Experience

Risk & Insurance Consultants, Inc.

• United States
• Insurance
• 1 - 100 Employee

• Claims Adjuster/Analyst

  • Jun 2016 - Apr 2018

  Greater Atlanta Area •Handles, manages and maintains a case load of assigned claims on an individual basis •Approves medical treatment on their designated claims within a timely manner •Communicates between the claimant, employer & doctors’ offices where needed •Performs monthly reviews required for file closures. •Contribute to collaborative environment by consistently demonstrating teamwork, high motivation, behavior and effort to achieve goals and objectives. •Provide accurate and timely expense… Show more •Handles, manages and maintains a case load of assigned claims on an individual basis •Approves medical treatment on their designated claims within a timely manner •Communicates between the claimant, employer & doctors’ offices where needed •Performs monthly reviews required for file closures. •Contribute to collaborative environment by consistently demonstrating teamwork, high motivation, behavior and effort to achieve goals and objectives. •Provide accurate and timely expense and loss assessments on Lost Time claims. •Timely and appropriately communicate with internal and external customers relative to account trends, issues, and claim activity. •Consistently demonstrate fundamentally sound claim handling by achieving compliance in the areas of investigation, coverage, loss assessment, and case management. •Ensure the establishment, documentation, and execution of appropriate strategies to bring early resolutions to assigned claims. •Recognize and properly address coverage issues, potential fraud, and subrogation; follow guidelines and completion of reporting forms. •Keep all files on a current diary system in order to monitor new developments, follow up on requests, update management and respond to all other diary activities in a timely manner. •Receives claim, confirms policy coverage & acknowledgement of claim •Determine validity & compensability of claim by investigating & gathering information, file necessary documentation with state agencies •Establish reserves & authorize payments within reserving authority limits •Develop and manage well documented action plan with case manager, attorney, supervisor & client to reduce overall cost of claim •Coordinating early return to work efforts with case manager & employer •Negotiates settlements when necessary •Actively manage the litigation process •Identifies potential subrogation claims

• Claims Coordinator

  • Mar 2016 - Jun 2016

  Atlanta



AIG

• United States
• Insurance
• 700 & Above Employee

• Team Lead

  • Mar 2005 - Jul 2015

  Alpharetta, GA Track team Production and Quality. Create and submit daily, weekly and monthly reports. Establish Notice Only/Medical Only Claims. Create and maintain training material. Distribute the day to day flow of work. Establish 3 Point Contact. Set claim reserves with a limit of 10K. Verify coverage in sections of the policy. Develop Training Material including SOP's Conduct classroom/one on one training sessions. Customer Service.

• Team Lead

  • Mar 2005 - Jul 2015

  Alpharetta, GA Consistently exceeded all performance goals and objectives for AIG, working with various State Boards, Attorneys, Claims Investigators, Insureds, and Claimants over tenure with the company. Managed both domestic and internal claims spanning Workers’ Compensation, Property & Casualty, Accident & Health, World Source Defense Base (Military/Civilian), and World Source Home Casualty. • Oversaw numerous successful projects and programs, including presenting the findings to executive… Show more Consistently exceeded all performance goals and objectives for AIG, working with various State Boards, Attorneys, Claims Investigators, Insureds, and Claimants over tenure with the company. Managed both domestic and internal claims spanning Workers’ Compensation, Property & Casualty, Accident & Health, World Source Defense Base (Military/Civilian), and World Source Home Casualty. • Oversaw numerous successful projects and programs, including presenting the findings to executive leadership. • Drove performance by creating training material for new hires and established employees, and by providing the coaching and leadership, and tracking team production to show weekly, monthly, and annual trends. • Owned a chain of custody regarding physical evidence for claims, ensuring 100% compliance to all internal policies and procedures, as well as with all external regulatory standards. • Made decisions on day-to-day functions and operations in the absence of management, in addition to motivating the team daily to increase production, quality, and morale. • Effectively managed special accounts, including the company’s leading multi-million dollar construction accounts. • Took the lead in complex investigations, made 3 point contact on each claim, established claim number and set reserves on claims as needed. • Conducted several successful presentations to outside vendors visiting the office on a same-day notice. • Increased claims processing effectiveness 63% by spending months gathering, capturing, and analyzing data to improve international claims processing. • Saved the company more than $46K annually by adding a new free application, and removing some redundant steps in the old process. • Consistent top performer, regularly exceeding all core metrics, goals, and Key Performance Indicators (KPI) throughout tenure with the company.