Luz Pinedo
Summary
Bilingual WC Claims Examiner with deep knowledge of workers compensation claims. Solid abilities in developing objectives and strategies to settle Full and Final settlements on WC claims. Excellent skills compiling, coding, categorizing and auditing information to manage claims. Motivated Workers Compensation Intermediate Claims Examiner specializing in management of Workers Compensation Claims. Negotiated peaceful resolutions of all claims with emphasis on fairness and thoroughness. Trustworthy and dependable. Motivated Senior Claims Adjuster committed to diligently investigating, evaluating and negotiating Workers Compensation claims for Banner Health policyholders. Trained and knowledgeable in all state, federal and local laws. Skilled in recognizing potential fraudulent claims.
Overview
7
7
years of professional experience
Work History
Intermediate Workers Compensation Claims Examiner
BannerHealth Corporate Center - Phoenix
Phoenix, Az.
01.2018 - Current
- Reviewed new WC claim files to determine current status of injury claim and to develop plan of action.
- Collaborated with claims department and industry anti-fraud organizations to resolve claims.
- Reviewed and analyzed suspicious and potentially fraudulent work injury claims.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
- Interviewed claimants and witnesses to gather factual information.
- Researched claims and incident information to deliver solutions and resolve problems.
- Investigated WC claims for all Banner Health employees.
- Finalized WC claims for insurance claim payment release.
- Worked with private investigators and attorneys on preparation of evidence, witness statements and other documentation in preparation for trial.
- Managed customer calls and providers inquiries and concerns
- Worked with claimants to understand needs and provide excellent service
Workers' Compensation Light Duty Work Specialist
Banner Health Corporate Center - Phoenix
Phoenix, Az.
01.2016 - 12.2017
- Conducted day-to-day administrative tasks to maintain information files and work with Banner employees with light duty work placement.
- Examined time cards to insurance proper coding of all light duty work employees.
- Conducted rapport with all facility leadership to maintain collaboration to assist in placement of placement for employees while on light duty work leave.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
Education
Certificate - Spanish Interpreter
Banner Health Interpreter Certified
Phoenix2011
Associate of Applied Science - Health Claims Examiner/Insurance Processor/Coder
Western Technical College
El Paso, TX08.2005
Skills
- Bilingual Spanish Interpreter
- Excellent Investigation of WC Claims
- Claims Quality & Understanding
- Settlement Negotiation
- Knowledge of Medicare guidelines
- Claims Evaluations
- Customer Satisfaction
- Knowledge of software systems: Origami, Lawson, Kronos, Microsoft 10, Excel
Timeline
Intermediate Workers Compensation Claims Examiner
BannerHealth Corporate Center - Phoenix
01.2018 - Current
Workers' Compensation Light Duty Work Specialist
Banner Health Corporate Center - Phoenix
01.2016 - 12.2017
Certificate - Spanish Interpreter
Banner Health Interpreter Certified
Associate of Applied Science - Health Claims Examiner/Insurance Processor/Coder
Western Technical College