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Skills

  • Expedited claims processing
  • Budgets
  • Cost-containment strategies
  • Negotiation with legal representatives
  • Multitasking in high-pressure environments
  • Risk assessment and mitigation
  • Litigation avoidance through mediation
  • Insurance policy interpretation and application
  • Insurance company relationship management
  • Medical treatment coordination with healthcare providers

Work Experiences

  • Authored guidelines for claims assessments.
  • Collected and analyzed feedback from claimants.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Determined liability as outlined in the coverage and assessed documentation from police and healthcare providers to understand the damages incurred.
  • Adhered to departmental deadlines.
  • Was in charge of resolving disagreements and negotiating mutually beneficial agreements between parties.
  • Examined claim forms and other records to determine insurance coverage.
  • Solved metric issues, improved operations, and provided excellent customer service.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Collaborated with safety teams.

Summaries

  • Oversee 16 cases per month with care.
  • Review documentation and assess properties efficiently to determine damage levels, complete cost estimates, and maintain liability control.
  • Bringing a proven track record of success in Workers' Compensation Administrator roles throughout a progressive insurance industry career.
  • Achieved results in 2015.
  • Achieved over 39% cost savings.
  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Conducted thorough negotiations with legal representatives.
  • Workers' Compensation Administrator is a multi-talented Workers' Compensation Administrator who is consistently rewarded for planning and operational improvements.
  • Achieved a 53% improvement in claims management efficiency.
  • Automated manual claim processing tasks.

Accomplishments

  • Analyzed claims data to identify process, leading to reduction of premiums by $18 within the past year.
  • Prepared annual compliance reports for state regulatory bodies, ensuring timely submission and zero penalty incidents.
  • Improved overall claims handling efficiency by 57% through the introduction of automated escalation protocols using framework.
  • Led efforts to overhaul claims handling processes, using method to reduce average claim processing time by 69%.
  • Implemented a continuous training program for claims adjusters, increasing efficiency by 77% during peak claim periods.
  • Led weekly claims strategy meetings, resulting in a 70% reduction in open claims backlog over 11 months.
  • Reduced incident rates for Vantage by implementing and managing a robust workplace rehabilitation program for injured employees.
  • Led departmental training on new method, improving claims response times by 81%.
  • Initiated a review of historical claims and identified opportunities for premium savings, netting an annual savings of $9 in 2024.
  • Engaged in detailed case reviews, leading to the closure of 14 complex workers' compensation claims within the past year.

Affiliations

  • American Medical Informatics Association
  • Attendee of the National Association of Subrogation Professionals (NASP) Conference
  • Affiliated with American Association of State Compensation Insurance Funds (AASCIF)
  • Society of Human Resource Management
  • Member of Society for Human Resource Management (SHRM) specialized in Workers' Compensation
  • Certified Affiliate of the Workers' Compensation Claims Resolution Tribunal 2024
  • National Association of Workers' Compensation Judiciary (NAWCJ) Member
  • Association of Information Technology Professionals
  • Member of the Public Agency Risk Management Association (PARMA)
  • Active Member of the California Workers' Compensation Institute (CWCI)

Certifications

  • ServSafe
  • Certificate in Legal Aspects of Workers' Compensation
  • Salesforce
  • Associate in Claims (AIC)
  • Certified Public Accountant
  • Insurance Regulatory Compliance Certification
  • Certified Managed Care Professional (CMCP)
  • CompTIA A+ Technician
  • CPDM - Certified Professional Disability Management Designation
  • Workers' Compensation Claims Law Specialist (WCLS)

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