1. Carlos Urrutia
Fairfield, OH
513-704-8186
Email Address: cubgcincy11@yahoo.com
SUMMARY
Accomplishedmedical professional withover10 yearsof medical claims/worker’scompensationand
customerservice experience.
FluentinSpanish.Exceptional attendance andpunctualityrecordthroughoutmycareer.
PROFESSIONAL EXPERIENCE
HealthSpan Incorporated: 2015 to present
Office location: Cincinnati, OH
Senior Account Specialist (SAS)
 Provides multiple levels of support with Customer service, Employer groups, Medical
management, maintenance of Data base, Third Party Administrators and varies Network
communication avenues.
 Manages UR telephone queue line, incoming faxes, voice mail, processing of MD
reviews and Claimreviews including other inquiries identified with resolution of the
request as well as managing Utilization referrals.
 Work collaboratively with Care Management nurses and assist other departments
within HealthSpan as needed.
SedgwickClaimsManagementServices,Incorporated: 2008to 2015
Office Location: Cincinnati,OH
Home Office: Dublin,OH
Trained and heldthe followingfourpositionswithinSedgwick,to fulfill the company’s needs:
ClaimsLiabilityAssociate Self-FundedKrogerAccount (2013-2015): Licensedasa PropertyandCasualty
Adjusterinthe statesforwhichI wasresponsible.
 Gatheredinformationtodetermine liabilityexposureof the store,whichconsisted of bodily
injury and/orpropertydamage.
 Assigned reserve valuestoclaims,made claimpaymentsasnecessaryandsettledclaimsupto
designatedauthoritylevel orauthorizationfromsupervisor.
 Managed subrogationof claimsandnegotiatedsettlements.Communicated claimactionwith
clientwithproperdocumentationandclaimscoding.
SpecialtyOperationsCoordinator-State Fund(2012-2013): Analyzedandprocessedlow-and-midlevel
workerscompensationclaimstodeterminebenefitsdue andensuredongoingadjudication of claims
withincompanystandardsandindustrybest-practices.
 Processed workerscompensationclaims (reviewed compensability),benefitsdue,andfiled
necessarydocumentationwithstate agency.
 Co-ordinated actuarial/settlementissues thatimpacted employers withrate andsettlement
departments.

2. Carlos Urrutia (513)704-8186
CustomerService Representative I:National Bill Review(2008-2010 & 2011-2012): Actedas primary
liaisonwithcustomerstelephonically;performed necessaryresearchtohelpresolvebillingissueswith
providers,claimsexaminers,employersandinjuredworkers.
 Handledall Spanishcallsinthe department.Educatedandinformed the customeraboutthe
documentationrequiredtoprocessabill,requiredtime frames,paymentinformationandbill
status.
ClaimsExaminer I-Departmentof Administrative Services-Mental HealthInstitutions-MCOinour
Cincinnati office (2010-2011). Processed Medical onlyclaims, contactedthe injuredWorkers,
EmployersandProviders.
 ReviewedC-9treatmentrequests,fromproviders,thatdeterminedthe appropriate decisionfor
approvedC-9’s,or staffed treatmentrequestswithNurse Case Manager,forfurther
determination.
 Continued communicationwiththe OhioBureauof Worker’sCompensationandfellow team
members.
 Ensureda highlevel of qualityandefficiencyof processed claims.
UNIVENTURE,INCORPORATED: 2006 to 2008
Office Location: Marysville,OH
 WebSalesCoordinator: Managed flow of telephonicandinternetordersandassisted
customersinplacingandupdated ordersandinformation.
 CustomerService Representative/SalesRepSupport:Wrote orders,quoted andfollowed up
withcustomersonorders.Calculated shippingcostsandupdatedinformationintothe database
on customeraccounts.
 Workedcloselywiththe MarketingDepartmentwith companiesinCentral andSouthAmerica
withSpanishTranslation.
Education:
The School of Radiology
Marion Technical College:
Pre-Radiology
ColumbusState CommunityCollege:
BusinessManagementProgram
PanamaCanal College:
Additional Training: CompletedLeadsProgram (Leadership) and ClaimsExaminer I SelfInsured
Program through SedgwickCMS University.
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