes documentations and records information on contacts and case

action

-File proper documentation to support settlement of a claim between

interrested parties, data entry all TWCC forms and any documentation

regarding claim

-Enter dispute, submit violation, documents all action taken

-Update and correct mainframe, ensure initial contact to injured workers

-Review documentation for formal and informal proceeding (BRC,CCH)

-Explain TWCC policies, procedures and regulations, Make recommendation to

other social services

-Provide guidance in completing TWCC forms and explained the complexities

of the TWCC law, policy & advisories to injured workers, attorney,

employers, healthcare providers and other participants

-Maintain records and statistical data, read & interpret court petitions to

determine eligibility

-Open, stamp incoming mail, export and type decision & order reports

electronically

Texas Worker's Compensation Commission

Secretary I

Bryan, Texas

August 1993 - February 1997

-Scheduled appointments and mailed out follow-up copy to injured workers

-Called all parties to clarify disputes

-Document all parties action taken

-Prepare and organizes documentation and records information on contacts

-Data entry of TWCC forms and any documentation regarding claim

-Make recommendation to other social services

Communicates, meets with and provides information and assistance to injured

workers, employer, insurance carrier, healthcare provider and other

participants

-Assist in resolving disputes through out the process, prepare and

organizes documentations and records information on contacts and case

action

-File proper documentation to support settlement of a claim between

interested parties, data entry all TWCC forms and any documentation

regarding claim

-Update and correct mainframe, ensure initial contact to injured worker

-Explain TWCC policies, procedures and regulations

-Provide guidance in completing TWCC forms and explained the complexities

of the TWCC law, policy & advisories to injured workers, attorney,

employers, healthcare providers and other participants

Texas A&M University

Front Desk Supervisor

College Station, Texas

June 1987 - September 1993

-Monitor office performance, responds to inquries and resolved issue from

the agency management

-Documents all action taken

-Assist companies and students with scheduling

-Initiating personnel action, resolving work related conflicts, and

participating in interviewing and hiring processes, assisted and monitor

work activities, preparing and performance appraisals

-Assists the manager in planning, coordinating, monitoring and directing

all field office operations and activities

-Review and maintain production reports

-Register companies and student for the program for interviews

Skills

Ability to work several office equipment and word processing software,

Xerox copier, laser jet 1,2 &3 printers, IBM compatible computers, Inter-

tel, All Telephone systems, Wordstar, Wordperfects 5.0 - 5-1 Microsoft

word, knowledge of Windows 95,98 and Lotus notes the email package

Professional Development

-Telecommunication certificate

-Office procedure

-Excellence through courteous service

-Public Speaking

-Basic of business writing

-Leadership skills for women

-Personnel managment for supervisor

-Comunication skills for supervisor

-Manager training course

-Adjuster License 03

Contact this candidate