Customer Service Home Health

*** ********* ****** 516-***-**** Cell

Floral Park, NY 11001 Email: ********@*****.***

Professional Summary: Providing excellent customer service, utilizing my strong organizational,

analytical skills. Excellent interpersonal communication, time management and a comprehensive

understanding of the health care system.

07/11-Present Partners in Care New York, NY

Home Health Aide Supervisor

Provide supervisory in home care along with case management. Coordinate all

administrative duties in compliance with corporate/state regulations. Document patient’s

status and overall health. Scheduling HHA case assignments, evaluate home health

aides in a residential setting. Submit billing to insurance carriers for payment via

Electronic transmission. Maintain database for accuracy. Provide self-pay statements for

direct payments.

11/08- 05/11 GAB Robins Risk Management Services New York, NY

Claims Examiner

Analyzed complex and technically difficult medical and liability claims by investigating the

claims exposure. Reviewed and processed No-fault claims in accordance to regulation-

68 and the ICD-9 fee schedule. Review and requested authorizations from health care

carriers. Provided reports to the insured or excess carrier. Negotiated claim settlement.

Assigned reserves to claims, coordinated legal defense by assigning and monitoring

defense attorneys. Reviewed invoices and appeal letters. Identify possible fraud and

subrogation recovery to reduce claim cost, maintained file diary.

11/05 – 07/08 Lending/Tree/Spherion Group Charlotte, NC

Benefits Customer Service Associate

Secured customer information for mortgage loans, reviewed credit data. Advised clients

on product lines, refinancing and home equity loans. Conformation of coverage’s and

policy dates. Verbal and written communication with departmental managers and staff.

Created and tracked request for payroll inquires, verify PTO, FMLA.

02/02 – 05/05 Warranty Central Inc. Charlotte, NC

Claims Area Supervisor

Supervised resolution of client concerns in conjunction with contract policies and

Provisions. Handled litigated and non-litigated claims. Set reserve maintained summon

log on all claims. Directed legal counsel, secured statements from insured and claimants.

Managed all small claims within coverage settlement authority. Investigate damages,

Follow-up with manufacturers on parts/service.

10/99 – 01/02 GAB Robins Risk Management Services New York, NY

Claims Examiner

Confirmed coverage, make contact with insured; secure recorded statements. Assigned

defense counsel to place an answer on the insured’s behalf. Obtained stipulation answer

from plaintiff’s attorney. Directed investigations and dictated reports to excess carriers.

Requested and reviewed all medicals and specials of the claimant’s scheduled IME and

scar-tissue review.

Computer Skills: MS Word, Excel, Invision, Med data, Outlook and PowerPoint

Education: Bachelors of Science Houston Tech. CNA, Hospice Cert ICD-9/Coding Cert

Spanish, English speak/read/write

Bilingual:

Military Service: U.S.M.C. Unit Diary Clerk, Honorable Discharge

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