
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.
• 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.
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