Kristine Mazzone
Eligibility Specialist
Taylors Lakes,Victoria
Summary
Eligibility Specialist with 16 years of expertise in the Victorian Worker's Compensation Industry, excelling in time management, attention to detail, and problem-solving. Demonstrates a proven track record in various roles, including Case Manager and Team Leader, with a focus on enhancing customer service and fostering team collaboration. Passionate about continuous improvement and innovation, dedicated to driving excellence in claims management and stakeholder communication.
Overview
16
16
years of professional experience
Work History
Eligibility Specialist
Allianz
02.2020 - Current
- Triaging claims to determine whether the claim needed to be pended or whether the claim could be accepted outright based on the available information
- Arranging and reviewing Independent Medical Examinations, Circumstance Investigations and Treating Health Practitioner information to determine liability within a 28-day timeframe
- Drafting decision notices utilizing the information gathered during the pending process
- Liaising with other internal stakeholders to assist with the decision-making process
- Contacting Injured Workers and Employers to advise of the decision made
- Providing assistance to Injured Workers and Employers with general Workers Compensation queries
- Liaising with other internal stakeholders to assist with the
- Calculating Pre-Injury Average Weekly Earnings (PIAWE).
Senior Case Manager
Allianz
09.2018 - 02.2020
- Managed short-term portfolios of claims between 0-52 weeks as the business required
- Ensured weekly payments were calculated, processed and paid in a timely manner.
- Reviewed medical and like services and ensured the appropriate decision was made as to whether the service was approved or denied
- Contacted external stakeholders to discuss and assist with the facilitation of return-to-work
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Contributed to case conferences actively, providing strategies to manage claims effectively and proactively
- Enhanced communication between clients and providers through consistent follow-ups and progress updates.
- Improved client satisfaction by efficiently addressing concerns or grievances in a timely manner.
- Identified the need to complete adverse decisions in accordance with the legislation
Team Leader
Gallagher Bassett
10.2016 - 08.2018
- Managing and mentoring three low risk case managers
- Responsible for the reporting of each individual team members Key Performance Indicators (KPI's)
- Undertaking 1:1 meetings with staff members and providing feedback
- Completing performance reviews with staff members
- Responsible for interviewing and hiring staff
- Overseeing and managing the teams workflow
- Reporting on claims that are within the 52 week continuance rate cohort and the 104 week Return to Work Index cohort
- Contacting Injured Workers', Employers and all other relevant stakeholders to assist with management of workflow and rapport building
- Attending claim reviews with employers to provide support to the Case Managers and to provide advice
- Escalation point with assisting and resolving complaints
- Delegating tasks to staff members for completion
- Completing Team Manager duties whilst Team Manager was on leave or absent
- Assisting all staff members on an as needs basis.
Eligibility Officer
Gallagher Bassett
08.2015 - 09.2016
- Triaging claims to determine whether the claim needed to be pended or whether the claim could be accepted outright based on the available information
- Arranging and reviewing Independent Medical Examinations, Circumstance Investigations and Treating Health Practitioner information to determine liability within a 28-day timeframe
- Drafting decision notices utilizing the information gathered during the pending process
- Liaising with other internal stakeholders to assist with the decision-making process
- Contacting Injured Workers and Employers to advise of the decision made
- Providing assistance to Injured Workers and Employers with general Workers Compensation queries
- Liaising with other internal stakeholders to assist with the
- Calculating Pre-Injury Average Weekly Earnings (PIAWE).
Technical Manager
Xchanging
04.2013 - 08.2015
- Reviewing, editing and providing feedback regarding drafted notices completed by other staff members within the team
- Endorsing notices in accordance with the Act
- Providing instructions and undertaking negotiations for legal matters
- Ensuring settlements were adhered to within the appropriate timeframes
- Ensuring compliance with Conciliation Outcomes
- Case Conferencing with Case Managers to assist with claims management
- Providing advice and mentoring to staff
- Completing Desk Top Reviews of claims
- Escalation point with assisting and resolving complaints
- Calculation of interest entitlement
- Attending conciliation matters, claim reviews and employer and injured worker meetings as required.
Return to Work Specialist
Xchanging
10.2011 - 03.2013
- Managing a portfolio of up to 30 claims, for a maximum period of 26 weeks
- Obtaining information by way of liaising with external parties, such as; employers, injured worker's, occupational rehabilitation providers, treating health practitioner's and other external stakeholders to assist with claims management
- Attending clinical conferences with General Practitioners and other treating health practitioners to build rapport and to assist with claims management
- Arranging and attending Worker Interviews
- Accompanying Senior Case Managers to Clinical Conferences and Worker Interviews as additional support
- Completing desk top reviews of claims to ensure that the appropriate strategies are implemented
- Mentoring new staff, to ensure they have the knowledge and skills to complete the necessary tasks and work load
- Providing assistance with the teams' workflow on an as needs basis.
Case Manager
Xchanging
10.2009 - 10.2011
- Responsible for the management of a portfolio of upto 50 - 55 claims, for a period of 0 - 78 weeks
- Liaising with external parties, such as; employers, injured workers, occupational rehabilitation providers and other external stakeholders to obtain information to assist with the management of claims
- Providing workers compensation advice and knowledge to both Injured Workers' and Employers
- Preparing case conferences and reviewing these with the leadership members to ensure effective strategies were implemented to assist with return to work
- Reviewing and processing Certificates of Capacity and Medical and Like expenses to ensure payments are made within a timely manner
- Additional tasks as required.
Claims Processor
Xchanging
06.2008 - 10.2009
- Managing low risk claims (under 10 days' time loss and under medical threshold)
- Providing high customer service to external parties, including corporate businesses, labor hire companies, occupational rehabilitation providers and other stakeholders.
Administrative Assistant
Xchanging
01.2008 - 06.2008
- Providing administrative assistance to Case Managers and Claims Officers which included, completion of letters, photocopying files and documents, completing telephone enquiries and follow ups, collection of files for audit purposes and other reviews.
Education
Certificate -
Applied Suicide Intervention Skills Training
ASIST2023
Graduate Certificate - Administrative Law
Griffith University
Queensland01.2016
Diploma - Personal Injury Management
Deakin Prime
Melbourne01.2012
Certificate IV - Financial Services (Workers' Compensation)
Deakin Prime
Melbourne01.2010
Victorian Certificate of Education - High School
Gladstone Park Secondary College
Gladstone Park, Victoria01.2007
Skills
- Effective communication skills
- Customer Education
- Knowledgeable in Novus, Action and Tempus
- Decision-Making
- Technical knowledge
- Analytical Thinking
- Attention to Detail
- Friendly, Positive Attitude
- Problem-Solving
References
Upon request
Timeline
Eligibility Specialist
Allianz
02.2020 - Current
Senior Case Manager
Allianz
09.2018 - 02.2020
Team Leader
Gallagher Bassett
10.2016 - 08.2018
Eligibility Officer
Gallagher Bassett
08.2015 - 09.2016
Technical Manager
Xchanging
04.2013 - 08.2015
Return to Work Specialist
Xchanging
10.2011 - 03.2013
Case Manager
Xchanging
10.2009 - 10.2011
Claims Processor
Xchanging
06.2008 - 10.2009
Administrative Assistant
Xchanging
01.2008 - 06.2008
Certificate -
Applied Suicide Intervention Skills Training
Graduate Certificate - Administrative Law
Griffith University
Diploma - Personal Injury Management
Deakin Prime
Certificate IV - Financial Services (Workers' Compensation)
Deakin Prime
Victorian Certificate of Education - High School
Gladstone Park Secondary College
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