Customer Service Quality Assurance
Resume:
Olivia Chaparro-Loya
Oxnard, CA 93030
805-***-**** Cell
Professional Summary
I am a highly organized and analytical claims professional whom possesses
an impressive background in the specialized field of California Workers'
Compensation claims adjusting and supervision. I offer multiple years of
solid work and management experience in personnel matters, claim
litigation, strategic claim review and planning, high-dollar claim
administration and Workers Compensation claims training in the insurance
industry. I have been recognized by management for excellence in team
leadership, customer service, and claims competency while working with
legally complex, high-dollar claims. I would be an asset to any claims
organization.
WCCA credential in Workers' Compensation claims.
Bachelor of Science in Nursing
Master of Social Work
Fluent in written and spoken Spanish
CORE COMPETENCIES
I am an experienced claims management professional whom has demonstrated
the ability to execute my responsibilities accurately, thoroughly, all
while adapting to change in a fast-paced environment.
I correctly implement critical thinking skills and high-level reasoning to
resolve issues, successfully working both independently and while guiding a
team.
I possess excellent oral and written communication skills, maintaining
confidentiality and correctly dealing with others in sensitive situations.
I operate with customer-oriented goals in mind and with a proven ability to
address the customers' needs while adhering to protocols. I am detail-
oriented and possess the ability to focus on minute details and a goal and
the large picture of a project or task, conforming to a set of values and
accepted standards producing a positive result.
I am truthful and seen as credible in the workplace, while making decisions
or taking action to solve a problem or reach a goal. I formulate sound
decisions utilizing the available information and following a systematic
method of performing all tasks. I possess the proven competency of
comprehending and evaluating complex technical and legal topics and issues,
I am team-focused and am able to develop a particular skill set in others
to bring them up to a pre-determined standard of work performance, while
simultaneously completing all assigned tasks
Areas of Expertise
I possess the ability to be able to interact effectively with team members,
claimants, and legal staff, to oversee claims handling and to define
coverage and pay benefits correctly within the state-mandated time frames.
I am experienced in dealing with catastrophic claims whose reserves are in
excess of $250,000 involving multiple insurance carriers.
I am experienced in claim and lien negotiation and settlement resulting in
fair and equitable resolution of all claims issues.
Employment History And Selected Highlights
Professional Experience
Sr. Claims Examiner 04/29/2011 to present
Keenan & Associates
2355 Crenshaw Blvd., Suite #200
Torrance, CA 90501
Sr. Claims representative handled complex legal issues, litigation
prevention and control, negotiation of settlements, lien resolutions and
cost containment. Identified, prevented, and mitigated potential penalties.
Reported excess files to the reinsurance manager in a timely manner.
Reported files to SIU for investigations, identified, and pursued
subrogation. Updated claim reserves upon review of file and accepted
delayed claims within 90 days based on substantial evidence and internal
processes. Requested settlement authority from management and issued
notifications to insured clients. Prepared legal referrals provided
direction to and monitored defense attorneys on litigated claims.
Maintained client and claimant satisfaction by timely and thorough
reviewing and completing of all necessary actions and activities on all
claims and requests. Oversaw new claims and reserve Negotiated any/all
outstanding liens. Completed required contacts on all claims and completed
all duties assigned by Manager and Supervisor.
Field Claim Supervisor
02/05/2008 to 04/11/2011
Farmers Insurance Exchange
31051 Agoura Road
Westlake Village, California 91361
Supervised assigned team members and office personnel in all aspects of
Workers
Compensation claim handling and personnel management.
Conducted individual case review for team caseloads and evaluations of team
performance through continuous Quality Assurance audits, review of claim
statistics,
open and closed file inspection, evaluation and observation of team
activities in the field
and office.
Ensured training programs were properly utilized and oversaw all team
training
events/curriculum.
Authorized and/or approved all claims payments in conformity with
established limits of
authority.
Submitted all claims and significant loss cases exceeding individual
authority with
personal recommendation to the appropriate Director.
Reviewed and resolved coverage matters within office authority.
Oversaw the preparation of strategic business plan for the Farmers Claims
Center of Excellence.
Reviewed the settlement and day-to-day activity of team and office to
ensure fiscally
sound claim handling practices and excellent customer service.
Personally exceeded yearly performance appraisals in all objectives for
claims and
team management as did my entire team earning yearly promotions.
Senior Claim Representative
04/25/2005 to 01/25/2008
Hazelrigg Risk Management - A Corvel Company
751 Daily Drive
Camarillo, CA 93010
Successfully and individually managed a caseload of workers compensation
claims for
private sector companies and government entities for the County of Ventura
including
Ventura County Fire Department and Ventura County Sherriff's Department.
Represented Ventura County in active claim litigation including Disability
Retirement
hearings.
Recommended and carried out programs designed to meet the administrative,
technical
training and overall developmental needs of all personnel of the Third
Party
Administrator and the County of Ventura Risk Manager.
Proper management of Safety Officer claims led to an extended contract with
the County
of Ventura and a decrease in litigation and claims-related expenditures.
Claim Representative 02/15/2002 to 04/15/2005
State Compensation Insurance Fund
2901 N. Ventura Road #400
Oxnard, CA 93036
Managed and processed a varied caseload of Workers' Compensation claims for
the
employees of the State of California as a dedicated account representative
for
Atascadero State Hospital and the Employment Development Department.
Completed investigations of reported claims and determined the
compensability of all
Claims.
Monitored reserve accuracy.
Filed necessary documentation with state agencies.
Maintained quality assurance standards to support performance management
initiatives
and consistent delivery of quality claims service.
Developed and managed claim action plans to resolution, coordinated return-
to-work efforts and approved all claim payments.
Education and Credentials
Bachelor of Science in Nursing
2002
University of Texas Pan American
Edinburgh, Texas
Completed double major - Masters in Social Work and Bachelor of Nursing.
Doctorate in Health Sciences
1999
Universidad De Monterrey
Monterrey, N.L., Mexico
Military Service
United States Air Force
06/21/1977 - 04/15/1982
Medical Services Corp
Affiliations
Member in Good Standing - National Association of Clinical Social Workers,
2000
Licenses
Self-Insurance Administrator's Examination - State of California,
Sacramento, California,
2007. Successful completion of examination given by Self-Insurance Plans
Pursuant to
Title 8, California Code of Regulations, and Section 15452, passing the
examination demonstrates individual competence as an administrator of self-
insured workers compensation claims.
Training
Claims Leadership Development University of Farmers, Westlake Village,
California, 2009 to 2009. Successful completion with Honors of Claims
Leadership Development program
Honors
Recognized by University Leadership by inclusion in Who's Who in American
Colleges and Universities, Edinburgh, Texas, 2000.
Recognized as a student leader, activist and member in good standing of
clubs and organizations which foster good will between University
Administrators and students
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