MARIE INTHAVONGSA
Sacramento,CA
Summary
I am a Claims Examiner with over 12 years of customer service experience, with expertise in complex and diverse claims analysis and investigation, adept at enhancing client satisfaction through strategic resolution strategies, and proactive communication. I have a deep understanding of managing insurance claims and investigating discrepancies. Strong ability to interpret insurance policies, verify coverage details, and negotiate claim settlements effectively. I am also committed to mentoring emerging insurance professionals, and driving successful outcomes in a dynamic environment.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Claims Examiner
Sedgwick
Roseville, California
11.2018 - Current
- Executed complex claims investigations while maintaining meticulous compliance standards, and adhering to strict regulatory guidelines.
- Negotiate settlements to achieve favorable outcomes, and maintain optimal reserve levels.
- Develop resolution strategies, enhancing client satisfaction through proactive communication.
- Collaborate with legal teams for cost-effective settlements, balancing client and company interests.
- Mentor and provide training sessions for new employees on proper procedures for handling claims.
- Participate in monthly claim discussions with client on treatment outcomes, plans for return to work and claim resolution.
Claims Associate - IAP
Sedgwick
Oakland, CA
11.2016 - 01.2018
- Investigate liability and coverage, ensuring thorough documentation for accurate claims processing.
- Ensured correct claims coding, reducing processing errors significantly.
- Managed comprehensive claim documentation, ensuring compliance with regulatory requirements and company policies, while meeting strict deadlines.
- Conducted in-depth liability assessments and risk evaluations, implementing strategic claim resolution approaches that enhanced settlement outcomes.
- Determined reserves for each claim based on estimated costs of settlement or defense.
- Prepared detailed reports on investigation findings and claim status.
Claims Associate - Medical Only
Sedgwick
Oakland, California
12.2015 - 11.2016
- Managed high-volume claims desk, ensuring timely and accurate documentation.
- Investigated claims thoroughly, maintaining consistency with injury reports.
- Maintained comprehensive medical file documentation system, ensuring accurate tracking of work status updates and medical progression reports
- Fostered productive relationships with healthcare providers and claimants to facilitate smooth information exchange and claim progression.
General Office - Billing Clerk/Cash Apps
Aramark Uniform Services
Concord, California
03.2013 - 12.2015
- Performed clerical and accounting tasks, supporting market center operations efficiently.
- Managed A/R reconciliations and discretionary forms, streamlining financial operations.
- Streamlined accounting operations by managing daily route audits, customer invoice processing, and payment batch documentation while maintaining precise data control systems.
- Orchestrated comprehensive customer information updates including contract renewals, price adjustments, and profile maintenance to ensure data accuracy.
Education
Associate of Science - SOCIAL SCIENCE AND BUSINESS ADMINISTRATION
College of Alameda
Alameda, CaliforniaAssociate of Science -
Berkeley City College
Berkeley, CaliforniaSkills
- Claims investigation
- Regulatory compliance
- Claims negotiation
- Risk assessment
- Claims documentation
- Settlement strategies
Certification
California - SIP
Office Tools
- MS Word
- MS Excel
- MS PowerPoint
- IVOS
- Juris
- SIR
References
References available upon request.
Timeline
Claims Examiner
Sedgwick
11.2018 - Current
Claims Associate - IAP
Sedgwick
11.2016 - 01.2018
Claims Associate - Medical Only
Sedgwick
12.2015 - 11.2016
General Office - Billing Clerk/Cash Apps
Aramark Uniform Services
03.2013 - 12.2015
Associate of Science - SOCIAL SCIENCE AND BUSINESS ADMINISTRATION
College of Alameda
Associate of Science -
Berkeley City College
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