HEATHER TARBERT
Columbus,OH
Summary
A motivated business professional seeks a full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills while utilizing the knowledge and experience obtained while earning a masters degree in Organizational/Business Psychology.
Overview
15
15
years of professional experience
Work History
Workers Compensation Claims Examiner
Big Lots Stores
Columbus, United States
02.2020 - Current
- Conduct thorough initial investigation of all new claims filed by store associates including 911 or emergent claims
- Interviewed claimants and witnesses to gather factual information.
- Manage return to work timeframes up to and including lost time including OSHA tracking
- Maintain communication with fields and store level management regarding store associates work status
- Developed and Implemented peer/team training in regard to new processes and software
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Examined photographs and statements.
- Worked with private investigators and attorneys on preparation of evidence, witness statements and other documentation in preparation for trial.
Medical Claims Examiner
Sedgwick CMS
Columbus, United States
03.2019 - 01.2020
- Review and research workers’ compensation claims for determination from 17 states
- Designated to one multi-jurisdictional clients
- Carry caseload of approximately 215 claims
- Track and document all communication via phone, mail, email, fax and text
- Complete diaries and tasks daily
- Maintain customer satisfaction standards and meet all best practice standards
- Meet all designated timelines as established by client contract as well as jurisdictional deadlines and timeframes
- Managed large volume of medical claims on daily basis.
- Paid or denied medical claims based upon established claims processing criteria.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Maintained contact with claimants and attorneys to determine treatment status.
Medical Claims Examiner
Ohio Bureau of Workers’ Compensation
10.2018 - 01.2019
- Review and research workers’ compensation claims for determination of compensability
- Manage and maintain appeal process from employers, injured workers and representatives
- Maintained knowledge of benefits claim processing, claims principles, medical terminology and procedures and HIPAA regulations.
- Carry caseload varying between 75-125 claims
- Track and document all communication via phone, postal mail and email
- Monitor tasks and diaries completed on daily basis
- Track completed work daily for audit and review by my superior
- Used administrative guidelines as resource or to answer questions when processing medical claims.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Reviewed new files to determine current status of injury claim and to develop plan of action.
CSS Operations Manager
Sedgwick CMS, Formerly CareWorks
Dublin, Ohio
01.2018 - 09.2018
- Audit claims for accuracy
- Performance reviews (30 days, 60 days, 90 days, 6 months and annual)
- Create and implement quarterly incentive program
- Provide staff training, conducted 1:1 meeting with each specialist for touch base sessions
- Provide accurate documentation and feedback for coaching and training as needed
- Monitor specialist metrics and KPI’s to ensure benchmarks are hit individually and department wide
- Conduct phone interviews as well as face to face interviews and assessments for team placement
- Create and modify job descriptions as needed for open position postings
- Established positive and effective communication among unit staff and organization leadership, reducing miscommunications and missed deadlines.
- Reviewed shift reports to understand current numbers and trends.
- Advanced productivity KPIs by leading trainings on procedures and practices.
- Trained new employees on proper protocols and customer service standards.
- Assisted in recruiting, hiring and training of team members.
- Tracked employee attendance and punctuality, addressing repeat problems quickly to prevent long-term habits.
- Trained and guided team members to maintain high productivity and performance metrics.
- Handled problematic customers and clients to assist lower-level employees and maintain excellent customer service.
Accounting Assistant
01.2016 - 01.2018
- Applied and posted daily cash receipts for 5 entities
- Tracked daily transactions for all Self-Insured clients (up to 750 transactions a day)
- Managed accounts payable reports for delinquent accounts
- Assisted with processing monthly invoices
- Audited case documents for accuracy billing
- Maintained/Tracked IRS documents for provider billing processes
FROI QA Specialist
01.2015 - 01.2016
- Reviewed and audited pending and completed claims for data accuracy (10-18 claims daily)
- Assisted small team of 6 specialists rotating quarterly with individual performance goals
- Developed action plans to assist with claim process for new hires and associates with specific areas of opportunities to maximize performance
- Weekly tracking of production standards to ensure assigned specialists are meeting standards
- Managed templates to expedite timely and accurate turnaround goals
- Created, tested and implemented process changes within Conduit system to expedite claim process
- Performed specialist evaluations and reviews as assigned
Special Project Specialist
01.2014 - 01.2015
- Managed and reviewed return to work with Ohio Bureaus of Workers Compensation database
- Resolve data discrepancies and resolutions
- Maintained weekly, monthly, and quarterly reports for performance and accuracy
- Worked in conjunction with claims teams and BWC to ensure most accurate RTW dates on file
FROI Specialist/Peer Mentor
01.2012 - 01.2014
- Researched and filed new workers compensation claims reported to CareWorks
- Maintained consistent and excellent rapport with assigned clients
- Coached new associates on process and claims
- Maintained assigned caseload with special employers
- Work 1:1 with new hires as assigned for training and coaching
- Point contact for name and SSN changes with the BWC as verified by injured workers
- Team resource for complicated claims that required additional research
Education
Master of Science - Organizational Psychology
Franklin University
Columbus, OH05.2021
Bachelor’s Degree of Business - Business Administration And Management
Franklin University
Columbus, Ohio05.2017
Skills
- Time management
- Administering Claims
- Training new employees
- Manage time sensitive documents
- Proficient in Excel and Word
- Critical thinking skills
- Claims Evaluations
- Human Relations Skills
- Workers Compensation
- Annual Reviews
- Sourcing and Compiling Information
Timeline
Workers Compensation Claims Examiner
Big Lots Stores
02.2020 - Current
Medical Claims Examiner
Sedgwick CMS
03.2019 - 01.2020
Medical Claims Examiner
Ohio Bureau of Workers’ Compensation
10.2018 - 01.2019
CSS Operations Manager
Sedgwick CMS, Formerly CareWorks
01.2018 - 09.2018
Accounting Assistant
01.2016 - 01.2018
FROI QA Specialist
01.2015 - 01.2016
Special Project Specialist
01.2014 - 01.2015
FROI Specialist/Peer Mentor
01.2012 - 01.2014
Master of Science - Organizational Psychology
Franklin University
Bachelor’s Degree of Business - Business Administration And Management
Franklin University
Similar Profiles
Jerse TannerJerse Tanner
Furniture Sales Manager at Big Lots Stores, Inc.Furniture Sales Manager at Big Lots Stores, Inc.
Kemela HardingKemela Harding
Cashier/Stock Team Member at Big Lots Stores, Inc.Cashier/Stock Team Member at Big Lots Stores, Inc.
Francine HarrisonFrancine Harrison
Assistant Manager at Big Lots Stores, Inc.Assistant Manager at Big Lots Stores, Inc.
Marla MMarla M
Grocery Stocker at Big Lots Stores, Inc.Grocery Stocker at Big Lots Stores, Inc.
Corey HendricksCorey Hendricks
Agency Information Security Professional at Ohio Department of Youth ServicesAgency Information Security Professional at Ohio Department of Youth Services