MARIA MACEDO LUGO

• Contributed to policy development by identifying trends in employee leaves, recommending improvements based on findings.
• Educated employees on their rights and responsibilities related to leaves of absence, promoting a well-informed workforce.
• Assisted managers in understanding the impact of employee absences on business operations, enabling informed decision-making processes.
• Supported employees during their time off by coordinating return-to-work efforts, ensuring a smooth transition back into the workplace.
• Utilized strong analytical skills to identify patterns in employee absences that may indicate larger workplace issues or concerns.
• Provided exceptional customer service when addressing employee inquiries about their specific leave situations.
• Enhanced organizational efficiency by maintaining up-to-date knowledge on leave regulations and best practices.
• Ensured compliance with federal, state, and local leave laws to mitigate risk and avoid penalties.
• Administered various leave programs for streamlined processes and accurate record keeping.
• Promoted a positive work environment by fostering understanding and support for employees navigating the complexities of leaves of absence.
• Reduced processing time for leave requests by implementing an efficient tracking system for all cases.
• Collaborated with HR teams to ensure consistent application of leave policies across the organization.
• Managed complex cases by conducting thorough research and providing appropriate guidance to employees and managers.

• Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
• Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
• Handled escalated calls efficiently, finding satisfactory resolutions for both customers and the company alike.
• Maintains up to date on federal legislation surrounding the Family and Medical Leave Act, and other federal laws governing administration of the program.
• · Work closely with workers# compensation staff, retirement staff, payroll and human resources staff to address questions/issues, address transitions for employees and referrals at the end of leave benefits.
• · Coordinate all aspects of employee leave, including FMLA, short-term disability, long-term disability, sick leave donation and paid and unpaid leave of absence
• Notify all employer contacts of designation determination
• Process and monitor long-term absences; determine eligibility according to established guidelines for various leave program(s) and provide employees with timely notices.
• Provide forms to the employee for leave of absence
• Responds to requests to review employee personnel records in an accurate and timely manner.
• Answer phone calls from employees who want to take a leave of absence or who have questions about leave.
• Monitors authorized reviews in accordance with policies, procedures, and guidelines.
• Respond to questions and calls in relation to employee benefits, retirement, and Workers Compensation
• Comply with best practices and procedures and share them with schools when appropriate.
• Monitor leave of absences continually on a case-by-case basis to determine the appropriate time to terminate a leave of absence.
• Consults with school principals and secretaries about an employee on leave or in need of leave forms.
• Provides technical assistance to schools as necessary for any employee absence coding in SAP.
• Knowledge of research and best practices related to subject matter area in leave of absence.
• Ability to research and analyze issues.
• Ability to respond to telephone calls in a courteous and professional manner.

• Prepared and delivered all information to sites referencing risk management issues
• Maintained tracking system of all Workers' Compensation claimants
• Coordinated with management to actively return injured employees to work with accommodations
• Expedited all legal requests, subpoenas, and correspondence
• Advised manager or director of all risk management issues via memos, reports, and correspondence
• Responsible for accurately preparing wage statements
• Attended depositions on behalf of the district
• Resolved employee questions and concerns regarding workers' compensation issues
• Delivers presentations concerning workers' compensation and risk management guidelines to District employees
• Responded to information requests from third-party administrator (TPA) to ensure timely payment of indemnity benefits and settlement of claims.
• Ensured time quotas are accurate as they relate to In Line of Duty Days
• Created check requests for payment to outside vendors related to claims administration
• Attended meetings involving case settlement/defense strategy with manager and legal counsel
• Works closely with the RN Nurse Case Manager from the TPA regarding claims management
• Serves as a backup to management at legal proceedings including Workers' Compensation and liability mediation hearings
• Updated website information on risk management, provided site consultations as needed, and trained all site risk management coordinators

• Provided exceptional customer service through clear communication, empathy, and proactive problem-solving during difficult situations.
• Improved customer satisfaction levels by providing timely, accurate, and empathetic support during the claims process.
• Prepared files, letters and notices.
• Ensured compliance with company policies and industry regulations through meticulous documentation of claim files.
• Assisted adjusters in the field, gathering critical information for accurate evaluations of loss events and damage estimates.
• Logged, allocated and managed claims.
• Managed a high volume of claims efficiently while maintaining attention to detail resulting in minimized errors and reworkings.
• Reduced claim resolution times with thorough investigation and prompt communication with involved parties.

• Researched and resolved billing discrepancies to enable accurate billing.
• Identified, researched, and resolved billing variances to maintain system accuracy and currency.
• Worked with multiple departments to check proper billing information.
• Assisted colleagues in resolving complex billing issues, promoting teamwork and knowledge sharing within the department.
• Prepared itemized statements, bills, or invoices and recorded amounts due for items purchased or services rendered.

Processed medical bills with an accuracy rate of 97% or higherPosted and maintained appropriate payment records and generated activity reports

• Utilized knowledge in CPT and ICD-9/10 coding to adjudicate payment on claims received
• Received an average of 50 provider calls per day in regard to bill status, payments received, and denials
• Adhered to HIPAA regulations when handling injured workers protected information
• Worked with staff to determine medical necessity for treatment outside of the pattern for the reported injury