Medical Management
Resume:
Tiwanda Steen
Yonkers, Ny *****
abgi66@r.postjobfree.com
**/** **/**** ****** Safety Mgmt
W/C Claims Examiner
Managed a case load of up to 300 lost time cases.
Initiated investigations to the employer, provider, and employee.
Determined compensability of claim.
Recommended payment via NYSIF, authorized diagnostic test requested by
provider, authorized treatment, such as PT, and authorized surgery
if needed.
Recognized the need to refer to Case Mgmt when assignment is needed.
Managed independently satelite office. Functioned independently, satallite
office in White Plains handling downstate and upstate claims. Interacted
with NYSIF on a daily basis.
02/01 09/01 ManagedComp
W/C Claims Adjuster
Currently handling a pending of 250 lost time cases for NYS.
Performed initial investigation by obtaining statements from the injured
worker,his/her employer and or legal representative and
determing compensability for all initial claims within designated team assignment
Determine initial reserve for new medical and lost time cases.
Recognized the need for and refer to Case Management when assignment is
appropriate.
Handle Second Injury Fund and Subrogation.
09/97 08/00 AIGCS INC
Claims Adjuster
responsible for investigating & determining the compensability of lt clms
within the team.
Prepared litigation management strategy for all controverted claims going to a
hearing.
Identified recovery via 2nd Injury Fund and/or Subrogation.
Medical Management
Provided status report to clients and brokers
1981 1996 Social Security Administration
Service Representative
Managed enrollment of medical & wage replacement assistance programs such
as Social Security and Medicare eligible clients through
interviews and knowledge of when to include and exclude the Annual Retirement
Test.
Certificates: AIGCS INC, Claims School, CETA Technical Certificates
Skills: Microsoft Word, Windows, Excel, LMS, CSO, CHS, & Pyramid
Reference Furnished Upon Request
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