Managing 150 Illinois, and Minnesota claims. • Facilitates communication between all claims parties to ensure high quality customer service• Implementing cost-savings opportunities by coordinating care with vendors and in-network providers • Completing thorough, 3-tiered investigations of new claims to determine compensability• Reviews claim details and evaluates claim reserves to reflect life exposure• Negotiating settlement with plaintiff attorneys or working with defense attorneys to successfully settle litigated claims• Participates in internal roundtable discussion with management to proactively review legacy claims and high exposure files• Maintains frequent communication of claim exposure and progression towards resolution with client • Actively participates in quarterly and bi-annual file reviews • Making determinations on whether claims are compensable under Workers Compensation Statutes or denied.• Managing medical treatment through Maximum Medical Improvement (MMI), including authorizing necessary and appropriate treatment, whether conservative or invasive. Guaranteeing all appropriate benefits and payments are issued timely.Manage any state form filing or communication with the state through resolution of the claim. Ensure benefits are issued timely per state statute requirements.

Managing 170 Illinois, Wisconsin, Indiana, Minnesota, Michigan, Missouri, Nebraska and Iowa claims. • Facilitates communication between all claims parties to ensure high quality customer service• Implementing cost-savings opportunities by coordinating care with vendors and in-network providers • Completing thorough, 3-tiered investigations of new claims to determine compensability• Reviews claim details and evaluates claim reserves to reflect life exposure• Negotiating settlement with plaintiff attorneys or working with defense attorneys to successfully settle litigated claims• Participates in internal roundtable discussion with management to proactively review legacy claims and high exposure files• Maintains frequent communication of claim exposure and progression towards resolution with client • Actively participates in quarterly and bi-annual file reviews • Making determinations on whether claims are compensable under Workers Compensation Statutes or denied.• Managing medical treatment through Maximum Medical Improvement (MMI), including authorizing necessary and appropriate treatment, whether conservative or invasive. Guaranteeing all appropriate benefits and payments are issued timely.

-Posted payments from EOB's by insurance carriers including Illinois and Iowa Medicaid Payers-Billing all primary and secondary insurance claims in a timely and accurate manner, demonstrating the working knowledge of all appropriate billing forms, ub04, 1500 or state specified forms, utilizing the electronic billing systems.-Demonstrating a working knowledge of federal, state, local and intermediary specific billing requirements to ensure appropriate authorizations are completed and/or notifies appropriate person of missing or incomplete billing requirements and following up in a timely manner.-Auditing each bill for charges, duplications and overlapped accounts before billing, making any necessary adjustments and documenting appropriately.-Maintaining and securing medical documentation to support claims or appeals as necessary.-Resolving the claim errors on the billing system in a timely manner by reviewing claim error reports and taking appropriate action.-Followed-up on all unpaid insurance claims with insurance companies and state Medicaid Departments -Ensuring all payors are processing according to contracts, negotiating all non-par agreements and working with the collection agency on past due accounts.-Communicating with insurance companies to check the status of medical claims and to ensure timely reimbursement.-Reviewing the explanation of benefits and making necessary corrections on the claims and resubmit for processing.-Preparing and submitting appeal letters for underpayments or denied claims-Following-up with insurance companies to check on appeal status of claims-Investigating all overdue or aged balances to resolve and receive payment due-Completing write-offs on balances that are unable to be resolved through payment to balance our accounts for each resident-Managing billing for 6 separate facilities in two states

Managed, tracked and resolved overdue account balances– Provided excellent customer service while resolving patient complaints– Implemented new paperless patient functions and patient verifications– Effectively managed secretarial duties including scheduling appointments and answering telephone calls– Maintained all office billing and collections. Proficient with healthcare reimbursement practices.– Explained and communicated best standard of treatment according to doctor’s diagnoses– Arranged financial agreements and scheduled restorative treatments for patients– Performed basic accounting functions including cash reconciliation– Reviewed monthly and daily sales, patient satisfaction, and budget reports– Communicated, and filed claims with insurance companies including Medicare and supplement plans

ESIS, Inc. is a division of Chubb Limited, the world's largest publicly traded property and casualty insurer. ESIS, a risk management company, is a third party administrator handling both Workers Compensation and Auto-General Liability claims. As a Claims Representative, my daily responsibilities include:• Managing 220 Illinois and Wisconsin Claims for 15 national accounts, including 120 claims for one client • Facilitates communication between all claims parties to ensure high quality customer service• Implementing cost-savings opportunities by coordinating care with vendors and in-network providers • Completing thorough, 3-tiered investigations of new claims to determine compensability• Reviews claim details and evaluates claim reserves to reflect life exposure• Negotiating settlement with plaintiff attorneys or working with defense attorneys to successfully settle litigated claims• Participates in internal roundtable discussion with management to proactively review legacy claims and high exposure files• Maintains frequent communication of claim exposure and progression towards resolution with client • Actively participates in quarterly and bi-annual file reviews (14 per year)• Making determinations on whether claims are compensable under the Illinois or Wisconsin Workers Compensation Statutes or denied.• Managing medical treatment through Maximum Medical Improvement (MMI), including authorizing necessary and appropriate treatment, whether conservative or invasive. Guaranteeing all appropriate benefits and payments are issued timely.

• Oversaw all operational responsibilities throughout the store – yearly inspections, environmental regulations, OHSA standards• Managed all outbound and incoming bi weekly freight shipments – Implemented a system to process freight trucks within 48 hours, as well as improved store-wide OMNI sales by a 117% year to date comp• Managed Children’s, Footwear, and Home departments by analyzing sales reports to recognize opportunities, to running monthly updates to merchandising• Shared HR responsibilities within the store – hiring, approval of scheduling, and counseling• Responsible for managing 108+ associates on a daily basis • Implemented a new order fulfillment process and responsible for 117% increase in orders• Introduced a receiving program for our merchandise shipment resulting in a 4.2% increase in accuracy of our inventory• Assisted with HR responsibilities throughout the store that included, but not limited to, development, talent acquisition, payroll control, and administering policies

• Supported the store management team by engaging in day – to – day operations, as well as supervising all store associates• Created credit incentive program with store associates to improve credit deficit from 16% to 10% within 8 weeks• Analyzed and interpreted store forecasting reports to increase sales potential in opportunity departmentsHandled cash register and manage incoming and outgoing cash.Recorded financial transactions and perform account reconciliations.I ensured fast financial transactions to minimize long register lines.I adhered to store policies and procedures for operational efficiency.I stocked and replenished merchandise according to store merchandising layouts.I regularly solved customer problems with negotiating and creative solutions.I ensured superior customer experience by addressing customer concerns, demonstrating empathy and resolving problems on the spot.

• Implemented break schedules, and oversaw shift duties• Assisted guests with returns, credit applications, online orders, problems, and everyday needs• Encouraged team members with incentive programs for selling our services and productsHandled cash register and manage incoming and outgoing cash.Recorded financial transactions and perform account reconciliations.I ensured fast financial transactions to minimize long register lines.I adhered to store policies and procedures for operational efficiency.I stocked and replenished merchandise according to store merchandising layouts.I regularly solved customer problems with negotiating and creative solutions.I ensured superior customer experience by addressing customer concerns, demonstrating empathy and resolving problems on the spot.

-I prepared food for daily sales, catering and customer orders. -I accompanied the kitchen team delivering food to various clients. -I cleaned the kitchen and reorganize for the next day. -I prepared food safely and on time. -I provided prompt, efficient and friendly customer service. -I prepared a variety of foods, such as meats, vegetables, desserts, according to customers' orders or supervisors' instructions, following approved procedures.. -I washed dishes to provide customers with clean utensils and plates handled food sales. -I learned the importance of teamwork, communication and problem-solving in a fast-paced environment. -I took and recorded temperature of food and food storage areas such as refrigerators and freezers. -I washed, peeled, and cut various foods, such as fruits and vegetables, to prepare for cooking or serving. -I had to stock shelves and keep everything clean. -I took phone calls and recorded customer orders or requests. -I took customers payments for food or items they were purchasing. -I processed cash and credit payments rapidly and accurately. -I handled cash register and manage incoming and outgoing cash. I recorded financial transactions and perform account reconciliations.