Extensive Workers Competency Statement

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11. SUMMARY STATEMENT Under close supervision during classroom or on the job training; once trained under supervision, the Disability Insurance Program Representative

Professional Summary
Highly dedicated and conscientious Workers Compensation Specialist with a proven record of high client satisfaction.
Experienced in obtaining optimal legal outcomes for legitimate injury claims across a wide variety of industries.
Knowledgeable in an array of injury-specific medical options for individual claims cases.
Core Qualifications
Extensive workers' compensation claim management experience
Excellent facility with medical terminology
High skills in handling
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Performed case work duties with disability insurance applicants and receivers including; planning and directing clients through the process of receiving benefits, as well as various insurances and coverages

Excelled with answering telephone inquiries from clients and the public in a call center like environment

Assisted disabled workers from work related injuries receive disability insurance benefits and Workmen's compensation benefits assistance

Extensive experience and expertise with California public assistance programs available and assisted clients with public out-reach affiars and education

Performed basic bilingual communication skills as needed with Spanish speaking clients

Performed all aspects of claims adjudication for first claims by the proper application of law, regulation, policy and procedure based upon the analysis of client and physician supplied medical information

Evaluated clients finances including wage information for income verification accuracy and made timely adjustments correcting financial errors

Investigated and disputed liability claims, including Workmen's Compensation, in a timely, proffesional
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Analyzed policy and medical information to provide clients with timely and accurate eligibility data while notating all necessary findings in a clear, concise manner
Qualified payments and issued disqualifications; elevated calls to management when necessary and referred calls to other offices when appropriate
Perfomed actions in accordance with Disability Insurance (DI) policies and procedures; such as referring customers to other agencies and available resources when appropriate; identified and reported any suspected fraudulent policy activities
Made accurate, timely, adjustments and corrections at the time of initial policy writing and documented all pertinent information in policy notes
Resolved disputes with insurance eligibility issues with clients, including timely notification of the department’s staff to ensure all information was correct and accurate
Gathered and analyzed data and reasoned logically; comprehended written material and interpreted and applied rules and instructions; communicated effectively; analyzed situations accurately and took effective action
Established and maintained cooperative relations with others; and related to members of all ethnic, racial, and disability groups while being sensitive to community group

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