Yolanda Hurtado
Summary
Enthusiastic Workers Compensation Insurance Technician eager to contribute to team success through hard work, attention to detail and excellent organizational skills. Analyzing and completing assignments in a timely manner. Talent for quick grasping new information and improvise to meet company goals. Accustomed to handling sensitive, confidential reports. Flexible and versatile, able to maintain a sense of humor under pressure. Motivated to learn, grow and excel as a State Fund Employee.
Overview
21
21
years of professional experience
Work History
Utilization Review Gatekeeper
State Compensation Insurance Fund
09.2016 - Current
- Exceed in processing all medial treatment for claims adjusters files in a timely manner.
- Work proactively with medical providers, Utilization Review Organization (URO) Injured Workers, and adjusters to ensure timely decisions on medical treatments.
- Identify legal issues relevant to Utilization Review and provide expertise when necessary.
- Review newly accepted claims bills for restart process
- Ensure Timeliness on Independent Medical Review processing in accordance with Sate Fund Policy.
Workers' Compensation Claims Adjuster
State Compensation Insurance Fund
11.2021 - 06.2022
- Ensure all claims have current case strategies and diaries for follow through on action plan to resolution.
- Provide accurate and timely benefits and benefit notices
- Document claims appropriately and timely with concise information.
- Proactively pursue claims resolution at earliest opportunity
Admin Support Technician
State Fund Insurance Compensation
02.2015 - 02.2016
- Provide support to claims adjusters by setting up medical appointments.
- Schedule treatment and/or Med-legal appointments
- Communicate with internal and external customers via phone, fax, and email.
- Managing all closed claims, establishing new claims and re-opening claims if needed.
- Completed special projects as assigned by manager.
Credentialing Coordinator
Santa Clara Family Health plan
05.2011 - 06.2014
- Prepare reports for Credentialing Committee, ensuring full compliance with agency requirements and tight deadlines.
- Processed initial & reappointment applications for Medical/Allied Health Professional Staff and clinical privileges to meet health plan policies and procedures.
- Maintained up-to-date physician database, including medical license, drug enforcement administration certificates, professional liability insurance, and renewal period's expiration dates.
- Initiated investigation into applicant's background, education and work history through the use of online systems, written correspondence or telephone inquiries and printed reference guides or reports.
- Conducted and completed Credentialing annual oversight audits of delegated partners.
Service Outreach Acquisition Retention Specialist
Santa Clara Family Health Plan
02.2010 - 04.2011
- Scheduled and coordinated outreach community events to provide information to the public/community on how to apply for healthcare insurance.
- Complete data tracking on company web-based, prepared spreadsheets, monthly reports, and client file-related paperwork on a routine basis.
Certified Application Assister
Santa Clara Family Health Plan
08.2008 - 01.2010
- Interviewed potential clients by phone and/or person to determine eligibility for health programs for families at no-cost or low-cost.
- Assisted the Eligibility Department in examining and processing Healthy Kids applications to determine eligibility and premiums as well as processing Healthy Kids payments and posting to appropriate accounts.
Health Service Representative
Santa Clara valley Medical Center
12.2006 - 07.2008
- Obtained current confidential patient information from established and new patients, accurately enter/update their information in practice management system.
- Researches raw data or computer output to correct errors in registration in a timely manner, verify insurance eligibility, collect correct co-payment amount.
Medical Assistant/Front Office
US Healthworks
11.2003 - 11.2006
- Answered and screened a high volume of incoming calls using a telephone switchboard from employers regarding work related injuries and obtained proper authorization for medical treatment.
- Scheduled or re-scheduled appointments for a variety of medical clinics, either by telephone or in person utilizing a computerized patient registration system.
Education
Medical Assistant
Silicon Valley College - Fremont
Fremont, CA2003
High School Diploma - General Education
Milpitas High School
Milpitas, CA2001
Skills
- Research Data Corrections
- Decision Making
- Interpersonal Communication Skills
- Detail Oriented
- Proficient in Computer system program
- Adaptability
- Time management
- Problem solver
- Extensive Organizational Skills
- Certified Bilingual Professional Fluent in Spanish
Professional Achievements
Enrolled in Emerging Professional Program: Currently participating in a structured professional development program designed for professional development training focusing on leadership skills and development growth.
Customer Service Committee: Active member of Customer Service Committee in Riverside claims. Develop and implement strategies to improve overall customer experience and ensure all internal and external communication is positive and exceed customer expectations.
Change in Liability Committee: Support the review and streamline the change in liability process to have all State Compensation Insurance Fund (SCIF) offices process bill restart using only one job aid to ensure consistency throughout all SCIF offices.
References
Gloria Serna
Assistant Claims Manager
P: 951-697-7588
Current supervisor (State Fund)
Todd Mercado- Knowles
Assistant Claims Manager
P: 909-239-3896
Former supervisor (State Fund)
Timeline
Workers' Compensation Claims Adjuster
State Compensation Insurance Fund
11.2021 - 06.2022
Utilization Review Gatekeeper
State Compensation Insurance Fund
09.2016 - Current
Admin Support Technician
State Fund Insurance Compensation
02.2015 - 02.2016
Credentialing Coordinator
Santa Clara Family Health plan
05.2011 - 06.2014
Service Outreach Acquisition Retention Specialist
Santa Clara Family Health Plan
02.2010 - 04.2011
Certified Application Assister
Santa Clara Family Health Plan
08.2008 - 01.2010
Health Service Representative
Santa Clara valley Medical Center
12.2006 - 07.2008
Medical Assistant/Front Office
US Healthworks
11.2003 - 11.2006
Medical Assistant
Silicon Valley College - Fremont
High School Diploma - General Education
Milpitas High School
Similar Profiles
Julie A JenkinsonJulie A Jenkinson
Sr Vice President, Insurance Services at State Compensation Insurance FundSr Vice President, Insurance Services at State Compensation Insurance Fund
Sunita DasSunita Das
Senior QA Engineer at State Compensation Insurance FundSenior QA Engineer at State Compensation Insurance Fund
Narineh Nikki SarkissianNarineh Nikki Sarkissian
Assistant Claims Manager at State Compensation Insurance Fund, SCIFAssistant Claims Manager at State Compensation Insurance Fund, SCIF