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
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
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
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
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