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Claims, Management, Leadership Development, Health Insurance

Location:
United States
Posted:
March 15, 2019

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Resume:

Tanisha S Phipps

Phone: 972-***-**** Email: ac8sqm@r.postjobfree.com

Work Experience:

Claims Adjuster- Workers Compensation 05/2017 – 08/2018

Sedgwick Claims Management 50-60hrs/week Irving, TX 75038

1. Investigate and analyze workers’ compensation claims within injured workers designated jurisdiction .

2. Ensured awareness and understanding of the workers’ compensation process, requirements, and entitlements to the injured worker.

3. Handled claim reserve levels over $100,000.00 by preparing cost estimates and of each assigned claim; monitor reserves budget and update amounts as necessary.

4. Coordinate medical treatment and curtailed time and cost by collaborating with medical providers which safely returned injured worker back to work.

5. Identify subrogation potential and pursue the process of reimbursement.

6. Acquired and directed aged litigated files towards successful closure.

7. Licensed Adjuster Texas, Michigan, Arizona, Louisiana, Oklahoma, Georgia

8. Handled Medical Only and Lost Time Work Claims

9. Collaborated with Nurses, Doctors, Lawyers and State Officials with success

Received Team Stars Award May 2018 for successful file closing ratio of 100 percent.

Customer Service Representative/ Benefits Analyst 09/2015 - 05/2017

Cigna Health 40-50hrs/week Bedford, TX 76021

Duties, Accomplishments and Related Skills:

1. Educated Medicare and Medicaid recipients about their health care benefits for Texas and Illinois

2. Collaborated with nurses, doctors and state officials regarding my findings related to resolving benefits issues arising from an individuals’ health care plan.

3. Patient Advocate for resolution to complex health care problems in reference to plan of care

4. Provider advocate to resolve complex claim issues in reference to billing, EOBs’, HCFA 1500, UB04, ICD -10, CPT coding, appeals, complaints

5. Frequently researched and resolved complex medical billing issues with minimal supervision.

Received multiple accolades for effective customer service.

Hospital Administrative Assistant 02/2012 - 09/2015

The University of Texas Southwestern Medical Center 45-50hrs/week Dallas, TX 75390

Duties, Accomplishments and Related Skills:

1. Maintained high level of service for both internal and external clientele.

2. Ensured patient requests were disseminated to nursing staff as appropriate.

3. Accurately and promptly transcribed orders.

4. Wrote in legible handwriting appropriate forms with required dates, times and signatures.

5. Coordinated scheduling of tests and procedures with appropriate departments

6. Generated accurate computer entries

7. Filed reports and documents in appropriate areas of patient's medical record established by policy.

8. Managed budget and supply of telemetry cardiac care unit.

9. Ensured correct bed status for patients.

10. Communicated appropriately with patients/families, physicians, and staff.

11. Followed all established policies when performing all tasks.

12. Assumed accountability for all actions in the workplace. Reported errors promptly.

13. Trained and orientated new staff .

14. Screened callers/visitors.

15. Read-Proofread incoming correspondence to determine proper action, along with preparing some responses.

16. maintained an electronic and hard copy filing system.

17. Reviewed outgoing correspondence for grammatical errors and format prepared for supervisor's signature.

Received UT Southwestern Honor Award for Excellence in Customer Service

Promotional Events Specialist 06/2014 – 08/2018

Crossmark 10-15hrs/week Plano, TX 75024

1.Possessed aptitude and knowledge of products and presented products to the general public.

2.Proactively intercept, engage, interact, and sell product to the consumer in a positive manner.

3.Effectively communicated benefits of product.

4.Maintained a professional appearance consistent with the requirements of the job.

5.Properly sets up and prepares Event Table for execution.

6.Achieves 100% execution on assigned work.

7.Assist with preparation for client visits and completes audit corrections.

8.Build and maintained rapport with store personnel to effectively meet company and client objectives.

9.Complete expense reports per Company Policy.

10.Accurately prepared and submit all on-line requirements on the same day as Event execution.

11.Ability to access the internet, navigate through company’s electronic systems, use Microsoft Outlook, and capability to view assigned documents, including Microsoft Word & Adobe PDF forms.

Education:

Major: Rhetoric and Writing Minor: Chemistry 180 hours

The University of Texas at Austin Austin, TX 78712

Bachelor's Degree 12/2008

SKILLS, LiCENSE,CERTIFICATIONS:

Microsoft Office for Windows; Word, Excel, PowerPoint, Adobe Professional, Outlook

Corel Word Perfect 10, Perfect Expert, Quattro Pro 10, SharePoint, PeopleSoft, JURIS, SIR, Texas, MI, GA, AZ, LA Claims Adjuster License

Mozilla Fire Fox, Internet Explorer

Technical Writing for both Life and Social Sciences

Mass Communicating via various technical resources

Health Occupation Students of America-1998-2002;

American Red Cross CPR Certified

American Red Cross HIV Peer Educator

Susan G. Komen Trainee for Cancer Awareness

Walgreens Pharmacy Tech Trainee Program

Texas Exes Undergraduate Chapter UT Austin

Team Leader- Six Flags Astroworld Houston –A Leased Company – Snack

Attack Concessions 1999-2001

Chemistry Courses Taken: General, Organic, Physical with Labs and Physics Mechanical with Lab



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