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Worker s Compensation Specialist

Location:
Austin, TX
Salary:
$70,000.00
Posted:
February 15, 2024

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Resume:

Victor J. Rodriguez

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

Buda, TX 78610

512-***-****

ad3noh@r.postjobfree.com

Positive leader with extensive experience as an effective advocate regarding dispute resolution processes, and knowledge and experience in administrative law settings, policies, and procedures, as well as project planning, legal documentation preparation and development skills. Articulate and solution oriented to consistently deliver optimal excellence.

Experience:

Office of the Injured Employee Counsel (9/2019-Current)

-Dispute Resolution Advocate II

I am highly trained and educated in the Texas Worker’s Compensation System, including but not limited to policies, procedures, rules, and regulations.

Educate injured workers on the policies, procedures, and laws within the Texas Workers Compensation system

Perform research regarding worker’s compensation claims

Perform scheduled case development appointments with injured workers who need assistance and review dispute issues.

Ensures insurance carriers followed the policies, procedures, and laws under the Texas Worker’s Compensation in providing medical treatment to the injured worker.

Compile, review, and analyze medical/documentation and prepare arguments to advocate in the favor of the injured worker.

Provide administrative and sometimes technical support to the injured worker

Prepare dispute arguments, file division forms and other documents in a timely manner to preserve the right of the injured worker.

Draft legal documents such as legal motions, legal petitions, and other legal documents

Prepare and provide correspondence to all parties involved in the worker’s compensation dispute throughout all phases of the dispute resolution process.

Maintain a tracking system and database to ensure all notes, discussions, phone calls, and any other grievances or disputes are logged into the Division of Worker’s Compensation in a timely manner.

Assists and advocates for the injured worker in presenting his/her claim for benefits

Maintain a constant form of communication with all parties involved in disputes, including responding to all claim requests by email or phone.

Perform other required administrative duties

Presents claim for benefits on behalf of injured workers

Outbound Engine (5/2019-7/2019)

-Account Executive

Fulfill an end –to-end inside sales cycle, from cold call to close; included scheduling and facilitating online product demonstrations and closing your own deals.

Execute a transactional sales process (1–3-day sales cycle)

Independently manage a pipeline w/ multiple prospects, utilizing Salesforce to track progress.

Prospect new business by cold-calling small and medium businesses

Have access to and participate in ongoing sales development and training.

Close business to achieve, if not exceed monthly metrics

Epic Health Services, an Aveanna Healthcare Company (6/2018-4/2019)

-Client Service Supervisor

Assign cases to clinical staff for in-home care nursing services based on member Medicaid and/or Medicare benefits.

Responsible for implementing and maintaining compliance with all State, Federal, and Company standards for Health Care Staff, and policies and procedures.

Assess performance of contracted nursing staff as required by policy and Standard Operating Procedures.

Responsible for collaborating with clinical supervisor in compliance and performance management leading to counseling of the nursing staff.

Responsible for recruitment, screening of employees, hiring process, and reactivation of all external/field employees.

Maintain an active involvement in issues of cost containment; effectively utilizes nurses when assigning cases.

Demonstrate an ability to identify and solve problems; uses initiative and good judgment to reach quality decisions.

Maintain an excellent rapport with clients and caregivers and effectively promotes harmonious interpersonal relationships while providing exceptional customer service.

Establish and maintains effective working relationships and communications with all staff, and patient families as well as provide timely responses to requests and inquiries.

Provide leadership through planning, organizing, coordinating, continually monitoring and thoroughly evaluating the services given to clients associated with Aveanna.

Develop action plans, when appropriate, to ensure compliance with standard operating procedures as well as State and Federal requirements.

Show commitment to the goals of Aveanna’s services, showed initiative to take on new projects, team-oriented and committed to outstanding customer service, and focuses on promoting efficiencies and accountability

Assist in responding to State and Federal audit requests.

SHI International (3/2016-4/2018)

-Inside Sales Account Manager

Provided updated sales and technical information on a range of products and services to commercial accounts. Acted as liaison to ensure communication regarding escalated technology related issues were resolved on behalf of customers

Provided excellent customer service to ensure positive experience and results

Communicated with management team in a timely manner regarding problematic issues and applied proper judgment to ensure action taken is appropriate

Met and exceeded customer key performance indicator metrics

Ability to drive new business on acquired accounts by outbound calling target lists, and planned strategic marketing and territory allowance

Marketed and leveraged SHI’s vendor/distribution channel partnerships to ensure best value pricing for customers

Worked with internal resources to ensure customer transactions were processed accurately and efficiently

Was consistently punctual per guidelines and work policies

Established customer relationships with appropriate customer personnel such as purchasing, management and end-users

Client Technical lead, seven (7) plus years of experience working with IT infrastructure, mainly client systems and software as well as enterprise related infrastructure knowledge

Ability to stay up to date on product and industry knowledge and understand and support the forecasting of IT infrastructure and its requirements

Dell Inc. (3/2011-3/2016)

-Inside Account Manager III

Provided updated sales and technical information on a range of products and services to K-12, Higher Ed, and State and Local Governments.

Responded in the request and in the development of RFPs and the evaluation of RFP responses within assigned timeframes per the customer’s request and guidelines

Ensure compliance within state contracts standards and assess performance by reviewing such contract deliverables, performance measures and assured compliance with state and federal regulations per the contract

Innovated and maintained a successful program that uncovered unforeseen clientele needs which exponentially increased margin and wallet share.

Promoted Dell products and services by responding to inbound or placing outbound customer calls, determining needs, overcoming objections, and providing solutions.

Established customer relationships with appropriate customer personnel such as purchasing, management and end-users.

Applied knowledge of Dell technology, products, and services and identified how these products and services aligned to customer needs.

Worked with team to support achievement of sales goals and deliver on customer service levels.

Education:

Texas State University- San Marcos, Texas – May 14, 2010

Bachelor of Arts in International Studies with a Major in International Business

Austin Community College – May 2023

Paralegal Advanced Technical Certificate

Skills:

Bilingual/ Bicultural/Biliterate in Spanish; Native Spanish speaker able to translate

Exceptional communication, leadership, interpersonal, and organizational skills

Worker’s Compensation Insurance Adjuster License

Ability to use office equipment including computers, fax machines, and scanners

Knowledge of Texas Worker’s Compensation Law System

Knowledge of Administrative Law Policies and Procedures

Extremely Proficient in Reading and Understanding Medical Documents

Knowledge of contract and compliance principles

Extremely Proficient in Dispute Resolution Information System

Knowledge of Adobe Computer Program

Awards/Achievements:

Dean’s List 2009-2010 from Texas State University-San Marcos

References available upon request



Contact this candidate