Pauline Mathews 3230 West Lincoln Avenue Apt. 225 Anaheim, CA 92801

(626) 789-4047

Paulinem808@yahoo.com

EDUCATION/CERTIFICATIONS: Self- Insurance Administrator’s Examination Carson, CA Certified as of April 20, 2016

University of Phoenix Pasadena, CA College GPA 3.79 of 4.0

-Bachelors of Science in Health Administration with a Concentration in Health Management March 2014 Graduate -Associates program in the Art of Business Administration March 2012 Graduate

High School Diploma Irwindale, CA June 2003 Graduate

OTHER TRAINING/SKILLS:

Bilingual (Spanish/English) Proficient in Microsoft Office: Excel, Power Point & Publisher

Risk Management, Assessment, Analysis, Limit Liability Work well in a fast pace environment

New/Existing Business Development Highly Organized

Leadership Development Skilled Multi-Tasker

Team Leadership Excellent Communicator

Business Strategy Professional Level Writing Facility Development, Assessment, Management Conflict Resolution and Facilitation

Task Analysis

Health Care Systems Health Care Professional

SPECIALTY SKILL COURSES:

Health Care Quality Management and Outcomes Analysis, Health Care Management, Facility Planning, Regulation and Compliance in Health Care, Health Administration, Leadership and Performance Development, Health Care Policy Health Care Ethics and Social

Responsibility, Health Care Information Systems, Health Care Consumer -Trends and Marketing, Health Care Financial Accounting,

Economics: The Financing of Health Care, Health Care Research Utilization, Public and Community Health, Foundations of Personal Finance, Foundations of Business, Business Information Systems, Organizational Ethics and Social Responsibility, Health Care

Delivery in the U.S., Health Care Communication Strategies,

WORK HISTORY:

Keenan & Associates

August 2016 – Present

Senior Claims Examiner

Managing claims tasks include but not limited to: Determine compensability of claim, documenting all medical reporting and activity of claim, monitoring appropriate treatment, issue benefits, conduct quarterly file reviews,

disputing inappropriate treatment and billing, bill payment, navigation of medical network programming, retaining defense attorneys, managing actions taken by defense, developing creative ways to settle claims, work

with client to ensure fast and appropriate return to work programs, completing all benefit and determination

notices, working with physicians to develop strategies for claimants treatment, work status progress, inquiring on MMI & P&S status in timely manner, litigation/ resolution of liens and maintain all timeline requirements.

Sedgwick CMS

July 2014 – Present

Self-Insured Policy Certified Claims Examiner

Managing claims tasks include but not limited to: Determine compensability of claim, documenting all medical reporting and activity of claim, monitoring appropriate treatment, issue benefits, conduct monthly file reviews,

disputing inappropriate treatment and billing, bill payment, navigation of medical network programming,

retaining defense attorneys, managing actions taken by defense, developing creative ways to settle claims, work with client to ensure fast and appropriate return to work programs, completing all benefit and determination

notices, working with physicians to develop strategies for claimants treatment, work status progress, inquiring

on MMI & P&S status in timely manner, litigation/ resolution of liens and maintain all timeline requirements.

Achievements: SIP certified, Completed IAP examiner training, maintained extensive amount and variety of

training, placed #1 in quarterly settlement’s for March 2016, maintained an average of 90%-100% in audit scoring since date of hire, acknowledged for meeting and over achieving timeline requirements since date of

hire on a regular basis and maintained excellent scores for performance reviews.

Kabbalah Children’s Academy

January 2007 – July 2014

Business Office Director/Worker’s Compensation Liaison

Business Management Director tasks included but not limited to: Accounting management with reporting, data

analysis, developing money saving programs (expenses and income), and budget analysis.

Risk Management duties included but not limited to: Liability assessments, Risk assessments, Designed

programs to limit workers compensation risks, structured risk procedures to limit liability and developed

emergency preparedness programs to limit risks.

Human Resource onsite representative tasks including but not limited to: Payroll, worker’s compensation

relations (reporting injuries, monitoring injury reports, work status and follow up visits) hiring and health insurance program relations (knowledge of all programs and assistance with enrollment periods).

Manager of all aspects of maintenance department.

Mission Care and Rehabilitation Skilled Nursing Facility

March 2006 – December 2006

Administrative Assistant

Conducted daily office tasks in a fast pace environment

Assisted the Human Resource tasks such as payroll and paperwork for worker’s compensation injuries

Assisted with Medical Records billing data entry

Assisted Marketing office with developing advertisement ideas, facility tours, developing ideas to enhance the

facility quality and developed innovative ways to raise amount of patient transfers

Conducted marketing tours of other facilities to gain clientele and expand relations

Central supply coordinator

Sunrise at San Marino Senior Living Facility

December 2005 – March 2006

Receptionist

Assisting Human Resources and the Marketing departments with daily tasks

Conducted facility tours

Provided excellent customer service to families and residence

Conducted every day office tasks

All County Courier

October 2004 – April 2005

Customer Service Representative

Call center atmosphere

Maintained client files

Data base entry

Ran traces on packages

Assisting dispatch and sorting department

Eagle Glenn Veterinarian Clinic

March 2004 – October 2004

Kennel Assistant / Receptionist

Maintained client files

ran everyday office tasks

Data base entry

Managed payment system and past due collections of accounts

Supply coordinator

Kennel assistant tasks included but not limited to: administering medications, assisting during surgeries,

patient care pre & post op