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Skills

  • Adherence to medical treatment guidelines
  • MS Office
  • Team building
  • Legal compliance
  • Benefit allocation accuracy
  • Fraud detection and prevention
  • Injury claims assessment
  • Medical treatment authorization
  • Claims system proficiency (Adobe Creative Suite)
  • Negotiating attorney agreements

Work Experiences

  • Analyzed the data gathered during the investigation and wrote a report with my findings and recommendations.
  • Identified insurance coverage limitations with a thorough examination of claims documentation and related records.
  • Achieved successful claim resolutions in 2018.
  • Boosted team collaboration.
  • Achieved results within three years.
  • Oversaw the delivery of framework project by program team, which resulted in framework.
  • Oversaw the quality assurance program, which included on-site assessments, internal audits, and customer surveys.
  • Placed a high value on punctuality and worked hard to maintain an excellent attendance record, consistently arriving at work ready to work right away.
  • Gathered and tracked evidence in support of legal processes.
  • Looked into and assessed property damage, as well as reviewing property damage estimates.

Summaries

  • Achieved 77% faster settlements.
  • Workers' Compensation Case Manager is a multi-talented Workers' Compensation Case Manager who is consistently rewarded for planning and operational improvements.
  • Collaborated with HR departments on complex claims.
  • Accomplished case manager specializing in workers’ compensation.
  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.
  • Achieved a 63% reduction in future claim rates.
  • Costs were consistently reduced while profits were increased.
  • Excellent communication skills as evidenced by 17 years of experience interviewing experts, witnesses, and claimants in order to compile data.
  • Achieved savings of $11.
  • Collaborated with medical professionals and third-party vendors.

Accomplishments

  • Collaborated with third-party vendors, improving service quality and ensuring compliance with workers’ compensation guidelines.
  • Assessed and validated injury claims through medical records review, preventing overpayments and saving the company $9.
  • Facilitated expert witness consultations to support high-value claim defense, achieving favorable outcomes in 6 high-stake cases.
  • Implemented fraud detection solutions that led to early identification of suspicious claims, saving the company $5 annually.
  • Managed a portfolio involving 17 high-profile workers' compensation claims, resulting in a 56% success rate in settlements.
  • Coordinated with medical providers and vendors for appropriate treatment plans, leading to improved outcomes for 17% of injured workers.
  • Resolved product issue through consumer testing.
  • Led the strategic resolution of workers' compensation claims, reducing overall claim resolution time by 17 days.
  • Initiated proactive injury prevention strategies with safety teams, reducing workers' compensation claims by 37% over 18 months.
  • Developed case management strategies that resulted in cost savings of $4 over several months.

Affiliations

  • Member, American Association of Nurse Case Managers (AANCM)
  • Certification Holder, Risk Management for Workers' Compensation (RMWC), 2019
  • Member, Risk and Insurance Management Society (RIMS)
  • International Association of Administrative Professionals
  • Active Member, Disability Management Employer Coalition (DMEC)
  • Lions Club
  • American Society of Safety Professionals
  • Member, International Occupational Health and Safety Association (IOHSA)
  • Association for Supply Chain Management (APICS)
  • American Marketing Association

Certifications

  • Case Management Administrator Certification (CMAC)
  • Certified Case Manager (CCM) by the Commission for Case Manager Certification (CCMC)
  • Disability Management Specialist Certification (DMSC)
  • Certified Insurance Counselor (CIC) by The National Alliance for Insurance Education & Research
  • Certified Occupational Safety Specialist (COSS)
  • CompTIA Security+
  • Workplace Injury Prevention Professional Certification (WIPP)
  • Apple Certified Associate (ACA)
  • Certified Workers' Compensation Professional (CWCP)
  • CompTIA A+ Technician

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