Claims Representative II Workers Compensation

• Jul 2021 - Present

Determine claim compensability within company guidelines and state laws. Investigates and adjust claims in accordance with established claim handling procedures. Negotiate settlements with claimants and attorneys for claim resolution within authority limits. Assess and monitor subrogation potential. Monitor and maintain reserves for claim exposure. Authorize and direct medical treatment. Maintain contact with defense attorneys for litigation. Determine claim compensability within company guidelines and state laws. Investigates and adjust claims in accordance with established claim handling procedures. Negotiate settlements with claimants and attorneys for claim resolution within authority limits. Assess and monitor subrogation potential. Monitor and maintain reserves for claim exposure. Authorize and direct medical treatment. Maintain contact with defense attorneys for litigation.

Claims Representative Workers Compensation I

• Aug 2019 - Jul 2021

Investigate and adjust workers compensation claims in accordance with established claims handling procedures. Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing workers compensation claims. Negotiate settlements with claimants and attorneys in accordance with client's authorization. Assist in selection and supervision of defense attorneys. Assess and monitor subrogation claims for resolution. Prepare reports detailing claims, payments and reserves. Compliance with Service Commitments. Delivery of quality claim service to clients. Show less

Claims Representative Workers Compensation

• Nov 2018 - Aug 2019

Investigate and adjust workers compensation claims to determine claim compensability.Negotiate settlements with claimants and attorneys in accordance with authority limits.Selection and supervision of defense attorneys. Assess and monitor subrogation claims for resolution.Prepare reports detailing claims, payments and monitor reserves for adequate exposure.Compliance with Service Commitments, company standard and best practices, and within state law regulations while delivery of quality claim service to clients. Show less

Claims Associate Workers Compensation

• Oct 2017 - Nov 2018

Analyze lower-level workers compensation claims to determine benefits due and ensures ongoing adjudication of claims within company standards and best practices. Timely escalation of claims, and monitoring reserves for ongoing treatment. Updating employers on claim status and progression.

Administrative Assistant

• Feb 2017 - Oct 2017

Administrative support to Workers' Compensation Team and related tasks including but not limited to file management and organization, provider notification and follow up, reporting, maintenance of risk management information system, preparation of workers' compensation forms. Assisting in document review, and mailing forms and letter to all parties involved on each claim.

Custodian

• Jan 2015 - Feb 2017

Cleaning the facility and making sure everything is up to par for the next day with clients came in. Working event with wheelchair rugby and President Bush had a conference at the location. Cleaning the facility and making sure everything is up to par for the next day with clients came in. Working event with wheelchair rugby and President Bush had a conference at the location.

Childcare Worker

• Oct 2014 - Jun 2015

Retail Cashier

• Mar 2014 - Oct 2014

Case Manager Assistant

• Oct 2011 - Feb 2013

Keeps cases organized by establishing and organizing files Confirming case status with attorney. Helps develop medical records for social security cases. Organizing materials for team case review. Help clients apply for social security. Obtain Medical records from the VA for Cases. Keeps cases organized by establishing and organizing files Confirming case status with attorney. Helps develop medical records for social security cases. Organizing materials for team case review. Help clients apply for social security. Obtain Medical records from the VA for Cases.