VALERIE HOLMES

**** ******* *****, ***: **-**

Atlanta, GA 30350

404-***-****

ejxu7a@r.postjobfree.com

WORKERS COMPENSATION CLAIMS EXAMINER I

“Demonstrated ability to manage high volume of claims; continually becoming more experienced in the field of insurance claims handling”.

CORE STRENGTHS

Over 20 years of experience in an insurance claims environment.

CWCP certified and licensed to adjust workers compensation claims in 14 states.

Strong interpersonal skills in client communication and relations.

Able to work under pressure efficiently with deadline and time sensitive issues.

Proven ability to organize, multitask and problem solve.

Committed to working with others to achieve a goal.

Proficient in MS office application (Word, Excel, Access and Outlook).

WORK EXPERIENCE

Risk Enterprise Management, Inc., Atlanta, GA

Workers Compensation Medical Claims Adjuster January 2009-present

Manage fast track injury claims with minor loss time for 17 individual companies with a monthly caseload of 200 claims.

Responsible for time sensitive claim management until resolution of claims with strict adherence to client specifications.

Initiate telephone investigation with recorded statements taken from injured employee, managers, attorney and witnesses to determine compensability.

Initiate daily telephone contact and written correspondence with involved parties to claim, along with excellent customer service given to inbound callers requesting claim status.

Establish and monitor claim reserves for review and approval of medical bill payments.

Effectively document file notes from opening to closure of each claim.

Sedgwick Claims Management Services, Duluth, GA

Workers Compensation Medical Claims Adjuster March 2005-January 2009

Evaluate, investigate and confirm compensability of medical only injury claims.

Conduct phone investigations with store managers, risk managers, claimants and physicians.

Schedule medical appointments with recommended referrals to specialist and set up transportation.

Research several client specified medical management websites to locate medical providers.

Create and monitor return to work claim status spread sheets until closure of claim.

Successfully review and complete multiple client generated spread sheets with deadlines for osha recordable reporting and Medicare eligible claimant status.

Workers Compensation and Liability Claim Assistant May 2003 - March 2005

Supported supervisor along with staff of 5 workers compensation and liability claims adjusters.

Provided outstanding customer service to inbound callers requesting medical and activity claim status.

Set up and coded First Report of Injury applications into several screens in Sedgwick Juris computer system.

Sort and index incoming mail to attach to each adjusters paper claim file.

Located missing files throughout office to re file in cabinets and drop file mail.

Met life Auto and Home Assurance Company, Atlanta, GA

Insurance Support Associate June 1999-November 2002

Entered Data from new business applications into system and ordered reports using windows 98.

Reviewed cancellation and nonrenewal notices.

Provided customer service answering telephone credit hotline.

Utilized Kodak 70 imager to microfilm mail and insurance claim documents.

Created log to document receipt of new business down payment checks.

Traveled out of state to other Met life companies to learn and train associates on new business insurance procedures.

Motor Vehicle Accident Indemnification Corporation, New York, NY

No Fault Insurance Claim Supervisor November 1993 - June 1999

Efficiently supervised staff of 7 claim examiners and 3 mail room clerks.

Assigned files and duties to staff. Performed staff performance evaluations.

Bodily Injury Pending Claim Examiner January 1991- November 1993

Investigated new claims by requesting and reviewing police reports, medical records, medical bills, DMV reports and insurance denial letters.

Communicated daily with attorneys, claimants, insurance agents and medical providers by telephone, in office meetings and with written correspondence.

Data Entry/Word processing Clerk September 1987 - January 1991

Entered information from new bodily injury claims into MVAIC claims documenting computer system.

Typed and printed letters using AS 400 word processor and IBM wheel writer 3 Typewriter at 55 wpm.

Receptionist/File Clerk June 1985 - September 1987

Supported accounting department, claims department and mail department.

Administered customer service answering telephone with 15 incoming lines, giving general claims information and transferring calls to other department extensions.

EDUCATION

Julia Richman High school, New York, NY

High School for the Humanities, New York, NY

Received G.E.D. 1983

State Insurance Adjuster licenses, CEU credit transcripts and references available upon request

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