Maria C. Rivera
Desoto,TX
Summary
Results-oriented Human Resources professional with 10 years of Leave and Disability case management, OSHA reporting, and Workers' Compensation experience.
Overview
14
14
years of professional experience
Work History
Worker's Compensation Specialist
Texas Health Resources
06.2018 - 04.2024
- Assisted and navigated injured employees through the Workers' Compensation process.
- Evaluated work related injuries daily and determined if a claim would need to be filed with insurance carrier or handled in-house.
- Analyzed and uploaded medical received into risk management program.
- Maintained active journal updates of medical care and progress.
- Served as point of contact, reviewed claims, reserved costs, and collaborated claims closure and return to work planning with the assigned insurance carrier adjuster.
- Monitored the leave of absences for employees losing time from work due to a work related injury.
- Proactively identified possible accommodations needed and initiated the reasonable accommodation process under the Americans with Disability Act (ADA) for injured employees.
- Communicated approvals, denials, leave extensions, return to work plans, and other important information regarding work comp claims, leaves, and/or ADA requests with the employees and internal departments such as HR Ops, Benefits, and Employee Relations/Legal.
- Audited injury causes and OSHA coding to ensure all files were properly designated and updated regularly for OSHA logs to be readily available for end of year reporting.
- Completed yearly OSHA surveys for all Texas Health Entities.
- Reviewed and Audited work comp files for compliance with TDI/DWC standards and deadlines.
Workers' Compensation Analyst
Texas Health Resources
10.2015 - 06.2018
- Assisted with the day to day support of Workers' Compensation claims processing.
- Collected and distributed all incoming medical related to claim to the Workers' Compensation Specialists.
- Completed all DWC forms and ensured compliance with federal and state law reporting requirements.
- Created files, uploaded necessary documentation, and maintained record keeping of all claims in Risk Console.
- Monthly claims reports were reviewed alongside Workers' Compensation Specialists to ensure proper and timely claim closure.
- Reviewed all billing statements received from vendors and providers, and initiated payments per Medical Fee Guidelines for claims managed in-house.
- Audited injury causes and OSHA coding to ensure all files were properly designated and updated regularly for OSHA logs to be readily available for end of year reporting.
- Administered the leave process from start to finish for employees losing time from work due to a work related injury.
- Verified leave eligibility, calculated and monitored duration of leave, and supported the return to work process to ensure compliance with all applicable policies, federal laws, and regulations.
- Proactively identified possible accommodations needed and initiated the reasonable accommodation process under the Americans with Disability Act (ADA).
- Communicated approvals, denials, leave extensions, return to work plans, and other important information regarding work comp claims, leaves, and/or ADA requests with the employees and internal departments such as HR Ops, Benefits, and Employee Relations/Legal.
- Served as back-up to other roles in department as needed to ensure all tasks and inquiries were completed promptly.
Return to Health Analyst - FMLA / ADA
Texas Health Resources
04.2014 - 05.2015
- Assisted the ADA/FMLA Specialist with all claims related to the Family Medical Leave Act (FMLA) and the Americans with Disability Act (ADA).
- Ensured all files were in compliance with State, Federal, and company regulations.
- Administered FMLA and ADA paperwork and requests.
- Reviewed documentation and determined employees eligibility to approve or deny requests.
- Provided employees prompt resolutions to complaints and inquiries by investigating and gathering information from FMLA, ADA, and Company acts and policies.
- Coordinated with employee Health Nurses to ensure employees would return to work in a safe and efficient manner.
- Managed and privately secured employees FMLA and ADA records by using the Sharepoint filing system.
- Maintained a detailed ADA quarterly report with ADA accommodation requests and resolutions.
- Tracked employees available FMLA time and sent letters of designation to notify them.
Auto Claims Adjuster
Affirmative Insurance Holdings
01.2012 - 03.2012
- Investigated and negotiated minor to complex auto claims that included collision, comprehensive, and physical damage.
- Resolved claims with significant coverage issues such as: policy cancellation, unlisted driver operating vehicle at time of loss, and other loss to vin/policy.
- Conducted interviews with people involve in accidents; requested and reviewed police reports, and negotiated estimates for repairs.
- Handled single vehicle to multi vehicle losses.
Fast Lane Claims Representative
Gainsco Auto Insurance
07.2010 - 08.2011
- Investigated, evaluated, and settled first-party comprehensive/collision claims in the state of Texas, New Mexico, Arizona, Florida, Georgia, and South Carolina.
- Obtained necessary appraisals and police reports for proper investigation of claims.
- Answered multi-line phone system/switchboard to collect and verify claimant and policy information.
- Assisted customers with general claim questions and claim status.
Front Desk Receptionist
Gainsco Auto Insurance
11.2009 - 07.2010
- Enhanced customer satisfaction by providing efficient and professional front desk services.
- Streamlined office operations for improved productivity with effective organization and communication skills.
- Managed high-volume phone calls, directing inquiries to appropriate personnel for prompt resolution.
- Increased guest retention by maintaining a welcoming and organized reception area.
- Assisted in processing endorsements, letters of experience, and credit to establish proof of insurance.
Education
Adjuster License - Workers' Compensation -
Kaplan
Dallas, TXAdjuster Texas Property, Casualty, & Surety -
Kaplan
Dallas, TXHigh School Diploma -
Irving High School
Irving, TX05.2000
Skills
- ADA Knowledge
- FMLA Expertise
- Workers' compensation
- OSHA Compliance
- SharePoint
- RLDatix
- Origami Risk
- Risk Console
- IRM
- Oracle People Soft
- Excel
- Audit Planning
Timeline
Worker's Compensation Specialist
Texas Health Resources
06.2018 - 04.2024
Workers' Compensation Analyst
Texas Health Resources
10.2015 - 06.2018
Return to Health Analyst - FMLA / ADA
Texas Health Resources
04.2014 - 05.2015
Auto Claims Adjuster
Affirmative Insurance Holdings
01.2012 - 03.2012
Fast Lane Claims Representative
Gainsco Auto Insurance
07.2010 - 08.2011
Front Desk Receptionist
Gainsco Auto Insurance
11.2009 - 07.2010
Adjuster License - Workers' Compensation -
Kaplan
Adjuster Texas Property, Casualty, & Surety -
Kaplan
High School Diploma -
Irving High School
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