Workers Compensation Customer Service

SUMMARY

Experienced insurance professional with a background as a Claims Adjuster and Senior Workers' Compensation Analyst, seeking a patient-focused support role in a medical, hospital, or dental office. Skilled in customer service, appointment scheduling, referrals, claims management, and medical documentation analysis. Proficient in ensuring insurance compliance, problem-solving, and coordinating with stakeholders. Known for empathetic communication and a dedication to helping patients navigate medical processes, ensuring a positive experience and supporting their care journey.

SKILLS

Customer Service

Patient Care

Medical Billing and Insurance Coding

Provider Relations

Insurance Verification

Patient Referrals

Prior Authorization Calls/Emails

Medical Assisting

Appointment Setting/ Confirmation

Answering Phones

Administrative Duties

Medical Office Support

WORK HISTORY

EXL Service – Hartford, CT

Subrogation Specialist August 2020 to November 2023

Handled subrogation/recovery for Workers Compensation carrier Amerisure. Performed subrogation recovery for all 50 states in the USA.

Responsible for obtaining and reviewing medical records for Worker’s Compensation cases and work with physicians and company nurse case management for proper medical and legal determinations.

Gallagher Bassett – East Hartford, CT

Senior Workers Compensation Analyst March 2018 to August 2020

Led investigations and coordinated investigations of all Workers Compensation claims for the State of Connecticut DMAS department.

Served as project leader in the investigation of complex Workers Compensation cases.

PMA Companies- Wallingford, CT

Senior Account Claims Representative September 2016 to January 2018

Handled complex and high exposure claims, set reserves, determined compensability, paid benefits and settled claims.

Ensured the delivery of quality claim service to customers, injured workers and other parties while protecting the assets of PMA companies.

Northeast Utilities/Eversource – Berlin, CT

Senior Workers Compensation Analyst July 2001 to September 2016

As a Workers Compensation SME, I Coordinated and investigated all Workers Compensation claims.

Represented company at informal Workers Compensation hearings regarding involved and/or disputed cases.

EDUCATION

Bay Path University – Longmeadow, MA

AS, Medical Technology – CMA – Certified Medical Assistant

University of New Haven – New Haven, CT

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