Melinda Guerra
El Paso,Texas
Summary
Self motivated and detailed-oriented professional seeking medical claims adjuster opportunity to demonstrate excellent customer service and claim management.
Overview
28
28
years of professional experience
Work History
Claims Associate
Sedgwick Claims Management
10.2021 - Current
- Worked productively in fast-moving work environment to process large volumes of claims.
- Modified, updated and processed existing policies.
- Provided exceptional customer service by addressing inquiries promptly and resolving issues professionally.
- Developed positive relationships with clients, fostering trust and open communication during the claims process.
- Managed high-volume claim caseloads, ensuring accurate documentation and adherence to company policies.
- Enhanced claim processing efficiency by streamlining workflows and implementing new software tools.
- Maintained up-to-date knowledge of industry regulations, ensuring compliance in all aspects of claims handling.
- Increased customer satisfaction rates through empathetic handling of customer concerns and timely resolutions.
- Followed up with customers on unresolved issues.
- Collaborated with internal departments and external vendors to resolve issue.
- Issues medical services payments to accounts and maintained records.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Improved team performance by providing ongoing training and support for Claims Associates on best practices and procedures.
- Provided exceptional customer service, addressing concerns and resolving issues promptly.
Customer Support Specialist IV/Ombudsman
Office of Injured Employee Counsel
12.2012 - 10.2021
- As an Ombudsman, I advocate, assist and educate injured employees of Texas about the workers’ compensation dispute process and workers’ compensation law/rules
- I assist the injured employee throughout the dispute resolution process, including answering questions the injured employee may have, set- up file according to dispute, study the case background on each claim, and review claims for medical and income benefits, gather and evaluating information (including medical records and letters from doctors), write letters to providers, refer complaints, track and provide information and claim status
- I assist and prepare the injured employee in mediations (Benefit Review Conference) and formal hearings (Contested Case Hearings)
- I assist with referrals to social services with other state agencies
- I communicate with insurance carriers to identify and attempt to resolve disputes
- I communicate with medical providers and staff obtain supporting claim documentation
- Document all customer contact in a computer system;
- Customer Support Specialist IV- Answer customers via phone and walk-in's questions, provide workers compensation program and procedure information
- Provide preliminary information and general assistance in claims activities
- Provide brochures and forms
- Verify and update claim information, review and log receipt of forms
- Assists in completing and filing of regulatory forms, document all customer contacts, explain or provide information about rights, responsibilities, and services
- Communicate with injured workers, healthcare providers, and insurance carriers
- I refer unresolved disputes to the Ombudsman Program in a timely manner, request medical records and alternate certifications from healthcare providers
- Review written documents and verbal information to identify issues and disputes; Refer injured workers to the Docketing Department for scheduling of case development appointments and make appropriate social service referrals to other agencies
- I backed-up the El Paso team lead for the Outreach Educational Seminars and Attorney Drops
Administrative Assistant III
TDI Division of Workers' Compensation
08.2012 - 12.2012
- My job duties consisted of answering telephone customers and walk-in's questions, provides preliminary information and general assistance in claims activities
- I would provide brochures, forms, information about rights, responsibilities and services
- Refer injured workers to OIEC and make appropriate social services referrals to other agencies
- Verified, updated claim information, and documented all customer contacts
- I reviewed and logged receipt of forms
Receptionist
Balance for Life
01.2012 - 07.2012
- Greet, check patients in and out and set up appointments
- Answer a 3 line phone system
- Collect any payments from patient, verified health insurance benefits via Internet and telephone
- Set up new patient files and file
Legal Assistant
Law office of Javier Martinez Jr., P.C.
01.2012 - 07.2012
- I set up appointments for new clients, interview new clients, process and set up new cases
- I answer potential clients’ questions and provide them with any information that they may need
- Verify that employers have Worker's Compensation coverage and then verify with insurance carrier that they have a claim set up
- Document all client contact, update clients information if needed, and reviewing and logging in any correspondence that is received
- Additional tasks: schedule court cases, preparation of exchange packages for hearings, applications for supplemental income benefits, calculating penalties/interest, quarter dates, and tracking court cases
- Close attention is also given to accurate scheduling, deadlines, collections and communicating with staff and clients
- Keep updated on county, state and federal laws pertaining to court filings and changes regarding Texas workers’ compensation and Family Law
- Draft and process divorce documents, Last Will & Testaments and Power of Attorneys
Receptionist / Workers' Compensation Technician
Law Offices of Bernardo Eureste
07.1996 - 06.1999
- Handled all internal communication, screening calls for potential clients, and answering clients questions if possible
- Responsible for setting court cases, hearings, and clients appointments with staff
- Up-to-date client personal information, case history, interviews, case & court information, and log daily mail
- Assist case workers with making copies, faxes or preparation of outgoing correspondence
Education
Elementary Preparation - Education
El Paso Community College
El Paso, TXLegal Assistant - Legal Studies
Penn Foster Career School
Scranton, PA12.1997
General Studies - Gender Studies
Parkland High School
El Paso, TX05.1994
Skills
- Complaint Handling
- Call center experience
- Quality Assurance
- Customer Response
- Appointment Scheduling
- Customer service excellence
- Attention to Detail
- Microsoft Windows and Office
- Customer Service
- Teamwork and Collaboration
- Problem-Solving
- Collaborative Team Player
- Interpersonal Skills
- Customer Communication
- Problem-solving abilities
- Issue and Resolution Tracking
- Support Services
- Friendly and Patient
- Highly Professional
- Call Center Operations
- Active Listening
- Creative Issue Resolution
- Incoming Call Management
Languages
Spanish
Professional Working
English
Professional Working
Timeline
Claims Associate
Sedgwick Claims Management
10.2021 - Current
Customer Support Specialist IV/Ombudsman
Office of Injured Employee Counsel
12.2012 - 10.2021
Administrative Assistant III
TDI Division of Workers' Compensation
08.2012 - 12.2012
Receptionist
Balance for Life
01.2012 - 07.2012
Legal Assistant
Law office of Javier Martinez Jr., P.C.
01.2012 - 07.2012
Receptionist / Workers' Compensation Technician
Law Offices of Bernardo Eureste
07.1996 - 06.1999
Elementary Preparation - Education
El Paso Community College
Legal Assistant - Legal Studies
Penn Foster Career School
General Studies - Gender Studies
Parkland High School
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