Customer Service Medical

Maritza Lamberty

**** ** **** **, *********, FL *3024 Cell: 954-***-**** ***************@*****.***

Driven Workers Compensation Adjuster trained in all aspects of insurance billing, claims and collections. Employs high-level negotiation skills in resolving claims to the satisfaction of all involved parties. Analytical thinker and innovative problem solver.

Claims file management processes

SUMMARY

HIGHLIGHTS

ACCOMPLISHMENTS Was acknowledge by 'In Touch Magazine' 3 years in a row with an 'In Touch Excellence Award'.

EXPERIENCE Medical Only Claims Adjuster, 10/2007 to 03/2014 Tower Group Insurance Company - Fort Lauderdale, FL Obtained relevant evidence and information regarding suspicious claims. Interviewed claimants, medical specialists and employers to determine pertinent claim information. Managed a caseload of 170 clients each month. Conducted interviews, gathered detailed information and completed field investigations.Investigated any potentially fraudulent claims with a focus on thoroughness, quality and cost control. Identified and collected evidence and determined its value to a specific claim. Closed an average of 60 cases per month. Contacted injured parties and legal representatives to negotiate final settlements for claims. Communicated with insured individuals to explain audit classifications and computations. Obtained all necessary information to complete proper evaluation of injury claims. Completed required investigations on referred files in a timely manner.

I worked from home for 2 years and did very well.

Claims Assistant, 04/2005 to 09/2007 Gallagher Bassett - Miramar, FL Responsible for providing assistance to Branch/Area Manager and to Adjusters, to assist in the overall branch work process. Creating documents including letters, memos, and forms. General office duties include customer service, mail room, setting up medical appointments for claimants and answering phones.

Medical Scheduler, 09/2004 to 03/2005 Medvision - Aventura, FL Responsible for scheduling workers compensation patients for diagnostic services, taking incoming referral calls from insurance adjusters. Communicating with physician's office for patient information, faxing authorization to the facilities. Entering patient data and pre-screening

Strong interpersonal and communication skills

Workers' compensation claims

Critical thinker

Very productive working from home and in an office environment.

Self-directed

Analytical

Team player

Decisive

Fluent in Spanish

patients.

EDUCATION Psychology Miami Dade Community College - Hialeah, FL

Workers Compensation Insurance Hollywood, FL Completed Florida Certified Claims Adjuster Licensing course in 2007.

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