Customer Service Data Entry
Resume:
Rosaline Johnson
Houston, Texas 77049
Cell:832-***-****
**********@*******.***
Education
A&M Consolidated High School
College Station, TX
Graduated - May 1982
Objective
I am seeking a position offering advancement with an opportunity to utilize
the skills already obtained and offers the opportunity to learn new skills
Experience:
Texas Department of Insurance
Office of Injured Employee Counsel
Customer Service Rep./Ombudsman assoc
Houston, Texas 77060
September 2007 - present
-Contacts injured employees to explain Ombudsman services; explains rights
and responsibilities;
responds to complaints and questions; assists with referrals to social
service agencies; provides information about workers'
compensation
processes; and contacts insurance carriers and medical providers to
identify and resolve disputes.
-Documents all customer contact in the mainframe system. Answers general
customer service calls.
-Reviews claim files to determine if required forms and documents have been
received; explores avenues for resolving disputes;
-Requests information from others, including health care providers,
witnesses, and parties, as appropriate; prepares Ombudsman file and index.
-Prepares injured employees for proceedings through education about the
workers' compensation process and provisions of pertinent law and rules;
explores alternatives for resolution of disputes; assists with obtaining
supporting documentation; and initiates follow-up contacts about the
results of proceedings and assistance provided.
-Coordinates workflow with Ombudsmen to assure effective delivery of
service.
-Performs related work as assigned.
-Use mainframe system to enter, retrieve, and review workers' compensation
information;
-Provide administrative or customer service support on an as needed basis.
-Other duties as assigned
Texas Department of Insurance
Division of Worker's Compensation
Claim Service Officer
Houston, Texas 77060
March 2004 - September 1, 2007
-Review requests for Pre hearing/ Benefit Review Conferences and Contested
Case Hearings and attempts to resolve disputes between system participants
within requires timeframe, includes talking with all parties to a claim and
preparing correspondence
-Evaluates designated doctor requests and take appropriate action.
-Initiate the proceeding setting process when dispute resolution attempts
are no successful.
Provide guidance in completing TWCC forms and explained the complexities of
the TWCC law, policy & advisories to injured workers, attorney, employers,
healthcare providers and other participants
-Train new disability determination officers
Communicates, meets with and provides information and assistance to injured
workers, employer, insurance carrier, healthcare provider and other
participants
-Assist in resolving disputes through out the process, prepare and
organizes documentations and records information on contacts and case
action
-File proper documentation to support settlement of a claim between
interested parties, data entry all TWCC forms and any documentation
regarding claim
-Enter dispute, submit violation, documents all action taken
-Update and correct mainframe, ensure initial contact to injured worker
-Review documentation for formal and informal proceeding (BRC,CCH)
-Explain TWCC policies, procedures and regulations, Make recommendation to
other social services
Texas Worker's Compensation Commission
Administrative Technician III
Houston, Texas
February 1999 - March 2004
-Communicates, meets with and provides information and assistance to
injured workers, employer, insurance carrier, healthcare provider and other
participants
-Assist in resolving disputes through out the process, prepare and
organizes documentations and records information on contacts and case
action
-File proper documentation to support settlement of a claim between
interested parties, data entry all TWCC forms and any documentation
regarding claim
-Enter dispute, submit violation, documents all action taken
-Update and correct mainframe, ensure initial contact to injured worker
-Review documentation for formal and informal proceeding (BRC,CCH)
-Explain TWCC policies, procedures and regulations, Make recommendation to
other social services
-Provide guidance in completing TWCC forms and explained the complexities
of the TWCC law, policy & advisories to injured workers, attorney,
employers, healthcare providers and other participants
-Train new customer service reps
Texas Worker's Compensation Commission
Administrative Technician II
Houston, Texas
September 1997 - February 1999
Communicates, meets with and provides information and assistance to injured
workers, employer, insurance carrier, healthcare provider and other
participants
-Assist in resolving disputes through out the process, prepare and
organizes documentations and records information on contacts and case
action
-File proper documentation to support settlement of a claim between
interrested parties, data entry all TWCC forms and any documentation
regarding claim
-Enter dispute, submit violation, documents all action taken
-Update and correct mainframe, ensure initial contact to injured workers
-Review documentation for formal and informal proceeding (BRC,CCH)
-Explain TWCC policies, procedures and regulations, Make recommendation to
other social services
-Provide guidance in completing TWCC forms and explained the complexities
of the TWCC law, policy & advisories to injured workers, attorney,
employers, healthcare providers and other participants
-Maintain records and statistical data, read & interpret court petitions to
determine eligibility
-Open, stamp incoming mail, export and type decision & order reports
electronically
Texas Worker's Compensation Commission
Secretary I
Bryan, Texas
August 1993 - February 1997
-Scheduled appointments and mailed out follow-up copy to injured workers
-Called all parties to clarify disputes
-Document all parties action taken
-Prepare and organizes documentation and records information on contacts
-Data entry of TWCC forms and any documentation regarding claim
-Make recommendation to other social services
Communicates, meets with and provides information and assistance to injured
workers, employer, insurance carrier, healthcare provider and other
participants
-Assist in resolving disputes through out the process, prepare and
organizes documentations and records information on contacts and case
action
-File proper documentation to support settlement of a claim between
interested parties, data entry all TWCC forms and any documentation
regarding claim
-Update and correct mainframe, ensure initial contact to injured worker
-Explain TWCC policies, procedures and regulations
-Provide guidance in completing TWCC forms and explained the complexities
of the TWCC law, policy & advisories to injured workers, attorney,
employers, healthcare providers and other participants
Texas A&M University
Front Desk Supervisor
College Station, Texas
June 1987 - September 1993
-Monitor office performance, responds to inquries and resolved issue from
the agency management
-Documents all action taken
-Assist companies and students with scheduling
-Initiating personnel action, resolving work related conflicts, and
participating in interviewing and hiring processes, assisted and monitor
work activities, preparing and performance appraisals
-Assists the manager in planning, coordinating, monitoring and directing
all field office operations and activities
-Review and maintain production reports
-Register companies and student for the program for interviews
Skills
Ability to work several office equipment and word processing software,
Xerox copier, laser jet 1,2 &3 printers, IBM compatible computers, Inter-
tel, All Telephone systems, Wordstar, Wordperfects 5.0 - 5-1 Microsoft
word, knowledge of Windows 95,98 and Lotus notes the email package
Professional Development
-Telecommunication certificate
-Office procedure
-Excellence through courteous service
-Public Speaking
-Basic of business writing
-Leadership skills for women
-Personnel managment for supervisor
-Comunication skills for supervisor
-Manager training course
-Adjuster License 03
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