Case Manager Claims Adjuster
Resume:
ALITA WHITE
*************@*****.***
PHILADELPHIA,PA
OBJECTIVE
Seeking positions to utilize my strong communication skills and problem solving skills to provide exceptional care and support to clients in need.
EXPERIENCE:
CASE MANAGER
MORGAN & MORGAN
APRIL 2023-PRESENT
Provide proactive, daily interaction with existing and potential clients, insurance companies, and medical providers, both via phone and in person.
Order medical records from providers and communicate with them during course of treatment, obtain Documents necessary to support and/or liability positions. Interact with insurance carriers and healthcare providers to secure records and account balances.
Negotiate case settlements with insurance carriers.
DIRECT CARE WORKER SUPERVISOR
HOME CARE ASSOCIATES
APRIL 2021-JANUARY 2023
Evaluated home health aide performance and competency while the HHA’s were providing service to consumers.
Actively participated in coaching HHA staff.
Provided back up to the scheduler, as necessary, worked with schedulers to ensure quality delivery to the consumers.
Worked with the schedulers to address HHA schedule changes and concerns.
Created and promoted individual HHA learning plans.
Communicated with the contracting agencies as necessary.
PROVIDER MAINTENANCE TECHNICIAN
AMERIHEALTH CARITAS
APRIL 2019-MARCH 2021
Responsible for maintaining both participation and non participation provider records in the provider base.
Mapped claims in the invalid provider queue.
Resolved provider related issues for claims suspended to provider maintenance coordinates the panel transfer process.
Interacted with internal/external clients on provider maintenance activities.
SENIOR CLAIMS ADJUSTER
AMERIHEALTH CASUALTY INC.- PHILADELPHIA,PA
JANUARY 2007-AUGUST 2018
Investigated, evaluated, disposed, and settled the most complex claims and highest exposures with minimal supervision.
Included the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserved.
CLAIMS ADJUSTER
WARD NORTH AMERICA- PHILADELPHIA,PA
NOVEMBER 2003-DECEMBER 2006
Investigated Claims to determine the compensation of a claim.
Identified potential subrogation and secondary insurance fund recovery.
Maintained regular diary.
Filed State forms within the proper time frame.
Obtained necessary information for claims adjustments.
SENIOR CLAIMS ANALYST
MANAGED COMP-PHILADELPHIA,PA
APRIL 2001-OCTOBER 2003
Reviewed medical bills and records.
Determined if treatment was rendered usual and customary and related to claim.
Issued appropriate state forms and filed in a timely manner.
CLAIMS ADJUSTER
GALLAGHER BASSETT- PHILADELPHIA,PA
DECEMBER 1997-MARCH 2001
Responsible for processing state forms, data entry or claims information and performing three-point contacts with clients.
Correlated with senior adjusters and providers regarding customer service issues.
Ensured that claim documentation was filled according to clients expectations.
CLAIMS ASSISTANT
ALEXIS INC- PHILADELPHIA, PA
JANUARY 1994-DECEMBER 1997
Responsibilities included handling workers compensation medical only claims and data entry of lost time cases.
Handled heavy telephone contact with claimants.
Coordinated payments, collecting and organizing supporting documentation.
EDUCATION:
LITTLE FLOWER HIGH SCHOOL
HIGH SCHOOL DIPLOMA
1986 GRADUATED
Skills:
Records Management
Claims
Documentation
Conflict Management
Excellent Time Management
Data analytics
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