Carmen Gaines Email and Phone Number

• Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to adisability plan•Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operativereports, etc.)•To determine if the claimant is disabled as defined by the disability plan• Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-houseclinicians)• Communicates with the claimants providers to set expectations… Show more • Analyzes, approves and authorizes assigned claims and determines benefits due pursuant to adisability plan•Reviews and analyzes complex medical information (i.e. diagnostic tests, office notes, operativereports, etc.)•To determine if the claimant is disabled as defined by the disability plan• Utilizes the appropriate clinical resources in case assessment (i.e. duration guidelines, in-houseclinicians)• Communicates with the claimants providers to set expectations regarding return to work Show less

• Researches federal and/or state statutes, recorded judicial decisions and other legal sources and reference materials in order to prepare responses to inquiries, complaints, claims and legal and/or administrative procedural issues to assist section attorneys• Performs Internet and other computer-assisted searches for information and documents• Assists in the preparation and presentation of cases in litigation, including document review, verification and organization• Helps prepare… Show more • Researches federal and/or state statutes, recorded judicial decisions and other legal sources and reference materials in order to prepare responses to inquiries, complaints, claims and legal and/or administrative procedural issues to assist section attorneys• Performs Internet and other computer-assisted searches for information and documents• Assists in the preparation and presentation of cases in litigation, including document review, verification and organization• Helps prepare and respond to discovery requests and public records requests• Contacts opposing counsel or court/board personnel as may be necessary to assist in case preparation and presentation of cases• Assesses, logs and indexes incoming and outgoing electronic and paper document productions• Uses document management software to prepare legal correspondence; uses case management software• Drafts legal briefs and memoranda, contracts, pleadings, motions, affidavits, legislation, rules and/or regulations• Prepares case summaries, legal documents and reports for review, approval and signature of and/or use by section attorneys• Maintains case calendars and case files• Manually and/or electronically files legal documents with court on behalf of attorneys• Responds to general inquiries• Processes and tracks payments and wire transfers• Tracks judgements, consent order, and related information for reporting purposes Show less

• To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary• Processes workers compensation claims determining compensability and benefits due;… Show more • To analyze reported lower-level workers compensation claims to determine benefits due; and to ensure ongoing adjudication of claims within company standards and industry best practices• Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision• Supports other claims representatives, examiners and leads with larger or more complex claims as necessary• Processes workers compensation claims determining compensability and benefits due; monitors reserve accuracy, and files necessary documentation with state agency• Communicates claim action/processing with claimant, client and appropriate medical contact• Ensures claim files are properly documented and claims coding is correct• Process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims• Maintains professional client relationships• Performs other duties as assigned Show less