JENNIFER BALDRIDGE
Pataskala,Ohio
Summary
To use my experience and education which I have obtained professionally, from an accredited university, as well as both the private and public sectors to strengthen and improve claims management teams to ensure the best care for patients.
Overview
12
12
years of professional experience
Work History
Front of House Manager
Elliots Woodfire and Tap
08.2022 - Current
- (70 hours a week) - Hired and trained new staff for restaurant opening
- Supervised a great team of developing professionals in the FOH
- Increased profits by developing, initiating, and managing marketing activities for restaurant group sales
- Implemented innovative programs to increase team loyalty and reduce turnover
- Developed weekly schedules and floor plans for the team
- Ordered and received daily deliveries from purveyors
- Provided services to restaurant guests as well as mentored the work force
- Educate new hire of policy, procedures and legal requirements in the fields.
Lost Time Claims Specialist
State Of Ohio
Columbus, Ohio
08.2019 - 10.2022
- (50-60 hours a week) - Review files to determine the current status of injury claims and develops a plan of action for future handling
- Investigates claims to determine the medical relevance of the treatment provided
- Ensures that all documents pertaining to a claim are electronically attached and labeled correctly in the claims management system
- Determines proper reserves are set on files and makes appropriate changes as new information is received
- Maintains contact with the claimant or their legal representative to determine the current status of treatment
- Responds to all emails, voicemail, mail, and faxes in accordance with the accountability standards
- Calculate figures and amounts such as discounts, interest, commissions, and percentages for claimants' medical bills, loss wages, and possible prescription reimbursement.
Senior Disability Claims Examiner
Sedgwick
Hilliard, Ohio
07.2018 - 08.2019
- (50 hours a week) - Reviewed and evaluated new and ongoing short-term disability claims to determine liability
- Reviewed contract provisions and medical/vocational evidence to support claims
- Referred claims to appropriate internal and external resources to impact a safe and timely return to work
- Established action plans to bring the claim file to a resolution
- Updated and maintained data records in a clear and concise manner
- Participated in additional pieces of training and competencies to include California State Paid Family Leave and Family Medical Leave Act training and utilization
- Requested and reviewed medical records and Physician Statements, and interviewed claimants regarding disabilities.
Senior Medical Claims Examiner
Nationwide Insurance
Columbus, Ohio
04.2017 - 07.2018
- (45-50 hours a week) - Carefully reviewed, evaluated and investigated insurance claims
- Obtained additional information from claimants’ doctors on questionable claims
- Detailed all conversations and filed periodic reports for review by claims managers
- Contacted claimant for pertinent information including description of injury
- Maintained thorough written records related to claims.
Lead Clinical Outreach Coordinator
Nationwide Children's Hospital
Columbus, Ohio
08.2012 - 04.2017
- (On call 24 hours/day) - Responsible for coordinating the access and delivery of support and services noted in annual health home care plan designated for individuals diagnosed with complex chronic health issues
- Responsible for locating and creating natural support and community resources
- Responsible for locating funded services, helping to determine eligibility, completing referrals, and facilitating visits and interviews
- Attend multi-disciplinary team meetings to discuss current goals and discharge planning from medical and psychiatrist emergency rooms and hospitalizations
- Responsible for ensuring that level of care assessments are completed annually.
- Provided leadership, guidance and support to staff members.
- Implemented strategies to increase public awareness of social and community service programs.
- Participated in community events to promote services and engage with public.
Education
Bachelor of Science - Nursing
Chamberlain College of Nursing
2015
High School Diploma -
Reynoldsburg High School
06.1998
Skills
- Leadership Development Training
- Human Resources Experience
- Diversity and Inclusion Training
- Conflict resolution training
- Complex medical background
- Medical Claims Experience
- Management Experience
- Knowledge of Policy and Procedure Development
Timeline
Front of House Manager
Elliots Woodfire and Tap
08.2022 - Current
Lost Time Claims Specialist
State Of Ohio
08.2019 - 10.2022
Senior Disability Claims Examiner
Sedgwick
07.2018 - 08.2019
Senior Medical Claims Examiner
Nationwide Insurance
04.2017 - 07.2018
Lead Clinical Outreach Coordinator
Nationwide Children's Hospital
08.2012 - 04.2017
Bachelor of Science - Nursing
Chamberlain College of Nursing
High School Diploma -
Reynoldsburg High School
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