Customer Service Data Entry
Resume:
Patricia LaGrange
*** ****** ****** ************, ** 78660
***********@*****.***
Work Experience
Patient Care Advocate
Medix Staffing/Austin Radiological Association
April 2022 – Current
Displays exemplary customer service at all times with both internal and external customers including a positive, friendly and caring attitude
Greets patients and visitors, determines the nature of their visit and provides accurate, appropriate information
Assists patients and visitors with the check in process
Performs clerical work that may require data entry, word processing, sorting or collating capability
Answers the telephone, answers questions, and directs callers as appropriate
Helps dissolve situations with irate patients on the phone or in the lobby, with good listening skills, and problem-solving. Enlists the help of Clinic Management, when necessary
Provides information regarding particular exams and procedures including prep information.
Prepares, processes, and maintains all confidential records on new and existing patients.
Schedules patients for appropriate exams or modalities
Maintains detailed knowledge of CPT and ICD-10 codes
Scanning, faxing, making CDs, downloading CDs
Verifies patient identity, retrieves and processes current patient insurance information and checks for exam authorization during check in and billing processes
Collects and processes all payments received from patient exams, including co-pays, deductibles, private pays and past due accounts
Demonstrates competency and proficiency in the Radiology Information System (RIS)
Works with technologists to improve patient flow. This includes helping to monitor the flow of patients to each modality by communicating closely with the technical and nursing staff regarding any possible schedule issues that occur throughout the day.
Assists the technologists with expediting patients to their exam areas when necessary (i.e. patient showed up late, schedule running behind, etc.)
TPA Claims Adjuster – Auto Catastrophe Claims
TPA The Littleton Group/Progressive Insurance
June 2021 – December 2021
Assess losses resulting from weather events (e.g., hail, hurricane, tornado, etc.
Investigate, analyze, and determine the extent of Progressive’s liability to affect settlement with claimant
Evaluate, make decisions, and effect settlement related to total losses
Negotiate with repair service providers, customers, and salvage vendors
Communicate proactively and maintain a requisite service level with customers
Provide clear explanation for customers regarding claims catastrophe process
Document claim related information appropriately and make decisions consistent with claims standards and local laws
Set clear and accurate expectations regarding repair duration, estimate detail, repair outcomes and financial obligation
Identify related and unrelated damage (prior damage)
Maintain Diary / Action Plan appropriately and meet productivity goals
Medicaid Insurance Follow Up Specialist
Sonic Healthcare USA – Austin, TX
October 2019 – April 2020
Read and interpret Explanation of Benefits (EOB/CSR)
Verify ineligibility with Medicaid Insurance
Follow up with Medicaid billing/payments for claim(s) denial due to billing error (s)
Coordinate with Sonic Healthcare Medicare Claims Department for proper payment amount(s)
Process a variety of daily reports and meet productivity goals
Customer Service Representative – Contract Position
Collabera/Texas Medicaid and Healthcare Partnership
September 2018 – January 2019
Provide unbiased assistance to Medicaid Clients and/or Medicaid Providers with questions regarding eligibility, medical claims status, and other program questions.
Assists with problem resolution, as needed.
Responds to phone inquiries in a prompt, courteous and concise manner.
Documents all encounters in clear and concise online logs.
Transfers callers to other Call Center units as needed.
Meets individual performance and attendance metrics.
Performs other duties as may be assigned by management.
TPA Claim Adjuster – Property Damage/Bodily Injury
TPA The Littleton Group/Turo – Austin, TX
July 2017 – March 2018
Review new claim reports assigned to determine most effective handling procedures required for each individual claim.
Responsible for complete contact on all new losses assigned in accordance with the account standards.
Assigns appraisers via claims pilot system to inspect damaged vehicles.
Authorize rental vehicles for 1st party via ARMS system in accordance with the account standards.
Respond to all voicemail, mail, faxes, emails and maintains effective diary.
Maintain a good working relationship with Staff Appraisers and Independent Appraisal Companies in attempt to encourage prompt and accurate property damage evaluations.
Authorize and/or approve all claims payments within the delegated authority. Submits claims payments and mail accordingly.
Ensures that all documents pertaining to a claim are electronically attached and labeled correctly in the claims management system.
Closely monitor claims involving salvages/total loss vehicles to ensure prompt handling of these files in attempt to keep towing/storage costs at a minimum.
Submits administrative reports as required.
Manage, investigate, evaluate, negotiate & and resolve 1st and 3rd party bodily injury claims from initial contact to final settlement and closure.
Claims involve personal lines auto bodily injury claims, including liability issues.
Adjust moderate to complex auto claims. Severity of claims includes soft tissue losses involving neck injury, back injury, and PIP/Med Pay to fatalities.
Negotiate heavily with claimant attorneys to bring claims to resolution and settlement.
Process bodily injury payments.
Knowledgeable on state and public legal matters as it applies to the settlement of bodily injury claims.
Claims Adjuster II – Workers’ Compensation
Texas Mutual Insurance Company – Austin, TX
March 2016 – December 2016
Conduct investigations for coverage and compensability, establish and maintain appropriate reserves, and make appropriate recommendations on claims
Administer workers’ compensation benefits to injured workers
Manage established claims on an ongoing basis
Insure regulatory compliance and proper handling of moderate to complex claims
Demonstrate proficiency in claim file management, work effectiveness, interpersonal skills and customer service.
TPA Claims Adjuster – Bodily Injury – Contract Position
TPA The Littleton Group – Austin, TX
November 2015 – February 2016
Review bodily injury limited timed demands in a timely manner
Evaluate medical bills
Maintain records for all assigned claims
Interpret bodily injury Reviewer and Analyzer reports
Conduct negotiations within assigned authority limits to settle bodily injury claims for Texas, Georgia, Mississippi and Alabama
Prepare bodily injury releases and process settlement payments
Other duties as assigned
TPA Claims Adjuster – Property Damage and Bodily Injury
TPA Hammerman and Gainer/TPGICA – Austin, TX
May 2013 – August 2015
Third party administration of application of insurance insolvency
Handle 160 – 200 claim case load
Review and interpret all historical notes, documents and payments of the insolvent estate
Evaluate insurance coverage based on claim report, the insurance policy and applicable statutes of the Guaranty Act Chapter 462 of the Texas Insurance Code to determine if a claim can be accepted as within coverage
Interpret and comply with various insurance policies applicable to the insolvent estate
Telephone, and/or correspond with insured, claimant and witnesses; obtain and review police, hospital records, appraisals and repair estimates to evaluate injuries and property damage
Evaluate damages to determine compensation amount and set reserves; revise case reserves based on developments in the course of adjusting the claim
Handle litigated claims and work with defense counsel to defend insurer’s position of disputed claims
Negotiate with claimant and/or Plaintiff attorney to settle claims
Review and process payments to service providers
Senior Claims Adjuster/Paralegal
ONEOK d/b/a Texas Gas Service Company – Austin, TX
February 2001 – June 2012
Claims investigation and processing of auto liability, auto subrogation, general liability, workers’ compensation and third party damage claims
Work closely with third party administrator to resolve complex liability claims including total loss, bodily injury and attorney negotiations
Investigate and process all general liability claims to include fair settlement negotiations
and identification of fraudulent claims
Responsible for collection and investigation of all documentation for catastrophic subrogation filing and recovery
Emergency first responder for the East region of Texas to perform field investigation, documentation and supervision of field personal
Prepare legal documentations and correspondence to meet required deadlines
Compose routine correspondence, notices, agendas and prepare various legal/business instruments to include proposals, contracts and reports to agencies
Collect data and prepare monthly operations reports and oversee retention of legal files
Manage all files for company permits and licensing in accordance with the Texas Railroad Commission to satisfy compliance with Texas law.
Responsible for overseeing and answering all company bankruptcy litigation
Education
Workers’ Compensation Claims Adjuster License – Current
Property and Casualty Claim Adjuster License – Current
Paralegal in Comprehensive Paralegal Program June 1998 to November 1998
University of North Texas – Denton, TX
Bachelor of Science in Criminal Justice – Denton, TX August 1996 to May 1998
University of North Texas – Denton, TX
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