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Medical Manager

Location:
Austin, TX
Posted:
November 17, 2020

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Resume:

Dear Hiring Manager:

This letter is to express my interest in your company position posted. The opportunity presented in this listing is very appealing, and I believe that my experience and education will make me a competitive candidate for this position.

I can be reached anytime via my cell phone, 512-***-****. Thank you for your time and consideration. I look forward to speaking with you about this employment opportunity.

Sincerely,

Marisa Maldonado

rev 11/13/2020

8000 Briarton Dr. Austin, TX.

Cell: 512-***-****

Marisa Maldonado Email: adhw6n@r.postjobfree.com

Objective: To obtain a position where my education and experience can be utilized.

Education: 1979-1983 Travis High School, Austin, TX – Graduated (Trade Training: Cosmetology).

1984-1985 Durham Nixon Clay Business College, Austin TX – Training in computer programming, accounting, cost accounting, business practices, economic and payroll.

1986-1987 Austin Community College, Austin TX – General Studies Paralegal – Legal Assistant and Law Studies.

September-2006 Kaplan College, Austin TX- Certification of Worker's Compensation Adjuster License. Continue and ongoing studies CEU.

Employment:

08/01/2013 to 11/13/20

RTW State Auto Insurance Company Austin, Tx

Workers Compensation Senior Adjuster

Certified in claim handling for other states: Arizona, Colorado, Georgia, Kansas, Missouri, Mississippi, Illinois, Oklahoma, Texas (primary), Utah

Investigate new claims for and loss time with large account handling. Make contacts call to policyholders, Providers, Injured works, TDI, Process DWC69, Request Peer Review and Designated Doctors, IME/EME, Catastrophic Claims, Death Claims, Loss claims Issue Letters, set reserves, issue Benefits payment in timely manner (loss earning, attorney fees, child support, and more), Review file Update for the employer/agent for large and small accounts, Filing of Texas claims; PLN, TIB, IIB's, SIBs, LIBS and DIBs payment, approve billing Triggers, Investigate for 3rd parties claim and settlement, and fraud, file disputes, prep for BRC and CCH issue PLN's, Approve and pay out medical bills, Set reserves, approve medical per ODG guideline,. Case Summary Reports. Review all med-only claims to see loss time occurs and medical for further investigation; work closely with nurse case managers and field case manager/Paradigm, Vocational Rehab Work side by side with assigned attorney. Work with certified investigator, Work one on with the employer to be TDI compliant in worker comp. Work with TPA, work closely with employers and do lunch and learns. assist in EDI compliance. Settle claims full and finial in medical and indemnity. obtain agreements to settle the claims. Filing of other state forms and proceedure. Reserve review work sheets for compliance of handling of the claim. Large Loss Claim for large report reserving of claims. mentor other adjusters of the state process and rules for workers comp.

09/01/11 to 06/03/2013

Tristar Risk Mgt. Dallas, Tx

Workers' Compensation Specialist ll

Investigate new claims for and loss time with large account handling. Make contacts call to policyholders, Providers, Injured works, TDI, Process DWC69, Request Peer Review and Designated Doctors, RME, Catastrophic Claims, Death Claims, Loss claims Issue Letters, set reserves, issue Benefits payment in timely manner (loss earning, attorney fees, child support, and more),TIB, IIB's, SIBs, and DIBs payment, approve billing Triggers, Investigate for 3rd parties claim and settlement, and fraud, file disputes, prep for BRC and CCH issue PLN's, Approve and pay out medical bills, Set reserves, approve medical per ODG guideline, continue education of the laws and rules of Texas workers compensation. Case Summary Reports. Review all med-only claims to see loss time occurs and medical for further investigation. Work with certified investigator. Work with TPA, work closely with employers. EDI compliance.

Page 2 04/26/07 - 08/25/11

Marisa Maldonado Texas Mutual Insurance Company Austin, Tx

Workers' Compensation Specialist

Adjust medical only claim-return to work. Review all med-only claims to see loss time occurs and

medical upgrades to return to Work and to CDU for further investigation. Investigate new claims

for compensability and loss time. Make contacts call to policyholders, Providers, Injured works,

TDI, Process DWC69, Request Peer Review and Designated Doctors, Issue

Letters, set

reserves, issue TIB's payment (loss earning, attorney fees, child support, and

more), IIB's and

SIB's payment,, Triggers, Investigate for 3rd parties, and fraud, file disputes, prep for BRC and

CCH issue PLN's, and more.

03/13/06- 04/25/07

Texas Mutual Insurance Company Austin, Tx

Claim Assistant

Assist Return to work adjusters, filing of DWC forms in a timely manner, Send medical packets, send out letters, assist on phone calls, pass out the GA and PA. Verify Designated Doctor appointment, follow with DWC office for RME and DWC32 requests and Issue payments for mileage, assist on RTW adjuster’s non-priority mail, Office machines: use of postal, scale, timer stamp, copy machines etc.

08/22/05 - 03/13/06

Texas Mutual Insurance Company Austin, Tx

Administrative Specialist

Loss Preventions

Perform general clerical functions including printing records, distributing mail, receiving and sending information by fax and email, assist Loss Preventions field consultants, Identify problematic issues and initiate referrals, participate in projects and focus group that impact the department or division. Compile data accurately and timely into excel spreadsheets and databases, provide clerical support for department staff, assist policyholders, route CAT claims to assigned LP consultants, assist on arrange festive and meeting function,

11/20/2000 – 08/16/05

Law Office of Richard Pena Austin, TX

Legal Assistant

Workers Compensation Duties and other: Supervises Worker Compensation Dept., Negotiation with Insurance Companies, attorneys, and healthcare providers, Direct Dispute Resolutions with Insurance Companies; Interview Potential Clients and screen for potential third party claims, Organize/Prepare exhibits for proceedings, Review of surveillance and evidence, Prepare/Respond/Exchange Interrogatories, Attend/Supervised Recorded Statements and

Vocational Rehabilitation Meetings, Attend Benefit Review Conference and Contested Case Hearing Proceedings, Review Pay-out Ledgers/Request and Review of Medical Records, Setting up /Reviewing of Files, Assisting in the completion/filing of workers compensation forms, Assisting in the completion of medical dispute forms, Preparation/Filing of Supplement Income Benefits, Legal Research including workers Compensation rules/law/appeals panel decisions, Preparing/Filing Exchange Packets and Supplemental Exchanges for Benefit Review Conference, Contested Case Hearings and Appeal, Review of Discovery, Drafting of documents/pleadings and Affidavits, Managing medical in assigned caseload, Request/Compile/Review documentation to include medical, Bill chasing Attorney Fees, Billing Attorney Fees, Bookkeeping/Account receive/payable, Scheduling/Filing clerical, Receptionist. Updating information in computer, Operation of Copier, Fax machine, multi-line telephone, Proficient w/10-key, type 55 wpm., Experience with Microsoft Word, Microsoft Outlook, Word Perfect, Excel, Internet Access, Quick Books, Act, adobe.

12/92 – 9/2000 American Beauty Trd. Est. Abu-Dhabi, UAE.

Manager

Manage daily business practices, accounting (daily cash counts, deposits), bookkeeping (journal, ledgers, inventory/stock and reorders), payroll, staffing training, customer service. Handled all

billing, quarterly and annual finance reports and met all deadlines. Responsible for handling all

public relations and advertising/marketing strategies for line of business.

Page 3

Marisa Maldonado

Skill Tri-Lingual (Spanish, Arabic). Typing –55 wpm. Proficient with 10 key,

Summary: VDI, XCM, MS Windows, MS Excel, AS400, Lotus notes, Content manager, Fair Issac, Clarify,acorsoft, lotus notes, various graphics software.

Hobbies: Snorkel, Reading, Paranormal Investigator, Soap Maker,



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