JIHAN JACKSON
Las Vegas,NV
Overview
14
14
years of professional experience
Work History
Workers’ Compensation Claims Analyst
MGM Resorts International - CORP
Las Vegas, NV
07.2024 - Current
- Manage and serve as the company claim advocate for Worker's Compensation claims administered by TPAs nationwide.
- Serve as the primary key contact with the TPAs, MGM department leaders, and the injured worker to ensure timely and appropriate administration of claims.
- Supervise TPA administration for quality assurance, appropriate claim management, control of medical management services, and oversight of litigation expenses.
- Carryout oversight and audit processes to monitor the TPA's adherence to their Best Practices and agreed upon Special Handling Instructions.
- Oversee Worker's Compensation claims the handling of the Companies Nevada, Michigan, Ohio, Massachusetts, Maryland, New York, New Jersey and Mississippi Workers' Compensation claims reviewing notes in TPA Risk Management Systems including, but not limited to, data entry, claim reporting, appropriate medical management, reserving, timely claimant communication, documentation, litigation, settlement negotiations, and return to work protocol.
- Works closely with the Director of Worker's Compensation in identifying trends and areas for program improvement.
- Conduct and facilitate claim reviews on a quarterly basis with the TPA adjusters to ensure TPA compliance with MGM requirements and quality assurance standards.
- Oversight of the TPA adjuster files for proper evidence and a plan for case resolution.
- Identify cases that should resolve and work with the adjuster to resolve at the earliest opportunity.
- Establishes a cadence of regular interactions with key TPA claims personnel to ensure alignment of expectations and strengthening of the partnership.
- Works collaboratively with the TPA claims handlers to develop strategies for cost containment and claim resolution.
- Responsible for collaborating with Company Return to Work Specialists and ADA Department to follow corporate guidelines regarding permanent restriction processes.
- Provide education and training to departments as needed, aimed to reduce frequency of injuries.
- Serve as a resource to the injured employee to assist in navigation of the Work Comp claims process.
- Weekly management of Work Comp claims system in order to supply relevant data to OSHA 300 and 301 logs, in coloration with the Safety Department, to ensure compliance with all federal, state, and local reporting requirements.
- Remains up to date of worker's compensation regulations, laws and ruling.
- Other projects and tasks as necessary and required by the Director of Worker's Compensation, VP of Risk Management, and other Risk Management department leaders.
Claims Representative
RAS
Sioux Falls, SD
09.2022 - 08.2024
- The role involves monitoring medical treatments, reserves, and payments for long-term claims, requiring a keen eye for detail and comfort with mathematical calculations
- Investigate and adjust workers compensation claims in accordance with established claims handling procedures using guidelines and direct supervision
- Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims
- Negotiate any disputed bills for resolution
- Authorize and make payment of workers compensation claims utilizing a claim payment program in accordance with industry standards and within settlement authority
- Assess and monitor subrogation claims for resolution
- Compliance with Service Commitments as established by team
- Delivery of quality claim service to clients
- Prepares necessary state fillings within statutory limits
- Uses appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients
- Reports claims to the excess carrier; responds to requests of directions in a professional and timely manner
- Communicates claim activity and processing with the claimant and the client; maintains professional client relationships
- Ensures claim files are properly documented and claims coding is correct.
Claims Associate
Sedgwick
Las Vegas, NV
03.2021 - 09.2022
- Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision
- Supports other claims representatives, examiners and leads with larger or more complex claims as necessary
- Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency
- Communicates claim action/processing with claimant, client and appropriate medical contact
- Ensures claim files are properly documented and claims coding is correct
- May process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims
- Maintains professional client relationships
- Provides support to the claims staff and to perform other office tasks depending on the client program
- Sets up and enters new claims into the claims management system
- Inputs and reviews notes/diaries in the claims management system as instructed
- Processes payments
- Processes mail; handles filing, faxing and photocopying
- Reviews, prepares, creates, and/or sends letters, reports, and forms
- Answers and initiates telephone calls, sets up medical appointments, and may provide customer service as required
- Other activities/projects as assigned including the preparation and distribution of computer reports.
Billing Assistant/Intake Specialist
FACE TO FACE MEDICAL MANAGEMENT
Las Vegas, NV
01.2021 - 03.2021
- Kareo EHR
- Insurance verification
- Verify correct coding of procedures and diagnoses
- Resolve claim denials
- Identify and addressing issues within the billing process
- Managing contact with insurance companies, both online and over the phone
- Contact patients regarding billing information
- Maintain and improving the practice's billing system
- Prepare presentations for training purposes.
Patient Service Specialist
SELECT PHYSICAL THERAPY/SELECT MEDICAL
Las Vegas, NV
04.2019 - 12.2020
- Optimize patient satisfaction by greeting with a smile, listening and displaying empathy
- Oversee daily clinic operations and coordinate daily administration of patients and clinicians
- Access patient medical records in EPIC and maintain patient confidentiality
- Complete and track day-to-day office operations by using daily checklists
- Utilize scheduling system to enter patient information for registration and check-in
- Schedule outpatient care plans in accordance with other treatments and process referrals via telephone, fax, and email
- Ensure complete, accurate entry of patient demographic and insurance information
- Verify patient insurance, obtain authorizations and remain up-to-date on insurance requirements
- Communicate with insurance companies and other payers to provide necessary clinical information
- Generate and balance monetary reports to close out the day, week, and month and post payments to patient accounts
- Attend and participate in monthly clinic meetings
- Collaborate with clinic manager on developing ways to resolve patient concerns and increase patient flow.
Senior Service Advocate
AETNA
Columbus, OH
09.2017 - 04.2019
- Served as single point of contact for handling member service inquiries
- Resolved complex customer issues with sensitivity and discretion
- Built and maintained trusting relationships with internal and external members
- Remained compliant with changing guidelines
- Assisted with research and participated in special projects.
Customer Care Representative
ALLIANCE DATA
Columbus, OH
03.2016 - 07.2017
- Served as liaison to customers and investigated and fixed their issues
- Interpreted customer's financial profiles and regularly updated database
- Maintained composure when handling hostile customers.
Customer Service Representative
REGENCY FINANCE COMPANY
Columbus, OH
08.2015 - 03.2016
- Pulled credit bureau reports to verify information and investigate applications
- Processed all loans and sales finance contracts
- Operated and balanced main cash drawer daily.
Teller
WELLS FARGO
Hillsboro, OR
02.2011 - 06.2015
- Provided account services to customers by receiving deposits and loan payments
- Performed various types of transactions for clients
- Demonstrated exceptional math skills by counting large amounts of cash daily
- Exhibited exceptional customer service by engaging in clients and maintaining confidentiality.
Education
Bachelor of Science - Health Administration
01.2017
Skills
- Policy Interpretation
- Claims history analysis
- Claims review
- Document workflow
- Accounting spreadsheets
Timeline
Workers’ Compensation Claims Analyst
MGM Resorts International - CORP
07.2024 - Current
Claims Representative
RAS
09.2022 - 08.2024
Claims Associate
Sedgwick
03.2021 - 09.2022
Billing Assistant/Intake Specialist
FACE TO FACE MEDICAL MANAGEMENT
01.2021 - 03.2021
Patient Service Specialist
SELECT PHYSICAL THERAPY/SELECT MEDICAL
04.2019 - 12.2020
Senior Service Advocate
AETNA
09.2017 - 04.2019
Customer Care Representative
ALLIANCE DATA
03.2016 - 07.2017
Customer Service Representative
REGENCY FINANCE COMPANY
08.2015 - 03.2016
Teller
WELLS FARGO
02.2011 - 06.2015