Michelle Robinson
Houston,Texas
Summary
Motivated Claims Service Officer who specializes in processing highly complex (senior-level) disability determination work, reviewing and approving and/or rejecting requests for approval of certain official actions. Studying case histories, evaluating data, conducting investigations, making decisions on requests for official actions from parties to claims and preparing disability determinations. Also, training others while working under limited supervision with considerable latitude for the use of initiative and independent judgment. Negotiating peaceful resolutions of all claims with emphasis on fairness and thoroughness. Trustworthy and dependable.
Overview
24
24
years of professional experience
Work History
Claim Service Officer III
TEXAS DEPARTMENT OF INSURANCE - DWC
Houston , TX
04.2008 - Current
- Identifies possible violations of law and refers them for investigations
- Researches and responds to customer inquiries
- Provides outreach and education to system participants and agency staff on DWC rules
- Conducts workshops, participates in development of staff including mentoring
- Ensures appropriate delivery of medical and Income Benefits and resolves disputes
- Investigates and resolves complaints
- Monitors and enforces compliance with Workers’ Compensation Rules and Laws
- Encourages timely Return to Work through education and disability management and return to work programs.
- Maintained accurate records and full compliance with government regulations and agency guidelines.
- Coordinated solutions for high volume of customer inquiries per day while meeting and exceeding performance quotas.
- Used coordination and planning skills to achieve results according to schedule
- Managed over 50 customer calls per day
Administrative Technician III
05.2004 - 04.2008
- Answers walk-in and telephone customers' questions; provides preliminary information and general assistance in claims activities including providing brochures and forms
- Verifies, with injured worker's assistance, that claim information on mainframe computer screen is accurate
- Attempts to resolve disputes at all stages of claim process
- Makes appropriate social service referrals to other agencies
- Managed 3 calendars to strategically coordinate meetings, appointments and events
- Identified and recommended changes to existing processes to improve accuracy, efficiency and quality service
- Established administrative work procedures to track staff's daily tasks
- Managed filing system, entered data and completed other clerical tasks
- Assisted coworkers and staff members with special tasks on daily basis
- Built and maintained excellent customer relationships through timely response to inquiries and going above and beyond to accommodate unusual requests
- Managed paper and electronic filing systems by routing various documents, taking messages and managing incoming and outgoing mail
- Liaised between clients and vendors and maintained effective lines of communication
- Surpassed team goals by partnering with colleagues to implement best practices and protocols
Clerk III
09.2003 - 05.2004
- Operates telephone switchboard console and performs receptionist duties
- Performs complex data entry work requiring complex work methods& procedures
- Enters and updates data from forms into various systems, updates injured workers or beneficiaries representative info into claim records.
Human Resources / Personnel Assistant
FEDERAL RESERVE BANK
HOUSTON, TEXAS
05.2002
- Responsible for meeting needs of each individual employee
- Established and maintained constructive relationship with employees
- Maintained employee records
- Responsible for general clerical duties, including filing, faxing, telephones
- Responsible for all confidential employee records.
- Assisted with on-boarding process of 6 new hires
Secretary IV – Secretary to Director
Region IV Education Service Center
Houston, Texas
01.1996 - 01.2001
- Provided secretarial support to director and consultants as well as working on related departmental duties
- Coordinated all office functions including receiving and responding to phone calls, filing, travel, timekeeping, and meeting arrangements
- Proficient in Purchase Order System, Direct Payment and District Invoicing
- Prepared payroll forms.
- Answered multi-line phone system and greeted callers enthusiastically.
- Scheduled appointments and conducted follow-up calls to clients.
Education
Some College (No Degree) -
Texas Southern University
Houston, TexasSkills
- MS Word
- MS Outlook
- Data Entry
- Customer Service
- MS Excel TXCOMP Multi-line Phones Organized
- MS PowerPoint Citrix Filing Typing (35 wpm)
- Benefits Explanations
- Sharepoint
- Confidential Records Management
- Word Processing/Key entry
- Mail Processing
- Texas Workers’ Compensation Acts and Rules
- Avaya Agent Desktop
- Avaya One X
- Microsoft Teams
Timeline
Claim Service Officer III
TEXAS DEPARTMENT OF INSURANCE - DWC
04.2008 - Current
Administrative Technician III
05.2004 - 04.2008
Clerk III
09.2003 - 05.2004
Human Resources / Personnel Assistant
FEDERAL RESERVE BANK
05.2002
Secretary IV – Secretary to Director
Region IV Education Service Center
01.1996 - 01.2001
Some College (No Degree) -
Texas Southern University
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