Claudia Martin
El Cajon
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
16
16
years of professional experience
Work History
OHS Claims Case Coordinator (QBS 1 Spanish)
Kaiser Permanente On The Job
01.2019 - Current
- Completed various administrative tasks such as making phone calls, answering emails and inputting data into systems.
- Maintained current knowledge of applicable procedures and compliance requirements to optimize effectiveness.
- Discussed cases with clients, providers and staff.
- Documented each patients' activity in program-specific databases.
- Administered patient follow-up, data collection, clinical monitoring and coordination with primary health care providers.
- Coordinated multiple facets of process without sacrificing performance.
- Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.
- Provided leadership, guidance and support to staff members.
- Researched best practices and developed strategies to improve program outcomes.
- Initiates case management for complex workers' compensation cases including the development and monitoring of a case management plan.
- • Acts as a liaison between employees, employers and medical staff to coordinate care, appointments, referrals/consult authorization, and communicates work restrictions, extended time off and the need for further treatment.
- • Monitors patients who present with complex workers' compensation issues and consults with employers, patients and medical staff to facilitate returning the patient to usual and customary duties or to assist in initiating the rehabilitation process.
- Manages OHS data from multiple sources which support case management, utilization patterns, practice guidelines and employer data. • Contributes to the patient and staff education concerning the workers' compensation system.
- Interviews and counsels patients/families concerning workers' compensation, home environment, safety, availability of support networks, community facilities/resources and supplemental benefits.
- Facilitates and promotes the identification of broad-based employer, employee, carrier and medical staff issues which are then referred to the OHS team for service improvement opportunities or activities.
OHS Claims Processor 1(QBS Level 1 Spanish)
Kaiser Permanente On The Job
06.2015 - 01.2019
- Utilized specialized software to process incoming claims, enter data and generate reports.
- Complied with regulations and guidelines related to claims processing to maintain quality and adherence to standards.
- Assisted in onboarding of new claims processors to familiarize with company procedures, policies and processes.
- Managed workload and priorities to meet claims processing meet deadlines.
- Utilized excellent analytical and problem-solving skills to quickly and accurately assess insurance claims.
- Followed up with customers on unresolved issues.
- Developed and implemented quality assurance processes to check accuracy of claims processing.
- Established positive and trusting relationships with injured clients, administering efficient customer service and processing claims quickly.
- Responded to customer inquiries, providing detailed explanations of insurance policies and claims processes.
- Checked documentation for accuracy and validity on updated systems.
- Maintained strong knowledge of basic medical terminology to better understand services and procedures.
- Maintained confidentiality of patient finances, records, and health statuses.
- Carried out administrative tasks by communicating with clients, distributing mail, and scanning documents.
- Resubmitted claims after editing or denial to achieve financial targets and reduce outstanding debt.
- Communicated effectively with staff members of operations, finance and clinical departments.
- Generated, posted and attached information to claim files.
- Calculated adjustments, premiums and refunds.
- Determined appropriateness of payers to protect organization and minimize risk.
- Posted payments to accounts and maintained records.
- Assured timely verification of insurance benefits prior to patient procedures or appointments.
- Made contact with insurance carriers to discuss policies and individual patient benefits.
- Collected premiums and issued accurate receipts.
Customer Service Representative
E & L Associates Physical Therapy
02.2007 - 06.2015
- Handled customer inquiries and suggestions courteously and professionally.
- Actively listened to customers, handled concerns quickly and escalated major issues to supervisor.
- Answered constant flow of customer calls with minimal wait times.
- Updated account information to maintain customer records.
- Maintained customer satisfaction with forward-thinking strategies focused on addressing customer needs and resolving concerns.
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Responded to customer requests for products, services, and company information.
- Clarified customer issues and determined root cause of problems to resolve product or service complaints.
- Participated in team meetings and training sessions to stay informed about product updates and changes.
- Delivered exceptional customer service to every customer by leveraging extensive knowledge of products and services and creating welcoming, positive experiences.
- Investigated and resolved customer inquiries and complaints quickly.
- Exhibited high energy and professionalism when dealing with clients and staff.
- Met customer call guidelines for service levels, handle time and productivity.
- Responded to customer requests, offering excellent support and tailored recommendations to address needs.
- Maintained up-to-date knowledge of product and service changes.
- Followed up with customers about resolved issues to maintain high standards of customer service.
- Educated customers about billing, payment processing and support policies and procedures.
- Promoted superior experience by addressing customer concerns, demonstrating empathy, and resolving problems swiftly.
- Developed highly empathetic client relationships and earned reputation for exceeding service standard goals.
- Collaborated with staff members to enhance customer service experience and exceed team goals through effective client satisfaction rates.
- Promptly responded to inquiries and requests from prospective customers.
- Trained new personnel regarding company operations, policies and services.
- Calculated correct order totals, updated accounts, and maintained detailed records for inventory management.
- Developed and updated databases to handle customer data.
- Monitored cash drawers in multiple checkout stations and maintained adequate cash supply.
- Enhanced productivity levels by anticipating needs and delivering outstanding support.
- Cross-trained and provided backup support for organizational leadership.
- Trained staff on operating procedures and company services.
- Investigated and resolved accounting, service and delivery concerns.
- Maintained clean and orderly checkout areas by mopping floors, emptying trash cans and wiping down surfaces.
- Increased efficiency and performance by monitoring team member productivity and providing feedback.
- Gained customer trust by providing knowledgeable and accurate information in both English and Spanish.
- Assisted customers with Spanish-language inquiries in a timely and professional manner.
- Operated cash register for cash, check, and credit card transactions with excellent accuracy levels.
- Worked flexible schedule and extra shifts to meet business needs.
- Welcomed customers and helped determine their needs.
- Counted money in cash drawers at beginning and end of shifts to maintain accuracy.
- Assisted customers with returns, refunds and resolving transaction issues.
Education
High School Diploma -
Vincent Memorial High Scool
Calexico, CA06.1988
Skills
- CPDm1 Certified in Disability Management
- Complex Problem-Solving
- Data Collection
- Case Support
- Customer Experience
- Critical Thinking
- Case Coordination
- Generate Reports
- Creative Solutions
- Patient Care Understanding
- Client Satisfaction
- Treatment Options
- Case Notes
- Service Quality
- Excellent Communication Abilities
- Research
- Customer Relationship Management
- Administrative Leadership
- Customer Inquiries
- Team Meetings
- Electronic Charting
Languages
Spanish
Professional Working
Timeline
OHS Claims Case Coordinator (QBS 1 Spanish)
Kaiser Permanente On The Job
01.2019 - Current
OHS Claims Processor 1(QBS Level 1 Spanish)
Kaiser Permanente On The Job
06.2015 - 01.2019
Customer Service Representative
E & L Associates Physical Therapy
02.2007 - 06.2015
High School Diploma -
Vincent Memorial High Scool
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