CAROLINE GARCIA
Topton
Summary
Skilled in managing claims processes and conducting detailed reviews to support efficient operations and successful outcomes. Leverages analytical and critical thinking skills to collaborate with diverse stakeholders and ensure accurate claim evaluations. Strong organizational abilities and adaptability contribute to effective problem-solving and decision-making in dynamic environments.
Overview
9
9
years of professional experience
Work History
Workers Compensation
Elevate Patient Financial Solutions
02.2023 - Current
- Applied knowledge of workers compensation regulations and industry standards while conducting reviews.
- Managed workers compensation claims process from reporting through closure.
- Tracked employer contributions such as unemployment insurance premiums or workers compensation insurance payments.
- Consulted with attorneys on malpractice, personal injury and workers compensation claims.
Medical Claims Adjuster
The Loomis Company
12.2021 - 06.2023
- Managed large volume of medical claims on daily basis with ICD-10 and CPT codes.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Resolved complex, severe exposure claims using high service oriented file handling.
- Documented information gathered in field and uploaded data to company database for efficient processing using AS400.
- Evaluated accuracy and quality of data entered into agency management system.
Personal Care Assistant
Tower Health Reading Hospital
10.2017 - 12.2021
- Recorded temperature, blood pressure, pulse, or respiration rate as directed by medical or nursing staff in EPIC charting system.
- Provided safe mobility support to help patients move around personal and public spaces.
- Assisted with ostomy bag, catheterization insertion, EKG, and telemetry.
- Assisted residents in and out of bed and wheelchairs, using safe lifting and transferring techniques.
- Assisted in maintaining a clean, safe environment by following infection control policies and procedures.
Education
High School Diploma - Health Sciences
Reading Area Community College
PASkills
- Claims Evaluations
- Claim Amount Calculations
- Eligibility Determinations
- Organization and Time Management
- Flexible and Adaptable
- Settlement Negotiation
- Health Insurance Industry Knowledge
- Healthcare Terminology
- Analytical and Critical Thinking
Timeline
Workers Compensation
Elevate Patient Financial Solutions
02.2023 - Current
Medical Claims Adjuster
The Loomis Company
12.2021 - 06.2023
Personal Care Assistant
Tower Health Reading Hospital
10.2017 - 12.2021
High School Diploma - Health Sciences
Reading Area Community College