Summary
Overview
Work History
Education
Skills
Accomplishments
References
Timeline
Generic

Samantha Cordle

Plain City,OH

Summary

To apply my extensive and diverse experience within the company to secure a position that allows me to share my knowledge with clients, while continuing to learn and expand my opportunities for advancement.

Overview

15
15
years of professional experience

Work History

Support Team Coordinator in Triage

Sedgwick Managed Care Ohio
07.2019 - Current
  • Serve as backup for Team Lead in Triage Department and support various duties as needed.
  • Researching and keying new claims (proven ability to exceed Triage Associate performance expectations).
  • Manage the email folder for new reports of work injuries submitted, and other multiple work queries.
  • Data Accuracy Report (identifying reasons for employer risk number/date of injury errors, and whether it’s an error against the colleague).
  • Audit Triage Associate's completed FROIs.
  • FROI Monitoring – spot-check pending FROIs and staff these FROIs with individuals as needed to get them completed and sent to the BWC for a claim number.
  • Resource for the team, answering any questions that arise throughout the day.
  • Delegate and prioritize work among colleagues.
  • Train new hires and monitor their development, coaching them in areas of opportunity, auditing all completed claims and recording results, and monitoring productivity for the first 90 days; write 90-day reviews.
  • I participated in conducting job interviews for job candidates.
  • Monitored FROIs that were not filed due to a lack of information by faxing to the BWC, or sending the FROI back to colleagues if more research is needed.
  • Tracked and documented accuracy and productivity metrics of colleagues; resolved accuracy and productivity concerns as necessary, and developed a plan to realign a colleague's performance.
  • Sent morning and afternoon emails to colleagues and upper management to inform them of departmental stats (how many claims are currently in the department, how many are completed, and sent to BWC, etc.). As well as staff absences.
  • Updated colleagues on workflow changes, and/or sent reminders of current processes.
  • Created job aides to assist colleagues in various processes of working a FROI.

Senior Specialist Claims Administration

CareWorks
08.2018 - 07.2019
  • All duties, as indicated below, in the Specialist Claims Administration III position, with the addition of:
  • Alternative Dispute Resolution (ADR) Coordinator
  • Acted as a liaison between the ADR department and the team with any ADR issues and questions.
  • Monitored decisions on additional allowance requests to later determine if a pended appeal should continue to be processed, or if the treatment decision for which the appeal is made should be readdressed.
  • Scheduled ADR mentors in order to take turns each day to pend or dismiss appeals, based on their availability throughout the month.
  • Delegated ADR-related work between the other ADR mentors and case specialists as needed.
  • Acted as a resource for any ADR inquiries.
  • All other responsibilities, as detailed below under ADR Mentor, in prior position of Specialist Claims Administration III.
  • New Hire Department Training - In a classroom setting, every new Specialist Claims Administration III hired into CareWorks will sit with an instructor on their first day of work to learn how to navigate the various systems utilized within the company. Help new hires retain information by providing quizzes, and answering any questions as they arise.
  • I took the initiative to learn how to audit claims within CareWorks’ system, and I will assist in this when needed.
  • Helped lead the team's roundtable discussions.
  • Acted as a leader on the team and was available to answer various questions from other Specialists of Claims Administration III.

Specialist Claims Administration III

CareWorks
12.2014 - 08.2018
  • Medically managed workers’ compensation claims while implementing strategies for getting an injured worker back to work as safely and quickly as possible, in order to meet company goals and contain claim costs, while working towards claim resolution.
  • Acted as a liaison to objectively guide and educate all claim parties through the workers’ compensation process.
  • Approved treatment requests within a case specialist’s scope of authorization based on guidelines set forth by the Bureau of Worker’s Compensation.
  • Fostered strong and professional connections with assigned employers through needs assessment, engagement in conference calls, and presence at meetings both on-site and off-site.
  • Mentor Duties
  • Alternative Dispute Resolution (ADR) Mentor: Pended and dismissed appeals received when applicable, set diaries for case specialist assigned to claim with the appeal filed to follow-up on status and take necessary action, and act as a resource to the team with any ADR questions.
  • Measurement of Disability (MoD) Mentor: Reviewed reports of claims from the team and identify any appealable issues to present to BWC in an attempt to bring MoD scores up, identify any trends on reports to use as an educational opportunity to the on what we can do to keep scores up, and act as a resource to the team with any MoD and sub-148 questions.
  • New Hire Mentor: Completed case load reviews, guiding new hires for Specialist Claims Administration III on the team with hands-on training over a period of a few weeks, and be available to answer any questions.

Alternative Dispute Resolution (ADR) Specialist

CareWorks
04.2013 - 12.2014
  • Prepared and perfected medical files, ensured all medical information related to the claim is available, and clarified or wrote out treatment decisions for injured workers when an appeal is submitted against a C9 decision. These medical files are sent out to a reviewing physician for a decision on the appeal.
  • Monitored all appeals to ensure a timely return of reports.
  • Performed a quality review of each report and completed the BWC order for the appeal.

ADR Independent Medical Evaluations (IME) Specialist

CareWorks
09.2011 - 04.2013
  • Scheduled injured workers around the state of Ohio, as well as some out of state, for IMEs to determine the appropriateness and necessity of treatment requests after an appeal is filed against the original decision of a C9.
  • Called injured workers to verify their home addresses and to obtain their availability for an examination.
  • Determined the doctor and location an injured worker is to attend for an examination based on that injured worker’s home address and their availability.
  • Generated letters on the Bureau of Workers' Compensation website to notify injured workers of the date, time, and location of their examination.
  • Tracked injured workers scheduled for examinations to ensure timely receipt of IME reports

ADR Prep Team Assistant

CareWorks
08.2010 - 09.2011
  • Prepared and organized medical files for physician reviewers in active injury appeals.
    Supported ADR team by handling faxing, copying tasks, and other responsibilities as assigned.

Education

Some College (No Degree) -

Columbus State Community College

High School diploma -

West Jefferson High School
West Jefferson, OH
05-2010

Skills

  • Multi-tasking
  • Work prioritization
  • Time management
  • Quick and adaptable learner
  • Self-motivated
  • Team collaboration skills
  • Attention to detail
  • Upbeat attitude
  • Excellent customer service skills

Accomplishments

  • In 2024, I was recognized with Sedgwick's Above and Beyond Award for saving a potential 479 days in average overall FROI turnaround time in 2023

References

References upon request.

Timeline

Support Team Coordinator in Triage

Sedgwick Managed Care Ohio
07.2019 - Current

Senior Specialist Claims Administration

CareWorks
08.2018 - 07.2019

Specialist Claims Administration III

CareWorks
12.2014 - 08.2018

Alternative Dispute Resolution (ADR) Specialist

CareWorks
04.2013 - 12.2014

ADR Independent Medical Evaluations (IME) Specialist

CareWorks
09.2011 - 04.2013

ADR Prep Team Assistant

CareWorks
08.2010 - 09.2011

Some College (No Degree) -

Columbus State Community College

High School diploma -

West Jefferson High School

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