Claims Adjuster Pharmacy Technician

CONTACT

• Allentown, PA

• 267-***-****

• ************@*****.***

• linkedin.com/in/sianiharris

SKILLS

Hard Skills:

• Negotiation

• Claims Adjusting

• PA, NJ Workers’ Compensation:

Medical

Indemnity

Subrogation

Litigation

• Settlement

• Investigative research

• Medical Terminology

Techniques:

• Claims Management

• Settlement Negotiation

• Claim Investigation

Tools and Software:

• Oscar

• Athena

• Zeus

• Microsoft Suite

• Microsoft Teams

• RingCentral

EDUCATION

East Stroudsburg University

Bachelor of Arts

Political Science: International

Relations and Comparative

Government, 2021

Minor: Economics

Minor: Politics and Government

Awards

:

Board of Governor’s Academic

Scholarship 2017-2021

Pi Sigma Alpha (National Political

Science Honor Society) 2021

Omicron Delta Epsilon

(International Economics Honor

Society) 2021

Siani Harris

Claims Adjuster

WORK EXPERIENCE

TheZenith, East Norriton, PA

Claims Adjuster (Hybrid) 11/2021 – 11/2023

● Manages an active file load of approximately 100 claims.

● Initial contact with employees, employers, and medical contacts within 24 hours of claim assignment to determine the compensability of the claim.

● Investigates claims by interviewing employees, employers, witnesses, and analyzing medical records to determine compensability, possible subrogation, and apportionment within 14 days of claim assignment.

● Coordinates care for claimants by approving and authorizing treatment, surgery, medications, and appointments. .

● Formulates detailed settlement evaluations and recommends appropriate settlement value, within authority.

● Negotiates claim settlements with injured workers and/or injured workers’ attorneys.

● Establishes reserves for both settlement and handling costs for each claim.

CVS, Philadelphia, PA

Pharmacy Technician 07/2021 – 12/2021

● Trained 4 newly-hired Pharmacy Technicians on pharmacy policies and procedures.

● Verified and processed patient insurance; effectively communicated with patients, insurance companies, physicians’ offices, and pharmacists to ensure quality patient care.

● Maintained patient and pharmacy records consistent with applicable federal, state, and local regulations.

● Inventoried and input medication and chemical data into an established inventory management system.

PREVIOUS EXPERIENCE - CUSTOMER SERVICE

Sales Advisor, H&M, Philadelphia, PA 06/2019 – 04/2021 Food Service, Aramark, East Stroudsburg, PA 01/2018 – 12/2018 Hostess, Buffalo Wild Wings, Philadelphia, PA 05/2018 – 08/2018

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