Customer Service Manager
Resume:
ALISA A. WEST, CWCP
Conyers, Georgia *****
********@*******.***
Meticulous risk management administrator with more than 15 years of experience providing
customer service to clients for insurance claim benefits, workers' compensation, FMLA and
disability programs, as well as contract interpretation. Proven diligence in managing various
caseloads while ensuring compliance of all state and federal (OSHA, HIPAA) regulations.
Administers benefits and facilitates claims adjustments related to insurance workers'
compensation, short-term / long-term disability, and FMLA.
Risk Management • Benefit Administration • Workers' Compensation Claims • Project
Management •
Civil, Federal & State Regulatory Compliance & Investigations • Reporting • Cost
Containment • SSA/Disability/ GA Medicaid • Claims Processing & Management • Claims /
Insurance Adjustments • Program Development • Training Implementation & Development •
Paralegal Case Management • Client Relations • Analysis • Customer Service •
Communication • Mediations/Arbitrations • Team Supervision • ICD-9 / CPT 4 Coding •
Medical Terminology and Clinical Background • Troubleshooting • Independent Problem
Solving • Group Relationships
PROFESSIONAL EXPERIENCE
Workers Compensation Specialist
Johnson & Bryan INC., Atlanta, Georgia • 2013-Present (temporary position)
The essential duties and responsibilities include client retention/satisfaction, approve reserves
and claim reviews. Respond to and follow through with internal and external audits, claims
review, guidance and direction, quarterly audit completion and conducts prospect meetings and
presentations with producers. Works with insured’s to bring conclusions to wkc. claims, reviews
claim reserves and costs to prevent over reserving. Analyzes claims data to spot trends while
working with safety team and Risk Manager to prevent further loses.
Human Resource Risk Management Administrator
ACOSTA SALES & MARKETING, Jacksonville, Florida • 2011-2012
Administered records related to workers' compensation, general liability claims, FMLA, ADA,
and STD / LTD. Collaborated with supervisors, managers, and general personnel to create
OSHA reports, manage workers’ compensation and general liability claims, document injuries,
and direct recommendations for safety improvements.
Responded to payroll issues related to eligible injury leave under FMLA and workers’
compensation guidelines. Developed and implemented company training and orientation
programs for workers’ compensation reporting protocol and facilitated ongoing communication
and development of trainings and materials related to safety, workers’ compensation filings, and
OSHA regulations. Employed risk management initiatives and encouraged prompt return-to-
work capabilities. Ensured proper dissemination of claims information, efficient claims
Resume
management, and cost effective closures by interfacing with field operations, human resources,
claims administrators, and attorneys. Supported follow up related to treatment
recommendations, medical documentation, and litigation response. Responded to
Unemployment Claim(s).
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ALISA WEST • Page 2 • ********@*******.***
Case Manager, Team Lead
GLOBAL SCR, Albany, Georgia • 2009-2011
Contracted with The State of Georgia DFACS evaluated and investigated customer needs for
assistance programs by facilitating competency-based interviews. Educated customers and
team on various childcare programs and program requirements. Supported case managers
during policy interpretation and quality assurance initiatives. Utilized appropriate criteria and
established policies while processing applications and reviews. Initiated recommendations for
performance improvement plans. Implemented team performance evaluations and training
related to new policy directives and program changes. Created weekly reports for approvals,
denials, and pending cases.
• Decreased public assistance dependency and enhanced customer self-sufficiency by
performing direct customer service.
• Exceeded or met accuracy and timeliness standards of 92% and 94% by leading team
efforts and establishing and achieving team objectives.
• Enhanced education on current policies, laws, trends, and developments by studying
appropriate policy notices / interpretations and participating in trainings.
Workers Compensation Specialist
ORTHOPEDIC & SPINE SURGERY OF ATLANTA, Atlanta, Georgia • 2007-2008
Served as liaison between OSSA and patients, adjusters, attorneys, etc. to ensure approval of
procedures and surgeries through state workers' compensation system. Directed workers’
compensation program. Facilitated communication between all parties to ensure proper
progression of case. Researched and identified appropriate doctor referrals. Performed
scheduling for initial client appointments. Established training programs to educate staff
members on appropriate workers’ compensation documentation, filing, and provider
responsibilities according to state and federal filing guidelines. Generated weekly, monthly, and
annual reports and analyzed findings.
• Improved surgeon's reputation as educated and feasible workers' compensation
provider and marketed workers’ compensation program to physicians needing IME and
surgery consults.
• Established and implemented training related to proper referral techniques and request
for workers' compensation authorizations.
• Increased surgery authorizations and number of treatment plans for physician.
Strengthened relations between customers and providers, attorneys, and adjusters.
Resume
Claims Specialist (Workers Compensation Adjuster)
AIG CLAIMS SERVICES, Alpharetta, Georgia • 2006-2007
Performed assessments on complex workers compensation claims and lawsuits against policy
holders related to coverage and loss exposure. Facilitated cost-effective and prompt case
closures in regards to denial, settlement, or litigation. Verified coverage based on policy
provisions and appropriate case law / statutory requirements while evaluating loss information.
Administered litigation and associated costs, and resolved critical issues and claims pre-
litigation by developing investigation plans. Assessed critical liability and damages matters in
order to implement valuing exposure. Spearheaded claims negotiations and settlements within
$250,000 allowance. Contributed to mediations as an AIG representative.
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ALISA WEST • Page 3 • ********@*******.***
Claims Examiner (Workers Compensation Adjuster)
COMP MANAGEMENT, Duluth, Georgia • 2006
Directed workers' compensation claims by identifying compensability and benefits due on
medical-only claims. Managed necessary documentation and provided appropriate reports to
state agency. Established and maintained workers' compensation claims action plans.
Administered return-to-work initiatives. Spearheaded approvals and processing of claim
payments and workers’ compensation claims. Presented claim action to claimant and client.
Developed and sustained professional relationships with clients.
Case Manager
AMERICAN ARBITRATION ASSOCIATION, Atlanta, Georgia • 2005
Assigned mediators and arbitrators to cases diverted from court into mediation. Oversaw all
mediators and arbitrators and facilitated periodic roundtable discussions and on-site debriefings.
Managed workers’ compensation cases by developing relationship with adjusters and attorneys
while sustaining updated records in program database. Enhanced mediation / arbitration
referrals by building relationships with judges, attorneys, and administrators. Recruited
arbitrators and mediators for cases related to employment law. Created arbitration materials,
including PowerPoint presentations, flyers, brochures, and pamphlets. Disseminated information
related to decision and / or award promptly.
Short Term Disability/LTD Claims Specialist/ Workers Compensation
CANADA LIFE ASSURANCE CO., Atlanta, Georgia • 2002-2004
Performed claims analysis and identified appropriate claim benefits in accordance to ERISA
regulations and policy provisions. Initiated claims investigations to decide short-term disability
benefit eligibility. Computed and allocated accurate benefit awards for each claim and
supervised benefit payments. Approved prompt claim payments upon obtaining proper medical
information. Streamlined communication between employees, employers, human resources,
and disability team. Identified claimants' restrictions and limitations and issued necessary
referrals to Transitional Return-to-Work Program. Managed leave time that ran concurrently with
short term disability and workers’ compensation.
Resume
Short-Term / Long- Term Disability Claims Manager
METLIFE INC., Alpharetta, Georgia • 2000-2002
Directed team of individual disability claim professionals while guaranteeing superior service to
customers and risk management according to state compliance and MetLife customer service
guidelines. Provided case management for short-term / long-term disability, FMLA claims, and
leave for absences concurrent with short term disability and workers’ compensation. Initiated
prompt and accurate processing for group disability income insurance claims while performing
customer service. Assessed information gathered from claimant, attending physician, and
employer to determine claimant eligibility. Established payment period and maintained payment
accuracy and timeliness.
continued...
Resume
ALISA WEST • Page 4 • ********@*******.***
EDUCATION
Bachelor of Science in Human Resource Management – anticipated July 2014’
Trident University, Cypress, California
University of Georgia Paralegal Certificate Program
April 2001
TRAINING
OCCUPATIONAL / SAFETY COMPETENCIES
Implemented training on safety issues relate to hearing protection and Hepatitis B awareness.
Initiated training sessions for employers with more than 1,000 staff members.
Managed OSHA reporting and MSDS guidelines.
Completed drug testing and post accident alcohol breathalyzer tests;
assisted with pre-employment and yearly DOT physical examinations.
University of Georgia School of Social Work Program:
Employment Services Training Program
Medicaid Services Training Program
TANF/Food Stamp Training program
CERTIFICATIONS
(CWCP) Certified Workers Compensation Professional
AFFILIATIONS
Society for Human Resource Management
Resume
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