800 hotline - Daily contact with all partners, clients, departments & vendors to ensure a smooth operational flow, and to identify and correct/mitigate any lack of efficiency for all company processes. - Assisted clients in the implementation of claims best practices, and Light/Modified duty improvements to better suit an injured worker along with the assistance of Medical Providers to make a quicker return to work, with the goal of reducing claims costs. - Trained & assisted staff with our Software systems & programs, as well as teamed with vendors to ensure Entera was taking full advantage of equipment & technologies. - Setup internal procedures for Claims Handling, including multilevel documentation filters for time stamps of all processes to better identify & improve claims handling efficiency. Relevant time reporting included date/time of Injury, date/time of injury notification, date/time of claim reporting to Entera, time/date of claim setup, date/time of claim assignment, date/time of claim reporting to carrier, & date/time of first Response from Claims Adjuster. - Set up call reports to ensure that all calls were being answered and returned. Also, these reports were used for documentation of claims handling for "he said, she said" legal disputes regarding litigated claims. - Developed a Litigation Claims Report for Entera Attorney Meetings. I exported information from our Claims System into Excel, then created a Mail Merge Word Document to customize a claim "One Sheet" for each individual claim by Attorney. This creation improved the effectiveness of the Attorney meetings, and helped to hold all parties accountable for goals and expectations set for the follow-up meetings. - Created a Claims Monthly Reporting Statistics program using Excel to import information from the Carrier, export certain information using set parameters, to allow for a 1 page summary of Claims information comparing each month to the prior month, to track progress of Closure rates, changes in Collateral, Paid dollars, Reserved Dollars and Total Incured dollars. * Claims Manager & Medical Only Claims Handler - Directly involved with Entera's ASO (Administrative Service Organization) & MCO (Managed Care Organization) analyzing & monitoring claims, assisting the claims personnel in addition to assisting the Carrier's TPA with hands-on, common sense claims handling. - Implemented and Customized Claims Software System for Client/Carrier use to better track & analyze claims day to day. following State Regulations. This was used for immediate claim reporting by the injured workers. Assisted & Approved the Nurse Case Manager for treatment of injured workers to better reduce costs of claims using a common sense approach. - Customized System reports to Micro Manage Employee's system & claim access to track & ensure that all claims were being worked timely. This helped improve our claims monthly closure rate from 75-100% to 150-240%.
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