acofdq@r.postjobfree.com

QUALIFICATIONS PROFILE

Detail-oriented, analytical, and versatile professional, with comprehensive experience in overseeing financial operations,

compensation management, and human resources functions. Knowledgeable of diverse facets of claims adjustment, strategic planning,

program implementation, change management, and regulatory compliance. Expert at mentoring employees and ensuring positive working

relationships with peers, clients, and supervisors. Armed with strong organizational, problem-solving, communication, multitasking,

and interpersonal skills. Technically well-versed in using Microsoft Word, Excel, and Outlook as well as Internet Explorer,

WordPerfect, Adobe Reader, STARS, Nitro Pro 9, Citrix, and BillQuick.

AREAS OF EXPERTISE

Workers’ Compensation Claims

Human Resource Analytics

Program Planning and Development

Talent Strategy Implementation

Business Strategic Planning

Organizational Development

Staff Coordination and Training

PROFESSIONAL EXPERIENCE

EXCEPTIONAL CASE SERVICES - JACKSONVILLE, FL

Office Administrator 2014–Present

- Play a key role in supporting the nurse case management company in providing more extensive service to their clients through

the use of expertise in litigation, claims, and Florida Statutes (Chapter 440)

- Arrange and facilitate training and Continuing Education Unit (CEU) courses to adjusters with focus on Florida Heart and Lung

Presumption

- Provide expert oversight for diverse human resource responsibilities, as well as daily operational needs

- Demonstrated solid adjusting knowledge, which resulted in a significant increase in marketing

- Presided over training for case managers and administrative aides concerning workers’ compensation claims procedures and

adjuster needs and expectations

- Initiated comprehensive research on new case law in support of business development and marketing

CITY OF JACKSONVILLE SELF INSURANCE - JACKSONVILLE, FL

Senior Lost Time Claims Examiner 1989–2014

- Oversaw complex workers’ compensation claims, involving Health Insurance Portability and Accountability Act (HIPPA)

compliance, medical records review, recorded statements, safety regulations, risk management processes, and union agreements

- Exemplified expertise in dealing with all facets of deposition, mediation, and live testimony/litigation

- Took charge of excess coverage claims, directed all nurse case management processes; and regulated claims reservation and

investigation

- Displayed extensive knowledge of Florida law covering reporting processes and procedures

- Monitored diverse phases of adjusting catastrophic claims, Permanent Total Disability claims, and Special Disability Trust

Fund Claims

- Strategically supervised both medical and new senior claims examiners

- Attained professional knowledge of vocational/reemployment cases, as well as claim reserving, which involved medical cost

projection and life expectancy

- Acquired comprehensive understanding of Florida Statues (Chapter 440) and insurance program / self-insured

- Gained specialization in Florida Heart and Lung Bill, exclusively for more than eight years with the successful litigation in

Florida

- Administered all aspects of CEU courses for adjusters and employers and contributed in developing Guiding Principles and Best

Claim Practices for the Workers’ Compensation program

- Participated in attaining awards of costs, from litigation, through human resources and civil litigation

VOLUSIA COUNTY SELF INSURED - VOLUSIA COUNTY, FL

Claims Manager 2008–2009

- Offered effectual leadership and direction to adjusters in developing tactics for settling and bringing claims to successful

closure

- Generated and submitted reports of findings and solutions to the risk manager to develop appropriate tactic

- Conducted thorough review and expertly oversaw all claims for cost reduction, tactic and reservation

- Succeeded in reducing the amount of open claims, and developed a manageable claim count for adjusters

EDUCATION

Coursework in Accounting - FLORIDA STATE COLLEGE AT JACKSONVILLE, JACKSONVILLE, FL

PROFESSIONAL DEVELOPMENT

Continuing Education Courses - Florida Workers’ Compensation Adjusters License

Continuing Education Courses - Florida Board Certified Workers' Compensation (CWC) Adjuster

Continuing Education Courses - Florida Board Certified in Workers’ Compensation Litigation (CWCL) Adjuster

Florida Division of Workers’ Compensation Certified Instructor

All-Lines Adjuster License

Health Insurance Portability and Accountability Act (HIPPA) Compliance

Human Resources Training - Seawright and Associates, Winter Park, FL

Multiple Courses - Fred Pryor Seminars

PROFESSIONAL AFFILIATIONS

Workers’ Compensation Claims Professionals

American Board of Quality Assurance and Utilization Review Physicians (ABQAURP)

Property and Casualty Claims Professionals

Jacksonville Claims Association

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