ELISABETH MEDINA

720-***-****

Professional Experience

10.2020 – 12.2021 Pinnacol Assurance Insurance Company

Bilingual Claims Adjuster II - Work with team members to manage complexity claims and claim-related issues to the most expedient, cost effective resolution; provide quality customer service to all stakeholders.

• Contact stakeholders as required by Company best practices on incoming claims to promptly investigate circumstances of accident and injury, investigate and determine compensability, and identify and address red flag issues, including late reporting, pre-existing medical issues, designated medical provider process and referral issues, medical treatment issues, legal issues, and potential subrogation and penalty issues.

• Determine compensability as required by Company best practices, case law and the Colorado Workers' Compensation Act.

• Manage open claims as required by the Company’s best practices, including expedient and cost effective medical case management and disability management, as well as identification, investigation, management and resolution of potential adverse claim development, including prior injuries, co-morbid and pre-existing medical conditions, migrating body parts, worsening medical conditions and delayed recovery, change of physician requests, multiple claims, multiple jobs, subrogation, penalties and offsets .

• Facilitate all necessary resources on a timely basis for optimal claim management, action plan development and claim resolution, including other claims team members, Claims Lead, Underwriter, Business Director, Legal resources, Return-to-Work Consultant, Safety Consultant, Medical Case Manager, Utilization Review, MedPay Liaison, Provider Relations Specialist, Claims Specialist and Claims Manager.

• Communicate and correspond with stakeholders as needed to manage and resolve open claims, including but not limited to policyholders, injured workers, agents, medical providers, service vendors and resources, attorneys and regulatory agency representatives.

• Facilitate early return to work for injured workers by working with policyholder, and Return-to-Work Consultant if needed.

• Facilitate and coordinate benefit authorization and payment on compensable claims as required by Company best practices, case law and the Colorado Workers' Compensation Act.

• Inform policyholders and agents of claim status and significant development as required by Company best practices.

• Review medical information received on claims to determine if authorization/payment is appropriate, or if referral is needed to other Company resources (utilization review, medical case manager, physician advisor, or others) as required by Company best practices and in compliance with DOWC Rules of Procedure.

• Set and maintain current, accurate and adequate reserves on all open claims • Process medical bill referrals as required by Company documented best practices • Process medical records as required by Company documented best practices.

• Other duties as requested.

•Evaluate and negotiate settlement as directed by Claims Lead.

06.2018 – 09.2020 Seattle Concrete Works, LLC

Administrator of Family Owned Business

• Organize meetings, company events or conferences; book transport and accommodations, for personal and company travel.

• Manage databases to include Office Microsoft Office Suite and Intuit Quickbooks Software.

• Prepare all correspondence, complaints, queries, letters, presentations and reports.

• Schedule and maintain calendar for on-site estimates for project managers.

• Bookkeeping of company to include annual tax preparation.

• Responsible for screening, interviewing and hiring of employment.

04.2006 – 05.2018 Law Offices of Miguel Martinez, P.C.

Litigation Paralegal - Personal Injury, Probate, Workers’ Compensation & SSDI

• Analyze facts and case material in initial intake/interview of prospective clients for acceptance of case.

• Comprehensive maintenance of complex cases and confidential documentation and information; conduct interaction with various levels of courts, insurance carriers, opposing counsel, physicians and experts of various fields.

• Prepare claims for litigation in Administrative, County and District Court levels. Litigation support; compose all correspondence, review and summarize legal documents and records; examine court records and client records; organize and assist with the drafting of pleadings, subpoenas, and responses to discovery requests; ensuring the timely filing of court documents; organize records for discovery responses; schedule depositions; general trial preparation to include preparation of exhibits and trial notebooks; locating and interviewing witnesses; communicating with client agencies or other governmental agencies or courts to obtain or disseminate information; compiling statistical data; developing and maintaining litigation support databases and document control systems.

• Negotiate settlement of claims for closure.

• Attendance of Independent Medical Evaluations and Vocational Assessments with clientele to serve as an advocate and interpreter.

• Extensive interpretation and translation for Spanish speaking clientele.

• Attend higher legal education seminars to keep abreast of industry changes.

04.2004 – 01.2006 Adams County Department of Human Services

Child Support Enforcement Officer

• Locate non-custodial parents to establish and obtain financial and medical support for their children.

• Negotiate logistics of interstate cases.

• Provide a variety of services ranging from paternity testing to enforcing and modifying court-appointed child support orders.

• Strived to put children first by encouraging both parents to assume economic and social responsibility so that the children’s health and stability are positively impacted when both parents are active participants in their lives.

• Collaborated with the Family Support Registry (FSR) as a centralized collection and disbursement unit for processing child support and maintenance payments.

• Collect court ordered payments through certain remedies, i.e., administrative offset, wage garnishment, contempt, credit bureau reporting, driver’s license suspension, federal prosecution, federal tax offset, judgments, lottery intercept, passport denial, professional occupational license suspension, recreational license suspension, state revenue tax offset, state vendor offset, unemployment garnishment and workers' compensation benefit garnishment.

05.1996 - 03.2004 Castaneda Law Office

Litigation Paralegal - Personal Injury, Workers’ Compensation & Social Security Law

• Analyze facts and case material in initial intake/interview of prospective clients for acceptance of case.

• Comprehensive maintenance of complex cases and confidential documentation and information; conduct interaction with various levels of courts, insurance carriers, opposing counsel, physicians and experts of various fields.

• Prepare claims for litigation in Administrative, County and District Court levels. Compose all correspondence, pleadings and memorandums. Conduct research for discovery; prepare clients and/or witnesses for recorded statements, depositions, medical evaluations and trial.

• Negotiate settlement of claims for closure.

• Attend Independent Medical Evaluations and Vocational Assessments with clients to serve as an advocate and interpreter.

• Extensive interpretation and translation for Spanish speaking clientele.

03.1991 - 04.1996 Colorado Compensation Insurance Authority k/n/a

Pinnacol Assurance

Legal Assistant - Hearing & Subrogation Sections for State of Colorado Workers’ Compensation Insurance

• Assist six attorneys in preparation for administrative hearings of workers’ compensation claims and trial of subrogation of third party claims.

• Transcription of correspondence, pleadings, meeting minutes and miscellaneous legal documentation via dictaphone.

• Maintenance of docket for hearings, trial, expert and lay witness depositions.

• Ongoing training and continuing education as applicable to job requirements to keep abreast of industry changes.

• Reception area relief to include, the operation of 50-line PBX Switchboard.

• Interpretation services provided for Spanish speaking claimants.

01.1986 - 11.1989 Joseph H. Hellewell, Attorney at Law

Office Manager/Legal Assistant - General Practice; Domestic/Family, Bankruptcy, Criminal & Traffic Law

• Perform office management duties of one-man law office; accounts payable/receivable, accounting of project expenditures, petty cash and payment requisitions; maintenance of office supplies, equipment and implementation of updated computer software, databases, application programs and the adoption of new procedures.

• Front office receptionist; operation of 10-line telephone system and greeting of clientele and public.

• Maintain master calendar to include, facilitation of consultations, seminars, court appointments at the Municipal, County and District levels.

• Prepare correspondence, legal pleadings and seminar presentations.

Skills

• Bilingual-English & Spanish; fluently read, write, translate and interpret

• Exceptional writing, oral and interpersonal communication skills

• Proficiency of computers and software

• Notary Public for State of Colorado/Washington

• Member of CAPI - Colorado Association of Professional Interpreters

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