Priscilla Saenz
Allen,Texas
Summary
A Texas-licensed Workers' Compensation Case Manager, with three-plus years of experience in managing claims in Ohio and Wisconsin. Skilled in claims assessment, medical terminology, collaborating with outside counsel and third-party vendors for a Fortune 100 company. Recognized for quickly adapting to state-specific regulations, organizational changes, and evolving responsibilities while exercising sound independent judgment.
Overview
20
20
years of professional experience
1
1
Certification
Work History
Workers' Compensation Case Manager (remote)
Walmart Claims Services
Carrollton, TX
08.2021 - Current
- Handled a caseload of claims, conducting investigations to assess compensability.
- Developed a plan of action, using facts, best practices, and protocols while ensuring compliance with company policies and procedures.
- Assessed claims to determine appropriate reserves, then monitored and adjusted reserves to align with claim developments.
- Reviewed and interpreted medical records, diagnostics, and requests for treatment while maintaining scrupulous documentation.
- Developed rapport with claimants, medical professionals, legal representatives, and other third parties to efficiently and compassionately handle claims to resolution or settlement.
Certified Pharmacy Technician
Walmart Supercenter
Palmhurst, TX/Allen, TX, USA
10.2008 - 08.2021
- Consulted with healthcare providers and patients to ensure quality customer service, patient safety, and accurate medical records.
- Prepared and dispensed medication prescriptions, and processed insurance claims.
- Implemented compliance with safety regulations and ensured proper procedures to maintain a safe work environment.
- Collaborated with key stakeholders and external agencies regarding pharmacy operations and regulations.
Lead Pharmacy Technician
Family Pharmacy
Alton, USA
10.2004 - 05.2006
- Oversaw technician operation management of pharmacy in a cost-effective manner.
- Managed staff, schedules, and day-to-day operations.
- Communicated and delegated responsibilities to ensure growth development opportunities for associates.
- Acted as point of contact for complex technical pharmacy issues for staff members.
- Assisted in resolutions for employee concerns and pharmacy requirements.
- Directed and coordinated orientation, training, and continuing education programs for technicians.
- Assisted in implementation of process improvement to ensure compliance for patient services, policies, and procedures.
Education
B.S. - Psychology
University of Texas – RGV
Edinburg, TX01-2021
B.S. - Biology
University of Texas-Pan American
Edinburg, TX01-2015
Skills
- Bilingual in English and Spanish
- Able to develop and follow sound action plans, with emphasis on managing priorities
- Strong communication skills
- Supports and uplifts others while tackling challenges with patience and care
- Highly success oriented
- Systematic, methodical, an able to multitask without letting anything "fall through the cracks"
- Diplomatic, whether working with customers, peers, or superiors
Certification
- Texas All Lines Adjuster License, 2021
- Pharmacy Technician License, 2004
Timeline
Workers' Compensation Case Manager (remote)
Walmart Claims Services
08.2021 - Current
Certified Pharmacy Technician
Walmart Supercenter
10.2008 - 08.2021
Lead Pharmacy Technician
Family Pharmacy
10.2004 - 05.2006
B.S. - Psychology
University of Texas – RGV
B.S. - Biology
University of Texas-Pan American
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