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Medical Customer Service

Location:
Los Angeles, CA
Salary:
$57000.00
Posted:
September 05, 2018

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Resume:

Courtney Vo

**** *********** ***. ***** ***, Ca *2703

E-Mail: ac6x12@r.postjobfree.com

714-***-****

HIGHLIGHTS

Strong knowledge of worker’s compensation claims handling, best practices and procedures.

Extensive background in lien resolution, lien filing legal compliance, and conflict resolution.

Proven ability to gain customers confidence and satisfaction.

Excellent in communicating with all levels of management, coworkers and clients.

Strong organization skills. PC literate. Medical background. Superior work ethic. Strong attention to detail.

EDUCATION

2013 Self Insurance Certificate Department of Industrial Relations, State of California

2011 Experienced” WCCP Claims Adjuster Designation

1994 AA Nursing Degree Santa Ana College, Santa Ana, CA

PROFESSIONAL EXPERIENCE

AMTRUST FINANCIAL SERVICES, Irvine, CA 2014 to Present

Claims Assistant Responsibilities:

Provided administrative support to a team of Examiners.

Prepared and transcribed all legal and non-legal documents.

Conducted medical status calls on injured workers for return to work or P&S status.

Processed all benefit payments (TTD, PDA, Medical, Life Pension and Death Benefits)

Prepared stipulations with Request for Award, Compromise & Release's and DEU rating filings;

Schedule AME, PQME evaluations with follow up.

Ensure timely benefit administration.

Interfaced with doctors, attorneys, investigators, nurses, to focus on return to work and the resolution of the claim.

INTERCARE INSURANCE, Orange, CA 2014

Claims Assistant Responsibilities:

Provided administrative support to the Examiner.

Prepared and transcribed all legal and non-legal documents.

Conducted medical status calls on injured workers current work status.

Processed benefit payments to municipal sworn personnel (LC 4850 benefits. TTD, PDA, Pension and Death Benefits)

Prepared stipulations with Request for Award, Compromise & Release with proper follow up.

Submit reports to DEU for rating.

Managed both Medical Only and Future Medical files setting reserves to exposure.

Made payments on a diary, and reviewed processed applicable invoices.

Interfaced with injured workers and explained rules, regulations, laws and policies related to their workers’ compensation claim.

TRISTAR RISK MANAGEMENT, Signal Hill, CA 2008 to 2013

Medical Only Claims Examiner Responsibilities:

Developed and adjudicated medical only compensation claims of sworn personnel against the County.

Primarily investigated and handled short duration, non-litigated, no lost time, lower severity, soft tissue type injury claims.

Made three (3) point contacts and addressed such issues as coverage, compensability, delay and or/denial of claim with full recognition that some issues went beyond the handling scope of the position. In those situations, the manager was notified of the need to re-assign the file per specific account instructions.

Calculated and assigned timely and appropriate medical treatment reserves, approved and processed medical benefits with MTUS and Utilization Review guidelines, and negotiated lien settlements.

Established, documented, and executed action plans.

Provided customer service- answered telephones by the third ring and provided guidance to injured workers trying to navigate the claims process.

Appropriately initialed QME process for unrepresented claims.

Completed assigned work diaries and work queues in a timely manner.

Prepared reports and presented file claim status to various county administrators in face to face meetings.

THE BEST IRS STAFFING AGENCY, Phoenix, AZ 2006 - 2008

Claims Assistant Responsibilities

Assigned to the Southern California offices of both Broadspire/Crawford & Company- and Kennan and Associates, respectively.

Provided administrative support to a team of Examiners.

Prepared and transcribed all legal and non-legal documents.

Conducted medical status calls on injured workers for return to work or P&S status.

Processed all benefit payments (TTD, PDA, Pension and Death Benefits)

Prepared stipulations with Request for Award, Compromise & Release's and DEU rating filings; AME, PQME.

Made payments on a schedule basis, and process all invoices.

Interfaced with doctors, attorneys, investigators, nurses, to focus on return to work and the resolution of the claim.

TEAM POST-OP, INC., Irvine, CA 2005 to 2006

Medical Lien Recovery Specialist Responsibilities:

Primary duties included the collection of delinquent workers’ compensation and commercial accounts.

Analyzed delinquent accounts and verify that all information collected was correct. Reviewed billed invoices to ensure they were paid correctly per OMFS/Fee Schedule. Called Adjusters/Handling Attorneys and made all efforts to collect on account balances.

Managed client’s monthly statements and resolved discrepancies on customer accounts.

Prepared and electronically filed legal documents such as liens, declaration of readiness, motions to compel, etc. and daily follow up of court hearings and dates.

Attended court hearing such as (MSC, Lien Conferences, Pre-trials or Trials.

Maintained statistics for computer database of Set-Off transactions and for preparation of collection reports.

Prepared, filed and served all legal documents. This included exhibits, subpoenas to parties involved including witnesses, stipulations, trial briefs with full understanding of the California Labor Codes and Forms.

VQ ORTHO CARE, Irvine, CA 2000 to 2005

Workers Compensation Collector Responsibilities:

Primary duties included the collection of delinquent workers’ compensation and commercial accounts.

Analyzed delinquent accounts and verify that all information collected was correct. Reviewed billed invoices to ensure they were paid correctly per OMFS/Fee Schedule. Called Adjusters/Handling Attorneys and made all efforts to collect on account balances.

Managed client’s monthly statements and resolved discrepancies on customer accounts.

Prepared and electronically filed legal documents such as liens, declaration of readiness, motions to compel, etc. and daily follow up of court hearings and dates.

Attended court hearing such as (MSC, Lien Conferences, Pre-trials or Trials.

Maintained statistics for computer database of Set-Off transactions and for preparation of collection reports.

Prepared, filed and served all legal documents. This included exhibits, subpoenas to parties involved including witnesses, stipulations, trial briefs with full understanding of the California Labor Codes and Forms.

Assisted colleagues with accomplishing yearly goal of collecting over $3,691,535.00 in delinquent revenue.



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