Experience

USIS, Inc

• United States
• Insurance
• 1 - 100 Employee

• Workers’ Compensation Claims Specialist II, CWC

  • Aug 2017 - Present

  Responsible for the investigation, evaluation, disposition and settlement of Workers’ Compensation claims for FCBI Self Insurers Fund, including complex and high exposure claims, with minimal supervision. This includes the investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves. Requires independent decision making and a high level of discretion and judgment in claim handling functions on behalf of client for claims service business operations, ensuring excellent customer relationships and quality customer service.



FRSA Self Insureds Fund

• Workers Compensation Adjuster

  • May 2014 - May 2017

  Administered Workers’ Comp claims pursuant to company and State regulations and ensured claims were managed and settled in a timely and effective manner, including investigation, determination of compensability and the setting of proper reserves. My clients business operated from roofing, contracting, electrical, landscaping, and refrigeration.  Handled a total of 100+ lost time/medical only and catastrophic claims with exposure ranging from 25k-500k.  Strong organizational skills; effectively utilize diary system and document all activities.  Communicated effectively with policyholders, injured workers, attorneys and others in a professional and timely manner.  Successfully negotiated settlements, aimed for low claim payouts/closed files, and handled EDI effectively.  Responsible for approving settlement authority requested, input or decrease reserves as necessary



Sihle Insurance Group

• United States
• Insurance
• 100 - 200 Employee

• Workers' Compensation Claims Analyst/Consultant

  • Aug 2011 - May 2014

  Responsible for the support of Sihle Agents enlisted in the Specialized Client program. Maintain working relationships with workers compensation insurance providers and insurers.  Gather comprehensive data to create reports, charts of trends in injuries.  Reviews, monitors and tracks open losses and provide monthly reports to client.  Review insured’s payrolls audits and loss runs to verify accuracy of NCCI rating.  Complete future experience mod projection prior to renewal. Responsible for the support of Sihle Agents enlisted in the Specialized Client program. Maintain working relationships with workers compensation insurance providers and insurers.  Gather comprehensive data to create reports, charts of trends in injuries.  Reviews, monitors and tracks open losses and provide monthly reports to client.  Review insured’s payrolls audits and loss runs to verify accuracy of NCCI rating.  Complete future experience mod projection prior to renewal.



USIS, Inc

• United States
• Insurance
• 1 - 100 Employee

• Sr. Workers' Compensation Claims Adjuster Team Leader

  • Nov 2002 - Jul 2011

  Administered Workers’ Comp claims pursuant to company and State regulations and ensured claims were managed and settled in a timely and effective manner, including investigation, determination of compensability and the setting of proper reserves. My clients business operated from roofing, contracting, electrical, landscaping, and refrigeration.  Handled a total of 100+ lost time/medical only and catastrophic claims with exposure ranging from 25k-500k.  Strong organizational skills; effectively utilize diary system and document all activities.  Communicated effectively with policyholders, injured workers, attorneys and others in a professional and timely manner.  Successfully negotiated settlements, aimed for low claim payouts/closed files, and handled EDI effectively.  Responsible for approving settlement authority requested, input or decrease reserves as necessary.



Gallagher Bassett

• United States
• Insurance
• 700 & Above Employee

• Medical Only Adjuster

  • Aug 2002 - Nov 2002

  Workers' Compensation Medical Only Examiner Sharing a Medical Only desk with another medical only adjuster with over 400+ claims. Processing bills via e-bill and 100% in house. Workers' Compensation Medical Only Examiner Sharing a Medical Only desk with another medical only adjuster with over 400+ claims. Processing bills via e-bill and 100% in house.



Sunshine Companies Leasing Company (PEO)

• Workers' Compensation Claims Coordinator

  • Nov 1998 - Aug 2002

  Assisting the claimant to seek medical treatment along with drug test. Phone communication with claimants, clients, nurse case managers, insurance carriers, attorneys, doctor's offices. Preparing wage statements and handling of litigated claims. Attending mediations as needed. Re-employment services to injured workers that are on light duty. Produced loss runs as requested. Assigned surveillance and background checks on suspicious claims. Assisting the claimant to seek medical treatment along with drug test. Phone communication with claimants, clients, nurse case managers, insurance carriers, attorneys, doctor's offices. Preparing wage statements and handling of litigated claims. Attending mediations as needed. Re-employment services to injured workers that are on light duty. Produced loss runs as requested. Assigned surveillance and background checks on suspicious claims.



Highlands Home Health Agency

• Administrative

  • Jun 1996 - Aug 1997