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4-19-06
Krista Ortega
14931 Crimson Trail
Houston Texas 77084
Phone (713) 825-9870
Email: mkortega2@yahoo.com
OBJECTIVE:
Customer service oriented with 8 plus years of specialized experience
in the Texas Workers Compensation Claims Handling. Dedicated to
providing excellent customer service in claims handling. I have
superior record of surpassing expectations of quality and claims
handling. I keep up to date with the law changes to best serve the customers.
SKILLS:
Typing 55 WPM 10-Key By Touch
Microsoft Word Lotus Notes
Excel Word Perfect
Detailed Oriented Excellent Computer Skills
Good Trainer Hard Worker
Excellent Customer Service Skills Flexible
Lost Time Claims Handling Team Player
Needs Little To No Supervision Critical Thinking
Information Gathering Excellent Organizational Skills
Team Leader Experience Problem Identification/Solver
Medical Terminology BRC Handling
Litigation Management Medical Management File Handling
Investigation Of Claims CCH Testifying
Scheduled Benefits Occupational Accident Policy
WORK HISTORY:
01/06 to 4/06 Adjuster Workers Compensation (Tribal Ordinance)
AS & G Claims Administration Inc.
Investigated and determined the compensability of Workers’
Compensation under the tribal ordinance for the state of California.
Reviewed and pay all benefits as they accrue in the accordance with
the Ordinance and the California Workers’ Compensation Guides.
Worked closely with various attorney representatives in preparing the
files for Mandatory Settlement Conferences and settlement of the
claim. Referred the file for investigation, peer reviews and 2nd
opinion evaluations as it was deemed the appropriate time in the
file. Completed and maintained 3-point contact with injured workers,
insured and treating doctor. Worked closely with nurse case manager
to ensure an early return to work.
01/05 to 4/05 Adjuster Workers Compensation & Occupational Disability
US Specialty Insurance Company
Investigate and determine compensability of Workers’
Compensation and Occupational Injuries of various states. Aggressive
claim handling. Review and pay all benefits as they accrue in
accordance with the Act or the disability policy. Work closely with
Attorney’s representative in preparing files for Benefit Review
Conferences, Contested Case Hearings, and SOAH and court hearings.
Refer files for investigation, peer review, RME’s and designated
doctor appointments when it was deemed the appropriate time in the
file. Completed and maintained 3-point contact with injured workers,
insured and treating doctor. Worked closely with nurse case manager
to ensure an early return to work.
08/01 to 09/04 Adjuster IV Workers Compensation
Crawford & Company
Investigated and determine compensability and extent of Texas
Workers’ Compensation claims. Aggressive claim handling. Review
and pay all benefits as they accrue in accordance with the Act. Work
closely with Attorney’s representative in preparing files for
Benefit Review Conferences, Contested Case Hearings and SOAH. Refer
files for investigation, peer review, RME’s and designated
doctor appointments when it was deemed the appropriate time in the
file. Completed and maintained 3-point contact with injured workers,
insured and treating doctor. Completed status reports as required by
the client instructions and company standards. Worked closely with
nurse case manager to ensure an early return to work. Helped train
new employees on the computer system and the company standards
regarding claim-handling requirements. Coordinated continued
education classes for all employees. Prepared files for audit when
required. I attended and handled file reviews as required per client
instructions. Interacted with the Carrier and the insured on the file
handling requirements.
06/00 to 08/01 Sr. Adjuster Workers Compensation
Cambridge Integrated Services
Investigated and determined compensability of Workers’
Compensation claims. Aggressive claim handling. Review and pay all
benefits as they accrue in accordance with the Act. Worked closely
with Attorney’s representative in preparing files for Benefit
Review Conferences, Contested Case Hearings. Referred files for
investigation, peer review, RME’s and designated doctor
appointments as deemed reasonable and appropriate time in the file.
Completed and maintained 3-point contact with injured workers,
insured and treating doctor. Completed status reports as required by
the client instructions and company standards. Worked closely with
nurse case manager to ensure an early return to work. Helped train
new employees on the computer system and the company standards
regarding claims handling requirements. Prepared files for audit when
required. Attended and handled file reviews as required per client
instructions. Interacted with the Carrier and the insured on the file
handling requirements.
06/99 to 06/00 Sr. Adjuster Workers Compensation
RSKco
Investigated and determined compensability of Workers’
Compensation claims. Aggressive claim handling. Review and pay all
benefits as they accrue in accordance with the Act. Worked closely
with Attorney’s representative in preparing files for Benefit
Review Conferences, Contested Case Hearings. Referred files for
investigation, peer review, RME’s and designated doctor
appointments as deemed reasonable and appropriate time in the file.
Completed and maintained 3-point contact with injured workers,
insured and treating doctor. Completed status reports as required by
the client instructions and company standards. Worked closely with
nurse case manager to ensure an early return to work. Prepared files
for audit when required.Attended and handled file reviews as required
per client instructions. Interacted with the Carrier and the insured
on the file handling requirements.
01/96 to 06/99 Adjuster Workers Compensation
Cambridge Integrated Services
Investigated and determined compensability of Workers’
Compensation claims. Work the claim aggressively until file is
closed. Review and pay all benefits as they accrue in accordance with
the Act. Worked closely with Attorney’s representative in
preparing files for Benefit Review Conferences, Contested Case
Hearings. Referred files for investigation, peer review, RME’s
and designated doctor appointments as deemed reasonable and
appropriate time in the file. Completed and maintained 3-point
contact with injured workers, insured and treating doctor. Completed
status reports as required by the client instructions and company
standards. Worked closely with nurse case manager to ensure an early
return to work. Helped train new employees on the computer system and
the company standards regarding claims handling requirements.
Prepared files for audit when required. Attended and handled file
reviews as required per client instructions. Interacted with the
Carrier and the insured on the file handling requirements.
EDUCATION:
1996 Leonard’s School Of Adjuster, Workers’ Compensation
1988 Mansfield Business School, Data Entry
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