Maria Ongpin
Corona,CA
Summary
Dynamic Medical Case Manager with extensive experience at Travelers Insurance, adept at leveraging analytical thinking and negotiation skills to optimize treatment plans and facilitate successful return-to-work outcomes. Proven track record in managing complex claims and building strong relationships with stakeholders to achieve optimal resolutions.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Medical Case Manager
Travelers Insurance
Diamond Bar, CA
07.2007 - Current
• Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate
appropriate medical care and return to work.
•Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement. Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim.
• Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan. •Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines. • Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU). • Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to
achieve an optimal outcome.
• Utilize internal Claim Platform Systems to manage all claim activities on a timely basis. • Utilize Preferred Provider Network per jurisdictional guidelines.
• Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate
claim reserves.
• Submit accurate billing documentation on all activities as outlined in established guidelines. • Customer Engagement.
• Participate in Telephonic and/or onsite File Reviews
• Participated in Habitat for Humanity Build - Altadena, CA in August 2023.
• Assisted other departments within the company upon ERT requests with calls out to Travelers customers after catastrophic events.
Education
Associate of Science - Nursing
Victor Valley College
Victorville, CA05-2000
Skills
Familiar with URAC standards
Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making
Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology Ability to effectively present file resolution to internal and/or external stakeholders
Negotiation: Advanced ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise
General Insurance Contract Knowledge: Ability to understand policies and contracts, as they apply to policy conditions
Principles of Investigation: Advanced investigative skills Follows a logical sequence of inquiry with a goal of securing information about the work accident, resulting injury, anticipated treatment, job duties and any material factors that may impact recovery and return to work
Value Determination: Advanced ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves
Legal Knowledge: Advanced knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry
Medical knowledge: Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed
WC Technical: Advanced ability to demonstrate understanding of WO Products and ability to apply available resources and technology to manage treatment plans and assist with claim resolution Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state
Customer Service: Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes
Teamwork: Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result
Planning & Organizing: Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goal
Affiliations
- Family and relationships are very important in my life.
- I love to travel, by boat, plane or train, to far off places and experience all the authentic beauty and on the different ways of life.
- I enjoy and appreciate the little things that bring happiness and joy to others.
Accomplishments
- Received multiple recognitions, exceeding targets for Teamwork and going "outside the box" securing customers to Travelers.
Certification
- Licensed Vocational Nurse
Languages
English
Professional
Tagalog
Limited
References
References available upon request.
Timeline
Medical Case Manager
Travelers Insurance
07.2007 - Current
Associate of Science - Nursing
Victor Valley College
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