Beatris Fernandez

** ***** ***** ****

Plainview, New York 11803

516-***-****

acs74m@r.postjobfree.com

OBJECTIVE

To further my career within workers’ compensation claims administration with an organization where I can use my skills to help build performance and thus mitigate insurers’ claim costs.

SUMMARY OF QUALIFICATIONS

Knowledgeable in the claims administration, case management, and cost containment solutions as applicable to Workers' Compensation rules in New York and Extensive studies in medical office technologies

Proficient in ICD-9, CPT codes, and medical terminology

Experienced in customer service and excellent interpersonal and communication skills

Familiar with New York Workers' Compensation Medical Treatment Guidelines

Ability to prioritize multiple tasks and meet deadlines

Acquainted with a number of computer based programs: Microsoft Office (Word, Excel, and PowerPoint) competent in internet usage including research and email

Fluent in English and Spanish

PROFESSIONAL EXPERIENCE

06/2015 TO 10/2015, AMTRUST NORTH AMERICA – MELVILLE, NY

Workers' Compensation Lost Time Claims Adjuster

02/2009 TO 05/2015, VISION RISK SERVICES LLC – COMMACK, NY

Workers' Compensation Lost Time Claims Adjuster 04-2011 to 05-2015

Review, investigate, analyze, and adjust Workers' Compensation claims in accordance with current laws and regulations

Establish claims reserves and authorize payments within reserving authority limits

Coordinate with defense counsel on litigated claims providing records and reports as necessary

Authorize appropriate payments of medical bills, temporary and permanent disability, and death benefits within pre-established limits

Perform other duties as assigned by Workers' Compensation Director

Assist Unit Manager with mentoring new claims examiner and/or supervisory functions

Administer indemnity benefits for valid lost time Workers' Compensation claims

Negotiate settlements to achieve the best possible outcome for each claim

Workers' Compensation Medical Only Claims Adjuster 02-2009 to 04-2011

Initiated "Three-Point Contact" with the client to verify the validity of the claim, the injured employee and medical provider

Coordinated and ensured early return-to-work efforts with workers and the clients

Reviewed progress of claims with the client, providing a well-documented action plan and acted as a resource for claims questions and guidance

Reviewed and processed medical bills for payment in accordance with the established site of injury and fee schedule

Requested appropriate forms from the client such as: C-11, C-107, and C-240’s

Licensed as a New York Independent Claims Adjuster for No-Fault, Motor Vehicle, and Workers' Compensation claims.

EDUCATION

Briarcliff College Bethpage, NY

AAS Medical Office Technologies 09-2004 to 12-2006

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