Team Manager Member

LISA WILLIAMS

**************@*****.***

*** **. ****** **. ***. 7A Orange, New Jersey 07050 ● 862-***-****

PROFESSIONAL EXPERIENCE:

Broadspire A Crawford Company

Medical Claim Analyst – July 2024 – Present Fairfax, VA

Processes claims, other than “M” cases, where all issues (indemnity, legal, etc.) have been settled and the claim is only open for payment of medical benefits.

Contacts, by telephone, insureds, claimant, and medical providers for additional information or medical verifications to verify and report the status of the claims.

May verify coverage on claims by following normal coverage confirmation procedures, as requested. Alerts Team Manager of any errors or discrepancies.

Reviews and updates data into a computerized system.

Approves payments of medical bills on lost time disability claims with payment authority, after compensability has been determined by the Team manager or claim technician/handler.

Informs Team manager of all Workers Compensation “M” Case classification per Claim Best Practice guidelines.

Answers routine questions, orally and in writing, from agents, claimants, insureds, or other interested parties.

Keeps Team manager informed verbally and in writing of activities and problems within assigned area of responsibility; refers matters beyond limits of authority and expertise to Team manager for direction.

Consults with other departments and business units.

Documents receipt and contents of medical reports. Reviews and handles other correspondence within authority including material from the team member, customer, or State.

Processes claims, other than “M” cases, where all medical issues have been settled and the claim is only open for payment of long-term indemnity benefits.

Identifies files that no longer meet the administrative criteria along with recommendation to team manager for reassignment.

With the team managers guidance, provides input on the completion of the status reports, initiate’s activity checks and/or widow’s statement of dependency forms.

Performs other related duties as required or requested.

Claims Examiner - Liab December 2021 – July 2024 Berkeley Heights, NJ

Receives claim assignment, confirms policy coverages, and directs acknowledgment of claims.

Manage strict confidentiality of documents and comply with HIPAA regulations stipulated by the facility and government.

Verify claimant’s personal information by telephone contact with claimants.

Send out correspondents to claimants.

Retrieve the claimant’s medical records.

Analyzes claims activities and prepares reports for management. Participates in claim reviews with management.

Establish reserves, using independent judgment and expertise, and authorize payments within the scope of authority, settling claims most cost-effectively and ensuring timely issuance of disbursements.

Oversee adjustment of all third-party liability losses, coverage assessment, investigation, and evaluations regarding litigation claims.

Interacted with assigned counsel for claim status.

Claims Examiner February 2021 – September 2021

Reviews Coverage determines compensability and handles overall management of COVID-19 claim file.

Initiates and maintains communication with all involved parties.

Investigates and secures information. Analyzes claims activity.

Ensures data integrity.

Evaluates exposures per statutory requirements and sets appropriate reserves.

Authorizes payments and settles claims within scope of authority and within account, carrier, and company guidelines.

Complies with Medicare Secondary Payer Act.

Provides direction and oversight to all assigned vendors.

Complies with licensing and continuing education requirements.

Surveillance Coordinator November 2017 – June 2020

Reviews Coverage determines compensability and handles overall management of the claim file.

Initiates and maintains communication with all involved parties.

Investigates and secures information. Analyzes claims activity.

Ensures data integrity.

Evaluates exposures per statutory requirements and sets appropriate reserves.

Authorizes payments and settles claims within scope of authority and within account, carrier and company guidelines.

Complies with Medicare Secondary Payer Act.

Provides direction and oversight to all assigned vendors.

Complies with licensing and continuing education requirements.

Additional duties

Assists and advises claims examiners concerning the monitoring of claimants' medical treatments.

Maintains records and prepares reports and correspondence related to the work.

Establishes channels of communication with providers to familiarize them with agency guidelines.

Evaluates claims referred for medical management and makes recommendations for follow-up, further investigation, or documentation, as necessary.

Norton Lilly International Elizabeth, NJ

Administrative Assistant 2015 – 8/2017

https://mail.yahoo.com/d/search/keyword=ajilon/messages/AHfSimIAAYFRUJFHiwaQ1lwyCqMAnswered, screened, and transferred inbound phone calls. Directed visitors and clients to meeting locations.

Preformed general clerical duties including photocopying, faxing and mailing documents.

Retrieve documents from filing system, Handled requests for information and data information.

Resolve administrative problems and inquiries.

Prepared written responses to routine inquiries.

Prepared and modified documents including correspondence, reports, drafts, memos, and emails.

Opened, sorted, and distributed incoming correspondence.

Billed agency invoices.

Processed and coded vendor invoices.

Worked closely with the head office accounting department to resolve billing issues.

Assisted with billing DAs in a timely manner.

Ajilon Professional Staffing Parsippany, NJ

Representative, Customer Service for (Ports America) 2012- 2014

Handled phone inquiries, responding to issues regarding container locations, data entry of dock receipt using system Dock Works.

Connexion Systems & Engineering Inc. Rockaway, NJ

Administrative Assistant (BASF) 2010 - 2010

Processed incoming IT tickets orders for current employees for software products and ticket orders for standard software for new employees.

Answered incoming phone calls for IT department for updating software.

Good Will Industries of Greater New York & Northern New Jersey, Inc. Harrison, NJ

Secretary/Receptionist for (Office of the Public Defender and VA Veterans Home) 2006 - 2009

Answered incoming phone calls.

Performed various administrative tasks including filing, faxing, photocopying, and data entry and typing correspondence.

Prepared legal briefs, motions, and other legal forms for attorneys.

Processed all cases for staff and pool attorneys that have been completed.

Scheduled appointments for clients.

Processed pool attorney expert witness and transcript invoices

City of East Orange East Orange, NJ

Secretarial Assistant (Mayor’s Office) 2003 - 2005

Reviewed, sorted, and routed incoming correspondence and prepared letters on routine basis.

Coordinated and obtained pertinent documents and materials from files and other sources arranged it in usable form, and prepared memoranda and summaries.

Provided requested information to division personnel, representatives of State, local, and other groups, organizations and agencies, and to the general public in accordance with established policy.

Maintained mailing lists as well as confidential personal correspondence records and files.

NYK Line Secaucus, NJ

Data Entry Specialist 2001 - 2003

Entered accounts payable invoice information into AS400 database.

Reviewed equipment inventory regarding proper payment.

Reconciled vendor statements by tracking short or non-payment of vendor invoices.

Answered vendor phone inquiries on accounts payable issues, analyzed invoice rejections and assisted accounts payable data entry supervisor with special projects.

Accenture Florham Park, NJ

Office Assistant/Analyst 1998 - 2001

Ordered business cards for the Metro New York office, by creating excel spreadsheet with all personnel information to be sent to printing company for processing.

Sorted mail in mailroom, other duties include data entry, timekeeping, reception and assisting service coordinator in customer service.

Additional duties

Consisted of received and processed travel profile and corporate credit card applications for the Metro New York office.

Reconciled charges for reproduction department, corporate housing, limousine service, paytech for UPS/FEDEX and postal.

Processed key cards for new and current personnel, monitored the security system making sure all doors were locking and unlocking on time, and updated data.

SKILLS

Microsoft Office; Lotus Notes; Lotus Organizer, Adobe Photoshop; Adobe Acrobat; Print Shop; MS Works; Flow Chart; MS Access

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