Summary
Overview
Work History
Education
Skills
Languages
Timeline
Generic

Allan Garcia

Porter,TX

Summary

Results-driven Workers' Compensation Claims Examiner with expertise in HIPAA compliance and data analysis. Proven ability to manage over 700 active claims while ensuring 100% processing timeliness.

Overview

25
25
years of professional experience

Work History

Workers' Compensation Claims Examiner

Department of Labor
Houston, TX
07.2021 - Current

• Monitor 700+ active disability claims, maintaining 100% compliance with processing timeliness

• Conduct in-depth reviews of medical exam documentation to ensure compliance with federal medical/legal standards

• Process and authorize compensation to injured claimants/survivors ranging from medical, intermittent,

reimbursements and schedule award payments.

• Lead and engage in internal and external communication with cross functional teams providing updates, case

statuses, risks, and strategize solutions.

• Analyze and evaluate medical and factual evidence, reports, and documents to make case approval/denial decisions.

• Consult with clinical staff to provide and update ICD9/ICD10 coding for medical diagnosis, and authorizations.

• Utilizes Integrated Federal Employee’s Compensation System (IFECS) and excel spreadsheets to provide case

updates and maintain timely case decisions and updates.

Social Security Claims Examiner

Social Security Administration, SSA
Houston, TX
05.2014 - 07.2021
  • Evaluated claims for accuracy and compliance with federal regulations.
  • Coordinated with medical professionals to obtain necessary documentation for claims processing.
  • Analyzed complex cases to determine eligibility and appropriate benefit amounts.
  • Conducted training sessions for new examiners on procedures and best practices.

Telecommunication Operator

Department of Labor
Houston, TX
08.2012 - 05.2014
  • Managed 24/7 dispatch operations handling 150+ emergency calls daily with 99.9% call-logging accuracy.
  • Entered caller information into the CAD (Computer Aided Dispatching) system up to 60 times a shift.
  • Verified outstanding warrants with local, state, and federal law enforcement agencies.
  • Reduced average response time by 22% through optimized dispatch protocols and real-time traffic data integration.
  • Provided Pre-Arrival instructions to callers in emergency situations using the National Academies of Emergency Dispatch (NAED) standards.
  • Maintained and updated comprehensive records of calls and incidents to assist in operational efficiency.

Military Police Officer

U.S. Navy Active Duty
Jacksonville, FL
06.2001 - 01.2012
  • Led a security team of 14 personnel to manage harbor security for assets valued over $9M, achieving 100% compliance during inspections.
  • Managed perimeter security and access control for 2,000+ daily visitors, reducing security infractions by 30%.
  • Served as Assistant Team Leader for Law Enforcement Operations, conducting over 50+ patrols and responding to base emergency calls.
  • Managed daily activities of 100+ inmates, ensuring compliance with strict safety regulations and procedures.

Education

Master of Arts - Business Administration

DeVry University
Houston, TX
08.2015

Bachelor of Arts - Criminal Justice

American Military University
Charles Town, WV
08.2011

Skills

  • Project Management
  • Medical Disability

    Health Information Technology

    Microsoft Office Suite

    ICD 9/10 coding

    Problem Solving

    Critical Thinking

    Electronic Medical Records Systems

    HIPAA & Regulatory Compliance

    Data Analysis

Languages

Spanish
Native or Bilingual

Timeline

Workers' Compensation Claims Examiner

Department of Labor
07.2021 - Current

Social Security Claims Examiner

Social Security Administration, SSA
05.2014 - 07.2021

Telecommunication Operator

Department of Labor
08.2012 - 05.2014

Military Police Officer

U.S. Navy Active Duty
06.2001 - 01.2012

Master of Arts - Business Administration

DeVry University

Bachelor of Arts - Criminal Justice

American Military University