Experienced Claims Assistant Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Operates well in both individual and team capacities. Offering 11.5 years of experience in the insurance industry and willingness to take on any challenge.
Hi, I’m
Andrea Salas
Phoenix,AZ
Summary
Overview
13
years of professional experience
Work History
Texas Mutual Insurance Company
Workers' Compensation Claims Assistant
10.2021 - 06.2023
Job overview
- Performed general claims-related clerical functions in accordance with Texas Workers' Compensation Act, rules of the Division of Workers' Compensation (DWC), and internal policies and procedures
- Transmitted case files between offices
- Completed timely and accurate letters and forms, including required medical examination requests, peer review requests, designated doctor requests, mileage reimbursements requests and DWC records requests
- Prepared medical records and attorney packets with high degree of accuracy
- Responded to internal and external customers promptly, accurately and courteously
- Prepared files, letters and notices
- Developed and implemented strategies to improve claim processes
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Generated, posted and attached information to claim files.
- Checked documentation for accuracy and validity on updated systems.
- Posted payments to accounts and maintained records.
- Verified client information by analyzing existing evidence on file.
Texas Mutual Insurance Company
Workers' Compensation Medical Bill Coder
08.2021 - 10.2021
Job overview
- Entered and validated medical bill information into company systems ensuring accurate and timely payment processing
- Entered billing data into company system from imaged bill claim forms such as HCFA Form (CMC1500) and UB Form
- Used company's provider match software to attach provider records to electronic bills for payment
- Reviewed system generated flags to determine if the bill is to be forwarded for research or deleted for return
Texas Mutual Insurance Company
Workers' Compensation Medical Audit Clerk
02.2012 - 08.2021
Job overview
- Act as resource to assist Medical Auditors and other departments.
- Delivered supporting documentation for records changes directly to auditor for analysis.
- Collaborated with managers to obtain missing information.
- Maintained daily and weekly production logs on Medical Auditors.
- Created and maintained monthly departmental performance spreadsheets and tracking reports for submission to managers and team leaders.
- Received daily reports and supporting documentation for routine audits and promptly reported any discrepancies for further review.
- Responded to routine requests for information from other departments, managers and customers.
- Organized data and reports that were effective for managers and team leaders to understand and utilize.
- Distributed incoming faxes and mail to proper departments.
- Submitted invoice transfers including follow up, check research, stop payments and creation of manual appeals.
- Created and mailing of recoupment requests to providers for overpayments, EOB requests and HB724 letters.
- Skilled at working independently and collaboratively in a team environment.
- Self-motivated, with a strong sense of personal responsibility.
- Managed time efficiently in order to complete all tasks within deadlines.
- Demonstrated respect, friendliness and willingness to help wherever needed.
- Paid attention to detail while completing assignments.
Texas Tech University Double T Zone
Assistant Store Manager
08.2010 - 01.2012
Job overview
- Managed opening and closing procedures and recommended changes to enhance efficiency of daily activities.
- Rotated merchandise and displays to feature new products and promotions.
- Walked through store areas to identify and proactively resolve issues negatively impacting operations.
- Maintained positive customer relationships by responding quickly to customer service inquiries.
- Supervised and evaluated staff to help improve skills, achieve daily objectives, and attain advancement.
- Processed payments for credit and debit cards and returned proper change for cash transactions.
- Responded to customer concerns, working with manager to significantly raise customer satisfaction ratings.
- Created and maintained safe and secure work environments for employees.
- Reconciled daily sales transactions to balance and log day-to-day revenue.
- Provided weekly work schedules to employees to accommodate business demands and vacation requests.
- Trained new employees on proper protocols and customer service standards.
- Monitored daily cash discrepancies, inventory shrinkage and drive-off.
- Assisted in recruiting, hiring and training of team members.
- Trained and guided team members to maintain high productivity and performance metrics.
- Scheduled employees for shifts, taking into account customer traffic and employee strengths.
- Supervised creation of exciting merchandise displays to catch attention of store customers.
- Interacted well with customers to build connections and nurture relationships.
- Reported issues to higher management with great detail.
Education
Monterey High SchoolLubbock, Tx
High School Diploma
1997
University Overview
Skills
- Microsoft Office: Outlook, Word, OneDrive, Teams, Excel, Powerpoint
- Excellent Administrative/Customer Service Abilities
- Claim Center/EC Browser
- Insurance Terminology
- AS01 & AS400
- Data Entry Software/Data Integrity
- Electronic Filing System
- Avaya
- Assisting Management
- Product Availability
- Point of Sale System
- Product Inventories
Triathlete who enjoys to swim, bike and run for fun!
Triathlete who enjoys to swim, bike and run for fun!
In 2019 I completed my first triathlon, the 70.3 Gulf Coast Half Ironman in Panama City Beach, FL.
Timeline
Workers' Compensation Claims Assistant
Texas Mutual Insurance Company
10.2021 - 06.2023
Workers' Compensation Medical Bill Coder
Texas Mutual Insurance Company
08.2021 - 10.2021
Workers' Compensation Medical Audit Clerk
Texas Mutual Insurance Company
02.2012 - 08.2021
Assistant Store Manager
Texas Tech University Double T Zone
08.2010 - 01.2012
Monterey High School
High School Diploma
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