Medical Manager
Resume:
Paula J Johnson
Greenwood IN 46143
********@*****.***
PROFESSIONAL SKILLS : 27 years of experience in the insurance profession working in various different departments including management for over 14 employees. Have experience handling complex claims in the lines of Auto, Property, Liability and Workers Compensation in both Personal and Commercial Markets. Have handled claims to resolution in excess of $500,000, including but not limited to litigation, medical management, lost wages, vocational rehabilitation, Permanent Partial Disability, Permanent Total Disability, Death Benefits and Medicare Set Asides. Have handled jurisdictions of: Illinois, Indiana, Kentucky, Michigan, Missouri, New Jersey, New Hampshire, New York, Pennsylvania, Tennessee, and Virginia for Workers Compensation. Have also handled PIP claims for the states of Michigan, Pennsylvania, New Jersey and New York. Completed training in the areas of Fraud, Reserving, Subrogation, Litigation, Medical Management, Medicare Set Asides.
SOFTWARE PROFICIENCY: ISRA, TPX, CS01, Microsoft, Excel, Lotus, LAN, WCIS, Schedule Plus, Bocomp, Focus, ASI, ACES, SMART, QuickBooks, Soft-Aid, Citrix, XCM and the internet.
PROFESSIONAL EXPERIENCE
2011 TO Nov 2011 Insurance Overload Staffing / State Auto / WC Resolution Claims Examiner
RESPONSIBILITIES: Handling of increasingly complex coverage and litigated issues for Workers Compensation claims. Handled and managed disability, medical, legal and vocational rehabilitation issues to resolution in accordance to Statutes for various different jurisdictions. Maintained reserve and settlement. Authorization of all medical treatment, evaluations and issuance of payments. Provided service to policyholders and customers.
2008 TO 2010 Kelly Services – LTCG – BANKERS LIFE / Claims Examiner
RESPONSIBILITIES: Interpret and apply fundamental policy language to claim scenarios. Perform investigations and research on standard claims, including obtaining proof of loss. Escalate cases that are in need of investigation.
2005 TO 2008 Wabash Medical Company / Patient Accounts-Collections Specialist
Responsibilities: To maintain records of paid and unpaid invoices. Follow up with various insurance companies, vendors and patients for payments on account balances. Maintain and document incoming payments in QuickBooks. Maintain a constant follow up diary on each open account. Submit delinquent accounts to an outside agency for collections when necessary.
2002 to 2005 SAFECO Insurance / Claims Examiner
Responsibilities: Handling of both Workers Compensation and Auto PIP claims. Complete full investigations to determine compensability. Maintain all medical, disability and legal management. Authorization of medical treatment, evaluations and issuance of payments. Maintain current and accurate medical records. Provide service to policyholders and customers including both defense and plaintiff attorneys. Active role in management of litigated files. Negotiating and completing settlements. Reserve and maintain cases in excess of $500,000 or more.
1984 to 2002 Liberty Mutual Insurance / Senior Case Manager
Responsibilities: Handling of increasingly complex coverage and litigated issues for Workers Compensation claims. Maintained reserve and settlement authority of $250,000. Authorization of all medical treatment, evaluations and issuance of payments. Provided training and mentorship to other team members as well as assist Unit Manager with Unit development. Provided service to policyholders and customers which included national and large business accounts as well as the more complex cases within the Claims Service Team. Quarterly meetings with large accounts to discuss complex cases and determine resolutions.
1996 to 1997 Citizens Insurance / Claims Representative
Responsibilities: Duties included but not limited to, resolution property and auto damage claims as well as complete medical and disability management. Authorization of all medical treatment and evaluations. Provided services to policyholders and customers including both defense and plaintiff attorneys.
Education:
Hamilton Southeastern High School
North Central High School / J Everett Light Career Center
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