Michele Castle Email and Phone Number

• Accurately and timely inspects vehicles and writes estimates, documents claim related information appropriately, and makes decisions consistent with claims standards and local laws.• Proactively provide customers with information and updates about the repair process.• Setting clear and accurate expectations regarding repair duration, estimate detail, repair outcomes and financial obligation.• Completes estimates timely, updates PD suite appropriately and meets productivity goals.• Identifies related and unrelated prior damage.• Evaluates and executes payments of claims and resolution of claims without payments.• Makes total loss determination and establishes total loss evaluation.• Reviews and assesses validity of all supplemental requests.

Determine coverage and liability.• Negotiate settlement with claimants and issue payments.• Refer appropriate claims to subrogation.• Settle claims and set reserves.• Estimates the cost of treatment or compensation for those injured in accidents.• Obtains medical and wage authorizations in order to obtain medical records and bills to evaluate personal injury claims.• Analyze and interpret medical reports, follow up with no fault parties, and manage the claim process to ensure efficient resolution.• Interviews, collect and document information from various people such as insured, claimants, agents, attorneys, police and witnesses.

• Determine home insurance coverage and interprets insureds' policies, forms in force, and other records.• Use varying methods of investigation, including taking recorded statements, consulting with police, inspecting property damage and reviewing documents.• Conduct damage analysis of property claims.• Identifies and communicates potential underwriting concerns, SIU involvement and subrogation.• Set appropriate case reserves to cover probable costs.• Estimates the cost of repair, replacement or compensation.• Approves and adjusts estimates of damage and loss amounts.• Submit assignments to vendors.• Prepares settlement letters, denial letters, Reservation of Rights, and other letters as needed.• Write clear and concise diary notes, uses the special handling area, sets field assignment, sets and saves contacts and makes payments.• Appropriately applies knowledge of multiple state statutes, including the insurance code of ethics, rules, regulations and guidelines.• Determine whether a file has a valid Assignment of Benefits and handles accordingly• Effectively handles difficult calls from customers, vendors and others.

• Accurately and timely inspects vehicle and writes estimate, documents claim related information appropriately, and makes decisions consistent with claims standards and local laws.• Proactively provide customers with information and updates about the repair process.• Setting clear and accurate expectations regarding repair duration, estimate detail, repair outcomes and financial obligation.• Develops and maintains relationships with shop owners, managers and technicians.• Completes estimate timely, updates PD Suite appropriately and meets productivity goals.• Identifies related and unrelated prior damage.• Evaluates and executes payments of claims and resolution of claims without payments.• Makes total loss determination and establishes total loss evaluation.• Reviews and assesses validity of all supplemental requests

• Determine liability by independently making decisions.• Interview customers, claimants, and witnesses (recorded).• Partner with appraisers and estimators to manage vehicle repairs.• Negotiate with customers and other insurance carriers.• Resolve and document auto claims as quickly and accurately as possible.• Manage a high volume of claim files from beginning to end.• Validate damage is consistent with the report of accident.

• Identify patients for inclusion in the program utilizing available metrics.• Perform comprehensive patient assessments upon entry to service and periodically to include an assessment of patient and family support system and needs.• Develop and implement individualized patient care plans (that is goal driven) with a focus on disease management and patient empowerment.• Assist patients and family with navigation of their health care system.• Monitor care plans and patients’ progress to goal achievement; revise plans as necessary providing education and support as appropriate.• Assist patients and family to access available community resources as appropriate.• Maintain contact with patients and family through transitions of care while coordinating with other care team members.• Participate as an active member of the patient's care team collaborating with patient, family, providers, site staff and other care partners.• Identify and reduce barriers to care utilizing organization and community resources as appropriate.• Document all encounters and patient related discussions, telephonic or in-person, in the patient medical record per organization.• Assess and present key data to the management team while maintaining accurate records regarding case load, stratification, and frequency of contact.• Develop a listing of community resources and programs on a monthly basis.• Conduct clinic visits, rehabilitation visits and hospital visits as appropriate, following establishes guidelines, policies and procedures.• Participate in departmental, site and other meetings as assigned; Support the goals and mission of MCRHS, Inc.• Adhere to safety policies and procedures, maintain a clean, clutter free and well-organized workspace.• Participate in community functions as appropriate and promote the concepts of “Patients First and “Patient Centered Medical Home”.•Maintained a caseload consistent with program guidelines; and maintain accurate travel documentation

• Conducts ‘Prep’ for clinic or department including the compilation of patient data and or documentation.• Follows up on errors and offers contributions and suggestions to improve current methods.Contributes innovative ideas to improve work practices and flow.• Answer 6 multi-line telephone and direct calls to appropriate staff; records and relay messages when staff is unavailable.• Perform registration routine duties such as scheduling 30 to 40 appointments per day, order entry, filing, data entry, correspondence as well as sort and distribute mail.• Upload documents, documenting in multiple Electronic Health Records and home health.• Train and mentor new employees by providing knowledge about the organization, hospital culture, policies, and procedures needed to assimilate new hires into their role.• Communicate policies, procedures and services to patients, family members and caregivers using administrative knowledge, customer focus, and interpersonal skills. Communicate with PCP andSpecialist daily.• Coordinate communication between patients, family members, care givers, in-patient and out-patient medical and administrative staff.• Respond to the sensitive Privacy Act inquires maintaining security of sensitive patient information. Investigate and direct patient inquiries to appropriate staff to ensure a satisfactory resolution

• Perform initial review and assessment of case information and referral objectives.• Verifies employee’s job title, job description and insurance.• Performs three-point contact to employee, provider and employer/adjuster/insurer.• Communicate with Physician and Therapist to set up medical assessments to develop an overall treatment plan that ensures quality and cost effectiveness of care while meeting state and other regulatory requirements.• Generate and fax, if requested initial or 72hr report, including appropriateness of treatment plan and recommendations.• Document thoroughly all calls and actions into the patient's chart.• Monitor and evaluate therapy for compliance, medical necessity, patient progress and appropriateness of discharge.• Serves as an intermediary to interpret and educate clients on his/her disability and the treatment plan established by the case manager, physician and therapist. Explains instructions and answers any other questions the claimant may have to facilitate his/her return to work.• Provide bi-weekly patient progress reports to employer, adjuster and insurer.• Maintain case load and connect patients with community resources such as transportation, meals on wheels, pharmacy assistance programs and research alternative treatment programs such as pain clinic and home health care.• Achievement of specific measurements criteria such as answer satisfactory level of incoming calls and abide by all policies and standard and operating procedures.• Demonstrate a high level of professionalism when dealing with injured workers.• Audit files, train new employees and proofread their work.

• Maintain the Centrax and Microsoft Access databases, entering information and investigation data.• Direct clients to appropriate staff and maintain good public relations and customer service.• Receive public health complaints and assign investigations to the public health inspector.• Extensive work experience with virtually all Microsoft software and related applications.• Perform duties and prepare all reports using personal computer, typing, copying and mailing for all Supervisors in the department.• Request by Supervisor as trainer and mentor for new employees, attend educational conferences and in service training as well as interdepartmental cross training to become more familiar with investigations and inspections.