Cindy Ritter Email and Phone Number

Essential Duties & Responsibilities:• Review, examine, analyze and investigate workers compensation claims• Adjust claims according to state specific statutes and regulations• Communicate with injured workers to educate them on the workers compensation processand requirements• Establish claim reserves• Prepare and issue mandated requirements and documents• Coordinate medical treatment for injured workers• Identify cases with subrogation potential and pursue reimbursement• Act as a liaison between the injured worker, legal counsel and medical providers• Review and interpret medical reports• Attend hearings, trials and claim reviews• Process indemnity payments• Audit and approve charges related to a workers compensation claim file• Manage litigation and settlements on a claim file• Maintain appropriate licenses and certifications• Perform other duties or special projects as assigned• Participate in departmental, company and team meetings as neededReasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

PRIMARY PURPOSE : To analyze mid- and higher-level workers compensation claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to identify subrogation of claims and negotiate settlements. ESSENTIAL FUNCTIONS and RESPONSIBILITIES Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.Approves and processes assigned claims, determines benefits due, and manages action plan pursuant to the claim or client contract.Manages subrogation of claims and negotiates settlements.Communicates claim action with claimant and client.Ensures claim files are properly documented and claims coding is correct.May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.Maintains professional client relationships.

Specialize in supplying goods and services to customers. Working with customers to find what they want, create solutions and ensure a smooth sales process. Initiate the process in finding new sales leads, through business directories, client referrals and events.

Responsible for ongoing outreach and communication with existing and possible new speaker/sponsor organizations. An articulate communicator who is comfortable engaging potential customers by phone, as well as seasoned in heavy email, Linkedin and other networking technology, and Constant Contacat communication. Understands marketing concepts and “why” someone would be interested in scheduling or presenting/sponsoring a program and how each fits within the insurance or healthcare industry. Creatively able to introduce new idea and has insurance or healthcare background.

Performs administrative and office support activities for multiple supervisors. Duties may include fielding telephone calls, receiving and directing visitors, word processing, creating spreadsheets and presentations, filing, and faxing. Extensive software skills are required, as well as Internet research abilities and strong communication skills. Staff in this category also may have the title of department assistant, coordinator or associate.

Identify and complete daily tasks to address pertinent issues and bring resolution to the claim under supervision of nurse case manager: Case Managed medical only files under the direction of a licensed Nurse,Schedule medical appointments and referrals, Coordinate ancillary services (Transportation, Translation, DME, Diagnostics), Create, edit and/or revise correspondence to all associated parties, Data entry of case notes with attached documentation, Communicate medical concepts to injured workers using layman’s terms to facilitate understanding.Document file and track using paperless computerized systems, Developed and implemented a Quality Assurance Initiative to monitor prescribed physical therapy against third party guidelines: Outlined a Course of Action for all AmeriSys case managers to prompt Return to Work and demonstrate effective cost savings,Created form to capture results.Presented the plan to QA committee and assisted with the implementation program approved by ACHA for 2010 and achieved a cost savings of 21,126.90 for the first half of 2010

Complete daily tasks necessary for medical management of workers compensation claims under the supervision and direction of nurse case manager: Data entry of Notices of Injury, Complete initial 3 Point contact, send out appropriate notifications & authorizations, Arrange and schedule medical appointments, Coordinate ancillary services ( Transportation, Translation,DME, Diagnostics), Document all activity in computer

Office Staff: Cashier; In charge of all money balancing for the stores volume each day; coordinated the cashier and baggers on the front end to ensure customers were taken care of; Scheduling; Payroll: Editing Employee punches, Ensuring correct pay rates Customer Service CounterStock Clerk: Inventories, Ordering, Stocking Deli Clerk: Handling of perishable foods, slicing, packaging, cookingTag/Sign Clerk: Changed out store price tag for weekly changes; made computerized signs for items on end capsReceiving Clerk: Checked in merchandise from vendorsBakery Clerk: Customer service