Medical Customer Service

Gayle Phillip

**** ***** ****, *** *

Alexandria, Virginia 22312

acdtq5@r.postjobfree.com

917-***-**** (mobile)

Employment

NYS OTDA

Disability Analyst

*/**** - **/****

Reviewed Social Security SSD and SSI claims and determined if applicants are disabled and therefore eligible for benefits. Updated claim data as part of the claims process. Queried and reviewed relevant federal government databases. Evaluated the basis for the claim after examining complex medical reports from physicians, hospitals, and medical labs as well as vocational information in view of the claimant's disability, age, education, and work history. Contacted claimants, administrators, physicians, attorneys, or other medical record personnel for clarification of information provided for adjudication of claim. Prepared a detailed written analysis of the case information providing a full explanation of the investigation, documentation, and assessment of the medical and other evidence that led to the decision concerning the claim.

Trax Etc. Inc.

Office Manager

10/2007 - 9/2008

Recruited and hired personnel. Completed financial transactions for business including bookkeeping and payroll. Completed job proposals. Planned and implemented business goals to ensure the company continued to steadily grow and prosper.

Linwood Consultant

Claims Examiner &Claims Adjuster

4/2007 - 9/2007

*Temp agency - worked 4/2007 - 9/2007 and 8/2006 - 11/2006* Analyzed and reviewed claims for subrogation or third party potential. Wrote and implemented plan of actions needed to resolve workers' compensation cases. Analyzed claims and calculated indemnity payments due to claimants. Reviewed medical bills and authorized payments - as needed. Negotiated settlement of cases with claimant's attorney. Prepped cases for hearing including completing hearing directives to attorneys which outlined outstanding claim issues. Filed necessary forms. Communicated with claimants, attorneys, medical providers, and other insurance personnel on a daily basis.

Insurance Overload Staffing

Claims Representative &Claims Adjuster

1/2007 - 3/2007

*Temp agency - worked 1/2007 - 3/2007 and 6/2005 - 12/2005* Reviewed General Liability and Workers' Compensation cases from various states and composed large loss reports as a tool to keep the insurance company abreast of the total exposure of claims. Reviewed claims and issued notices of determination based on the liquidation rules and laws of the state of Pennsylvania. Analyzed claims and calculated indemnity payments due to claimants. Reviewed medical bills and authorized payments - as needed. Negotiated settlement of cases with claimant's attorney. Prepped cases for hearing including completing hearing directives to attorneys which outlined outstanding claim issues. Analyzed cases and created plan of actions needed to resolve outstanding claim issues. Filed necessary forms. Communicated with claimants, attorneys, medical providers, and other insurance personnel on a daily basis.

Lovell Safety Management

Claims Examiner

1/2006 - 6/2006

Reviewed files and requested specific carrier actions in order to defend claims and limit insured's liability. Advised insureds on actions to take when reporting various types of compensation cases. Analyzed claims and calculated indemnity payments due to claimants. Prepped cases for hearing including completing hearing directives to attorneys which outlined outstanding claim issues. Analyzed cases and created plan of actions needed to resolve outstanding claim issues. Filed necessary forms. Communicated with claimants, attorneys, medical providers, and other insurance personnel on a daily basis.

NYBCOICF

Assistant Claims Manager

4/2003 - 6/2005

Advised and directed Claims Facilitators on plan of actions in handling workers' compensation cases. Reviewed and made recommendations on compensability of cases under Article 6-F. Updated files as part of the claims review process based on Worker's Compensation Board decisions. Filed required Workers' Compensation Board forms in a timely manner. Investigated Workers' Compensation cases with claimants and member bases. Requested required information from attorneys, medical facilities and other insurance carriers. Maintained worker's compensation dairy to assist in keeping opened cases updated. Reviewed and approved Claims Facilitators' case reserve worksheet. Reviewed and made recommendations to Claims Facilitators on the handling and documentation of workers' compensation cases.

York Claims Services, Inc

Workers'Compensation Adjuster

4/2000 - 1/2003

Responsible for setting up claims, three-point contact. Knowledge of 25-A, 15-8, and subrogation issues. Update and analyze medical and indemnity reserves. Interact with claimants, insureds, and providers on a daily basis as part of the claims process. As a Third Party Administrator, handled AIG Insurance permanent disability (classified) claims. Handled Empire Insurance Group lost time claims of varying degrees of complexities.

Education

John Jay College of Criminal Justice (CUNY) - 6/1999

Bachelor's Degree - Computer Information Systems

Bauder College - 10/1990

Associate's Degree - Fashion Merchandising

Art Institute of Fort Lauderdale - 9/1989

Fashion Merchandising

Skills

Customer service

Multitasking

Attention to detail

Microsoft Office suite

Prepare statements of legal opinion

SQL

References

Available upon request.

Contact this candidate