Administrative Assistant Claims Representative
Resume:
PAULINE MARDIROSIAN
Reseda, CA *****
***************@*****.***
PROFESSIONAL SUMMARY:
Highly organized and resourceful candidate with extensive knowledge in worker’s compensation, office administration and university education in legal studies and political science. Thorough and detail oriented with a demonstrated commitment to excellence. Ethics oriented working style; known for exercising discretion and maintaining confidentiality. Proven ability to thrive in a high case load and fast paced environment through advanced multi-tasking skills and professionalism. Fluent in English and Armenian.
EXPERIENCE:
Claims Representative – ESIS inc. Northridge, California January 2022- January 2023
(hybrid)
Handled a caseload of 500+ in worker’s compensation (WC) claims. Handled both indemnity and medical claims from start (initial) to finish (closing). Initial investigation performed timely to see compensability of claim. Knowledge in AOE/COE claims and the insight to hire surveillance when the claim was deemed questionable. Extensive communication with employers, medical providers, claimant, applicant attorneys, defense attorneys and subrogation. Experience in calculating and posting reserves up to employer’s standards. In addition, issued timely benefit payments (TTD, PD, TP) alongside medical and legal payments. Thorough understanding of deadlines of claims and sending out proper benefit letters (TD resume, TD stop, PD stop, PD delay, delay of claim, denial of claim etc). Working one on one with defense attorneys on claims to follow up on making sure that the claim is moving towards settlement (stipulations or compromise and release). Experienced in pushing for Maximal Medical Improvement (MMI) from primary treating physicians (PTP) on claims. In addition, experience with objecting to care and starting QME process on litigated and non-litigated claims. Experience in responding to RFA’s in a timely matter and authorizing appropriate treatment to admitted body parts. Once, requested treatment was costly per RFA, would submit the RFA to utilization review. Experience in UR deferrals and denying treatments based off various reasons (denied body part, provider requesting is not PTP, etc). Extensive experience in handling maximum volume phone calls and emails. Responsiveness to medical providers, attorneys, employers, and injured workers is a priority because I understand the vast complexities of worker’s compensation and it is my responsibility to ensure claims are going smoothly and that I am pro-active and ready for any scenario. Taking information from QME report which indicates (whole-person impairment) PD rating and FMC then valuing for settlement preparation. Training in cooperating with MSA to get claimants over the age of 65 and on Medi-caid proper estimates and values for FMC. Loads of experiences on closing out claims.
Senior Paralegal – Law offices of Alen Aydinian, Glendale, California December 2018-2021
(In office and remote)
Caseload of 300+ in worker’s compensation claims. Worker’s compensation insurance defense; assisted over 10+ attorneys in trial preparation, legal documentation, and investigational services. Reviewed and edited pleadings prior to filing/e-filing. Calendared all attorney’s depositions and/or hearings and/or trial dates. Extensive experience in correspondence between AA (applicant’s attorney), claimant (injured worker), claims adjuster and employer. Utilized Merus-Case to organize all attorney’s new claims. I set up new claims daily, per firm’s standards. Extensive knowledge of medical treatments and the complex inter-workings of medical costs per WC injuries. Experience in assisting attorney with panel strike list for QME. Formulated many WC files such as NORA, NORW, EAK and 409c. Set up depositions for 10+ attorneys and used third party translation services when deemed necessary. Billing and administrative duties were part of my everyday tasks along with detailed invoices to ensure the firm was being compensated for all legal duties.
Administrative Assistant- Commercial Refrigeration, Los Angeles, California—2013-2017
Maintained customer files and confidential records. Communication with clients regarding invoices, reminder maintenances and services. Provided efficient accounting and record keeping for office. Detailed expense sheet was formulated on a month to month basis. Organized client data base. Drafted contracts for clients and business. Maintained high level of customer service and professionalism throughout employment.
EDUCATION:
Bachelor’s degree in Political Science and Legal studies – American Jewish University- 2020
Completed coursework: Business Law I, Business Law II, Constitutional law (level 3), Labor law, Legal studies and Ethics, Model UN (Lead Delegate), Law and Society, Human Resource Management, Law and Public Policy, Comparative Politics and Global Studies.
Ventura colleges of law – currently attending (night courses)- 2023
OFFICE SKILLS:
Proficient knowledge in Microsoft Works (Word, Excel, Outlook, Powerpoint), Web-x, Teams, Google applications (gmail, drive, docs, sheets, etc.) Proficient knowledge In converting documents to pdf; vise-versa. Proficiency in applications such as Apollo, ECOS, Tymetrix 360, EMIT, and MerusCase.
AWARDS:
SUMMA CUM LAUDE (highest distinction award, top 10%) 2020
PI GAMMA MU HONOR SOCIETY (Lifetime membership for academic excellence) 2019
(MUNFW) MODEL UNITED NATIONS POSITION PAPER AWARD 2019
DEAN’S HONOR AWARD LIST 2011
100 HOURS OF COMMUNITY SERVICE AWARD 2011
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