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Skills

  • Negotiation and settlement strategies
  • Data tracking and trend analysis
  • Vendor relationship management
  • Communications
  • Conflict resolution between stakeholders
  • Cross-functional team collaboration
  • Handling of high-risk, complex claims
  • Budgets
  • Budget management for compensation programs
  • Team building

Work Experiences

  • Solved system issues, improved operations, and provided excellent customer service.
  • Conducted agent and claimant interviews to review questionable claims to correct omissions and errors.
  • Achieved a 71% improvement in injury claims forecasting.
  • Oversaw the delivery of system project by method team, which resulted in procedure.
  • Answered 16 calls per 6 months to help customers with their questions and concerns.
  • Administered over 8 workers' compensation claims per month.
  • Achieved 42% reduction in file reopenings.
  • Achieved an accuracy rate of 30%.
  • Reviewed original investigation reports and documents to address secondary concerns.
  • Audited and formalized adjusted loss reserves for over 16 cases, providing accurate financial reporting for end-of-year settlements.

Summaries

  • Accomplished Workers' Compensation Specialist adept at overseeing comprehensive claims management processes, reducing customer dissatisfaction by 48% and enhancing operational efficiency.
  • Dedicated to learning, growing, and succeeding in Miscellaneous.
  • Achieved a 74% success rate in hearings.
  • Within Miscellaneous, senior Workers' Compensation Specialist and outstanding performer in workflow optimization and stakeholder engagement.
  • By applying all policies fairly, she is adept at balancing business and customer interests.
  • Accomplished within one year.
  • Collaborative and effective communicator.
  • Achieved 29% reduction in claim handling costs.
  • With strong case management and relationship-building abilities, I am meticulous, systematic, and highly experienced.
  • Insurance adjuster who investigates and analyzes liability in the event of a personal, casualty, or property loss.

Accomplishments

  • Collaborated with compliance officers to ensure company-wide adherence to state and federal workers’ compensation guidelines, reducing penalties by $9 in 2018.
  • Utilized data analytics tools to analyze claim patterns, enabling the redesign of safety measures that reduced reported workplace injuries by 83% over 2021.
  • Implemented proactive file management tools that allowed for quicker identification of high-priority workers' compensation cases, reducing critical response time by 78%.
  • Served as a point of contact for employees, medical staff, and legal professionals, facilitating smoother resolution of claims within procedure.
  • Assisted in the development and execution of a new claims review protocol that directly reduced open claims duration by an average of 11 days.
  • Spearheaded the implementation of return-to-work programs, decreasing lost workdays by 15% within 2018.
  • Tracked departmental key performance indicators, identifying areas for improvement that decreased the overall duration of claims settlement by 49%.
  • Analyzed medical records and worked closely with healthcare providers to ensure the proper documentation for workers' compensation claims, reducing the number of inaccurate filings by 25%.
  • Reduced workers' compensation reserves by $9 while adhering to ethical guidelines and ensuring fair compensation for injured workers.
  • Collaborated with team of 18 in the development of procedure.

Affiliations

  • Certification, Workers’ Compensation Adjuster Certification (2023, Colorado)
  • Active participant, Workers’ Compensation Claims Professional Network
  • Membership, The American Staffing Association (related to workers' compensation compliance)
  • Board member, National Workers’ Compensation Defense Network (2021)
  • International Council of Nurses
  • Member, Insurance Information Institute
  • Member, Society of Claim Law Associates (SCLA)
  • Certified Member, American Institute for CPCU & Insurance Institute of America (CPCU, ARM)
  • Active participant, Self-Insurance Institute of America (SIIA)
  • Toastmasters

Certifications

  • ServSafe
  • Google Certified Professional Cloud Architect
  • Certified Workers' Compensation Professional (CWCP)
  • Disability Management Specialist (DMS)
  • Certified Safety Professional (CSP)
  • Certified in Healthcare Compliance (CHC)
  • Associate in Claims (AIC)
  • Apple Certified Associate (ACA)
  • OSHA 30-Hour Construction Safety and Health Certification
  • Certified Business Analysis Professional (CBAP)

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