Workers' Compensation Claims Specialist

INSURANCE PROFESSIONAL

Workers' Comp Disability • Investigations • Scheduling • Time Management • Fraud Detection Compliance • Interviewing • Strategic Planning • Research • Settlement Negotiation • Troubleshooting • Customer Service • Subrogation

Innovative, creative, and focused professional with a progressive record of achievement effectively managing complex insurance claims from inception through completion. A relationship builder able to work with employees, managers, clients, and outside professionals to facilitate the completion of all requirements resulting in consistently achieving and exceeding goals and expectations. Noted for exceptional ability to adapt quickly to fluid situations while maintaining full data and client confidentiality and trust.

CAREER TRACK

Hazelrigg Risk Management Services San Diego , California

Workers' Compensation Claims Examiner Since 2001

Responsible for managing all aspects of workers' compensation claims to successful conclusion. Key duties include analyzing claims, developing approaches based upon unique requirements of each claim, investigating all aspects of the case, and gathering additional data through interviews with employers, medical professionals, legal personnel, and witnesses. Identify, investigate, and initiate further investigations for fraud cases, troubleshoot and resolve other issues as required to meet deadlines and quality requirements. Ensure full compliance with workers' comp state law labor codes.

•  Direct legal counsel in defense of employers of moderate to severe bodily injuries. Take steps to control and minimize current exposure and future risks.

•  Execute an aggressive plan of action and consider various options and other perspectives in coming to a conclusion.

•  Take a leading role in overall strategic planning, efficiency improvements, and as required, special projects.

•  Overall, consistently meet all deadlines and production goals resulting in an attainment of management goals and expectations, lowering costs and exposure while ensuring high client satisfaction.

Fremont Compensation Insurance Group San Diego , California

Rehabilitation Assistant / Short Term Disability Analyst 1991 - 2001

MD Health Plan New Haven , Connecticut

Group Service Representative 1990 - 1991

Blue Cross Blue Shield of Virginia / Connecticut Richmond , Virginia

Benefit Resolution Analyst 1987 - 1990

LEARNING CREDENTIALS

Diploma in Business Administration 1985

Kee Business College Newport News , Virginia

Additional courses, seminars and workshops include:

Advanced classes, Insurance Education Association (IEA)

Coursework, Southern Connecticut State University

CERTIFICATES & LICENSES

WCCA, WCCP Self-Insured License – State of California

Certificate of Completion – Rehabilitation Return to Work Program

INTERESTS & ACTIVITIES

American Sign Language • Salsa Competitions • Sewing

REFERENCES And further data PROVIDED UPON

ESTABLISHMENT OF MUTUAL INTEREST