Experience

Q-Temps Insurance Staffing

• Insurance
• 1 - 100 Employee

• Workers Compensation Adjuster

  • Oct 2013 - Mar 2014

  Currently registered with Insurance Staffing company. Handled temporary duties of Texas Workers Compensation Adjuster on last assignment. Duties consisted of contacts with client, claimant, medical provider and legal reps in an effort to determine if reported claim compensability. Responsible for timely filing of all state required forms, billing payments, disability and impairment checkss issuance, medical treatment coordination/management, working with vendors to schedule both Independent… Show more Currently registered with Insurance Staffing company. Handled temporary duties of Texas Workers Compensation Adjuster on last assignment. Duties consisted of contacts with client, claimant, medical provider and legal reps in an effort to determine if reported claim compensability. Responsible for timely filing of all state required forms, billing payments, disability and impairment checkss issuance, medical treatment coordination/management, working with vendors to schedule both Independent Medical and Designated Doctor Evaluations, file resolution and closures. Show less Currently registered with Insurance Staffing company. Handled temporary duties of Texas Workers Compensation Adjuster on last assignment. Duties consisted of contacts with client, claimant, medical provider and legal reps in an effort to determine if reported claim compensability. Responsible for timely filing of all state required forms, billing payments, disability and impairment checkss issuance, medical treatment coordination/management, working with vendors to schedule both Independent… Show more Currently registered with Insurance Staffing company. Handled temporary duties of Texas Workers Compensation Adjuster on last assignment. Duties consisted of contacts with client, claimant, medical provider and legal reps in an effort to determine if reported claim compensability. Responsible for timely filing of all state required forms, billing payments, disability and impairment checkss issuance, medical treatment coordination/management, working with vendors to schedule both Independent Medical and Designated Doctor Evaluations, file resolution and closures. Show less



Claims Management Inc

• United States
• Legal Services
• 1 - 100 Employee

• Workers Comp Claims Adjuster/Insurance Professional

  • Nov 2001 - May 2013

  Managed workers compensation claims by completing contact with injured worker, physicians, employers and evaluating medical records to determine claim compensability; Contact with treating physicians/medical reviewer to discuss medical status, diagnosis assessments, recommended treatment plans, anticipated disability or MMI status , completion of surgical intake forms when applicable; Completed client contact to ensure timely return to work whether light duty or full duty in an effort to cut… Show more Managed workers compensation claims by completing contact with injured worker, physicians, employers and evaluating medical records to determine claim compensability; Contact with treating physicians/medical reviewer to discuss medical status, diagnosis assessments, recommended treatment plans, anticipated disability or MMI status , completion of surgical intake forms when applicable; Completed client contact to ensure timely return to work whether light duty or full duty in an effort to cut both disability and medical treatment cost; Manage worker compensation claims while adhering to state guidelines and regulations; Managed an average caseload of 135-160 clients each quarter as New Jersey is highly litigated state. Managed monetary aspects of assigned claims by establishing appropriate reserves, authorizing payments based on approval level, facilitate claim denials, engage in negotiations with minimal supervision in an effort to prevent fines and penalties; Participated in serious case reviews (SCR’s) by reviewing files, summarizing facts, identifying legal issues, reviewed with team leader to obtain recommendations to address issues, anticipated settlement exposure and reserve changes; Maintains current adjusting knowledge by reviewing case/state laws, and completing required continuing education courses. Show less Managed workers compensation claims by completing contact with injured worker, physicians, employers and evaluating medical records to determine claim compensability; Contact with treating physicians/medical reviewer to discuss medical status, diagnosis assessments, recommended treatment plans, anticipated disability or MMI status , completion of surgical intake forms when applicable; Completed client contact to ensure timely return to work whether light duty or full duty in an effort to cut… Show more Managed workers compensation claims by completing contact with injured worker, physicians, employers and evaluating medical records to determine claim compensability; Contact with treating physicians/medical reviewer to discuss medical status, diagnosis assessments, recommended treatment plans, anticipated disability or MMI status , completion of surgical intake forms when applicable; Completed client contact to ensure timely return to work whether light duty or full duty in an effort to cut both disability and medical treatment cost; Manage worker compensation claims while adhering to state guidelines and regulations; Managed an average caseload of 135-160 clients each quarter as New Jersey is highly litigated state. Managed monetary aspects of assigned claims by establishing appropriate reserves, authorizing payments based on approval level, facilitate claim denials, engage in negotiations with minimal supervision in an effort to prevent fines and penalties; Participated in serious case reviews (SCR’s) by reviewing files, summarizing facts, identifying legal issues, reviewed with team leader to obtain recommendations to address issues, anticipated settlement exposure and reserve changes; Maintains current adjusting knowledge by reviewing case/state laws, and completing required continuing education courses. Show less