Irene Villodas

**** ***** ****** #**

Brooklyn, NY 11235

917-***-****

acrzil@r.postjobfree.com

Experienced administrative, casualty and no fault Specialist, superior organizational skills with the ability to multi-task and provide accurate, excellent customer service with consistency and efficiency.

Allstate Insurance Company, Brooklyn, NY

Sr. Claims Service Specialist Associate III/ Administrative Assistant January 2015-Present

Achieved 100% compliance and quality review from higher individuals to achieve business success.

Produced 100% compliance results for the entire Medicare claim discipline for 2013 and 2014.

Successfully complied with all disciplines of the organization to identify fraudulent claims and work towards resolution with Special Investigators.

Complied with all necessary information for time sensitive forms and payments that are required by New York State and Regulation 68.

Successful in communicating with customers to inform them of status of claim and payments issued.

Construct bi weekly spreadsheets for Medicare reporting, logging and documenting down to desk level.

Compliant by sending delays to attorneys, policy holders and providers pending missing information needed to make appropriate payments.

Excelled in maintaining several different logs for production, wage tracking, Medicare reporting, delays and task completion.

Hand-picked to receive security variance to access CMS Medicare Secondary Payer Recovery Portal.

Participate and run the Recognition and charity Committees for the entire Metro Claims office.

Design and tested the Medicare Service Reporting Portal countrywide.

Received Customer Service Award (2014) and recognition awards in 2013 and 2014 for Customer Service handling.

Provide training for both prospects and new hires within my discipline. Sr. Claim Service Advocate/ 3rd party Medicare Processor May 2009 – January 2015

Exceeded all aspects of Customer Service Complaints, Inquiries, direct policy holders and third party customers to the proper department.

Proven ability to identify the need to recommend and adjust the appropriate reserve setting.

Excelled in Indexing, sorting medicals reports for data entry receivable paperwork including contacting plaintiff attorneys on a daily basis to obtain injury information for system upload.

Create and establish daily reports and work logs for manager review, calendar and track suspense system for claim handling.

Handle, inform and review with providers CPT codes for medical billing.

Collaborates with team members to resolve issues and identify appropriate issues for escalation.

Successfully handled and accomplished the “One in a Million Call” on behalf of Allstate and Agents.

Sr. Casualty Represented Processor/3rd party Medicare Processor December 2003 – May 2009

Completed ICD - 9 Injury Codes & Diagnosis Codes for Medicare Reporting Purposes including calls made to report for maintain 100% compliance.

Irene Villodas 917-***-**** page 2

Input ICD – 9 alleged Cause of Injury per Injured Beneficiary, ICD 9 Injury Diagnosis Codes for Injuries claimed by Medicare Beneficiaries and handle and processed over 300 pending files utilizing a suspense system.

Requested and investigated reports from doctors, emergency rooms, police and requested MRI reviews.

Compiled records, file documents and attended to counter and written inquiries, including due diligence with attorneys, private investigators and doctors on a one-on-one basis.

Processed summons and complaints, affidavit of no excess coverage, next gen claims.

Determined liability on Express files.

Set expectations for Insured’s on 100% liability files direct repair and drive in assignments for all parties. Casualty Defend Processor July 2003 – Dec 2003

Requested specific judgments and/or notices to be made.

Requested both Independent Medical Exams and Radiology reviews on files.

Successful in working with our legal department with regards to Note of Issues, Ninety Day Notices, Summary Judgment Motions, and motions to preclude.

Exceeded goal dealing one-on-one with outside counsel and in-house counsel on all legal matters.

Arranged and scheduled travel for policyholders to attend court appearances.

Performed computerized data entry for all internal/external legal paperwork Auto Express Processor January 2002 – July 2003

Handled and processed over 225 pending files utilizing a suspense system, secured certified Police Reports, motor vehicle reports and statement of property damage reports.

Handled and processed customer service inquiries and complaints.

Issued payments to policy holders, claimants and repair facilities.

Scheduled appointments for vehicles to be appraised and determined percentage of comparative negligence and set direct bills for rentals.

Claim Processing Specialist October 1995 – January 2002

Obtained statements and was responsible for investigating claims, police reports, medical documentation, kept and updated records, filed documents and attended to counter and written inquiries.

Handled and processed all requests for management and claim representatives, was responsible for the word processing and compiling of large technical documents.

Handled and processed pre-billing to be generated in monthly billing cycle including Police Reports for over 10 adjusters and assigned files to the proper departments for handling.

Served as daily coverage at reception desk.

Maintained the expense and duplicate check logs for entire claim department. Education

Kingsborough Community College A.A.S. in Business Administration 2000 Skills

Microsoft Office, PCCSO, Main Frame Claim File 34.0, Next Gen 2.35, WordPerfect, Internet, Intranet, Mitchell Decision Point, ISO Claim Search and Keyboarding –70+ WPM, Switchboard and receptionist.

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