Carmen Garcia
Austin,TX
Summary
A highly organized and detail-oriented claims examiner with a professional career in various positions of benefits administration, claims processing, and customer service. Known as a friendly and confident individual with strong skills in organizing & time management. In addition, critical thinking, exceptional oral and written communication skills, outstanding customer service, and skills in positive and effective interaction with challenging customers. Proven ability to work with minimal supervision while multitasking on a daily basis.
Overview
33
33
years of professional experience
1
1
Certification
Work History
Claims Coordinator II
Southwest Key Programs
Austin, TX
01.2018 - Current
- Provide oversight in the review of processing documents for all business claims
- Ensure compliance with relevant policies, procedures, regulations, and laws
- Update and advise injured employees, program management, and risk Department in the administration of claims
- Reviewed and processed all work-related accident reports
- Completed and submitted claim documentation to WC carrier
- Use management portal for efficient management of claims
- Monitors claims and monitor reserve alerts at designated threshold
- Maintain post-accident and random drug screen process and procedures
- Participate in claim reviews
- Collaborate with the Leave and Accommodations team regarding accommodation meetings
- Conduct trainings on Risk Department policies and procedures.
Sr. Integrated Claims Examiner
Matrix Absence Management
Austin, TX
01.1991 - 01.2016
- Facilitate the decision-making process in determination of claim eligibility in tandem with federal and state laws as well as individual clientele policies
- Process and manage intermittent, continuous, and client-specific leave of absences
- Establish duration of absences based on information from healthcare providers
- Communicate with clients as well as individual employees regarding approval, denial, extensions, and return to work plans
- Train new employees on established claim processing practices
- Manage the medical aspects of a claim from onset to return to work.
Data Transcriber (Seasonal)
Internal Revenue Service
Austin, TX
02.2007 - Current
- Transcribe and key verify a wide variety of taxpayer prepared tax returns, related schedules, and documents
- Identify missing, incorrect, and/or unrecognizable data and take appropriate action to resolve errors or referred to others for corrections
- Independently handle a variety of programs to ensure completion of workflow priorities
- Accurately input prepared taxpayer information from various tax forms while applying appropriate procedures to meet tax laws, regulations, and procedures
- Switch between programs as needed to meet cycle dates and learned new programs when needed.
Education
Graduate -
William C. Overfelt High School
General Studies -
San Jose City College
Skills
- Short Term Disability and FMLA Benefits Administration
- Billing & Claims Processing
- Interpersonal Communication
- Program Management
- Resource Management
- Recordkeeping & Documentation
- Client Confidentiality
- Microsoft Office
- Team Leadership
- Mentoring & Training
- Worker’s Compensation administration
- Claims Management
- Excellent Communication
- Analytical Skills
- Cross-Functional Collaboration
- Attention to Detail
- Multitasking and Organization
- Documentation and Recordkeeping
- Regulatory Compliance
- Written Communication
- Customer Service
- Time Management
- Problem-Solving
- Insurance Knowledge
- Workflow Optimization
Certification
Texas Adjuster – All Lines
Timeline
Claims Coordinator II
Southwest Key Programs
01.2018 - Current
Data Transcriber (Seasonal)
Internal Revenue Service
02.2007 - Current
Sr. Integrated Claims Examiner
Matrix Absence Management
01.1991 - 01.2016
Graduate -
William C. Overfelt High School
General Studies -
San Jose City College
Texas Adjuster – All Lines
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