Cristina Pacheco

Manages 100+ concurrent workers' compensation, FMLA, ADA, and state leave cases from intake through resolution, ensuring compliance with federal and state regulations. Interprets policy terms and regulatory requirements to make sound decisions on complex cases.

Conducted concurrent and retrospective utilization reviews, evaluating documentation against clinical and payer guidelines. Processed precertification and prior authorization requests in compliance with payer guidelines and regulatory standards.

Independently investigated and managed medical-only workers' compensation claims, including California claims, from set-up to closure. Determined compensability and administered statutory medical benefits while ensuring regulatory compliance.

Managed high-volume accounts receivable operations, contacting 100-300 customers daily to resolve billing and invoicing discrepancies. Identified a pattern of fraudulent check activity and helped implement an online data management system.

Grade: Distinction

Earned an Associate of Applied Science with distinction in May 2026, with a growing focus on data analysis and systems.