Medical Customer Service

Deborah B. Overton

*** *. ******* ****** ( Philadelphia, PA 19144

267-***-****/cell ( email: *************@*****.***

Summary:

Pursuing a higher level of professional growth, and responsibility that would be both challenging and rewarding. Recognized for analyzing, problem solving, and excellent customer service skills.

Professional Experience:

Patriot Risk Services ( Workers’ Compensation Medical Only Adjuster ( 401 Plymouth Road, Suite 420, Plymouth Meeting, PA 19462 ( 09/11 – 11/17

Processed medical only workers’ compensation claims, make contact with employers, request medical records and determine compensability.

Ensured claims are reserved timely and appropriately, with current action plans to bring the file to closure.

Assign nurse case managers to assist with medical management and return to work.

( Coordinate with employers and providers to ensure timely return to work efforts.

( Provide status reports to employer and brokers.

Recommend settlement on limit exposure files.

Schedule independent medical evaluations on questionable claims and prolong treatment.

Respond to all inquiries in a timely and efficient manner.

Sedgwick CMS ( Claims Examiner Trainee/temporary position ( 1801 Market Street, Philadelphia, PA 19103 ( 04/09 – 09/09

( Processed limited lost time workers’ compensation claims for several jurisdictions, determined compensability, and issued temporary total disability benefits timely on all compensable claims.

Discussed all questionable claims with employers and communicated plan of actions.

Coordinated return to work with physicians, employers and claimants.

Reserved files for full exposure.

Participated in Claim Reviews via teleconference.

Completed and issued all State Forms.

Monitored and approved all appropriate medical treatment.

Scheduled independent medical evaluations on all questionable treatment.

Liberty Mutual Insurance ( Medical Only Claims Adjuster ( 111 Presidential Blvd, Bala Cynwyd, PA 19004 ( 08/05 –11/07

Made timely two point contacts to assist with compensability decision.

( Coordinated return to work efforts with physicians, claimants and employers.

Monitored and determined the necessity of all medical treatment.

Communicated action plans and reserve analysis to employers.

Requested utilization reviews from the PA Bureau on all excessive medical treatment and scheduled Independent Medical Evaluation on questionable injuries and treatment.

CorSolutions ( Enrollment Specialist ( 301 E. Germantown Pike, Norristown, PA 19401 ( 01/04 – 08/05

Corresponded with members in reference to health benefits eligibility.

Responded to insurance inquires, and assisted with processing claims accurately.

Reconciled and documented members’ charts.

Implemented corporate collection policies and made appropriate reserve recommendations.

Education:

The Cittone Institute - Philadelphia, PA

Major: Medical Administrative Assistant

2004

Skills:

PBX Multi-line phone systems, Medical terminology, data entry, Medisoft Billing & coding Software, MS Office 2010

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