Experience

Sedgwick Claims Management Services, Inc.

• United States
• Insurance
• 1 - 100 Employee

• Casualty Claims Examiner

  • Aug 2022 - Present



Morgan and Morgan, PC

• Legal Services
• 1 - 100 Employee

• Case Manager

  • Jun 2013 - Aug 2022



MetLife

• United States
• Insurance
• 700 & Above Employee

• Claims Examiner

  • Aug 2008 - Jun 2013

  - Manages assigned caseload with limited supervision. - Provides timely, balanced and accurate claims reviews, documentation and recommended decisions in a time sensitive and fast-paced environment. - Compiles file documentation and correspondence requiring extensive policy and factual detail. - Identifies information and resources needed to adjudicate claim. - Communicates decisions to policyholders in verbal and written form. - Conducts detailed information-gathering phone calls that obtain medical condition details, financial details, occupational details and other information. - Refers to external and internal resources, such as physicians, attorneys and CPAs to gather data such as medical/occupational information in order to ensure well-reasoned decisions. Clarifies and reconciles inconsistencies. - Proficiently calculates benefits due after elimination period, COLA, Social Security Offsets, and residual and non-routine payments. - Drafts responses to Department of Insurance and Presidential complaints. Identifies and refers appropriate matters to legal counsel. Show less



Travelers Insurance Company

• Tampa/St. Petersburg, Florida Area

• Claim Representative

  • May 1993 - Dec 1997

  - Worked closely with Account Risk Management in handling claims and utilizing special claim handling requirements. - Maintained positive customer relations with all accounts by making on site visits and scheduled account review conferences. - Negotiated and settled Bodily Injury exposures with damage value over $100,000, including structured settlements. - Handled suit files through entire litigation process, attended mediations and completed outside investigations. - Participated in Home Office Project to develop and improve communication between claim, underwriting and marketing divisions. - Organized training sessions, coordinated team meetings and interviewed potential claim personnel. Show less