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Medical Workers Compensation

Location:
7030, United States
Posted:
March 16, 2011

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KELLY M. ELVIN

*** ********** **. ***. * Hoboken, New Jersey 07030 (908) ***-**** abhqn6@r.postjobfree.com

PROFESSIONAL EXPERIENCE: June 2004 - Present

Progressive Insurance

Claims Specialist Intermediate Iselin, NJ June 2008- Present

• Maintains a superior performance rating in file quality handling of 91%, exceeding the 80%

departmental goal.

• Consistently meets individual productivity goals by settling 9.5% of injury inventory on a monthly basis.

• Makes business decisions to pursue lowest ultimate cost strategies for settlement.

• Recognizes and addresses all exposures timely and sets suitable company reserves.

• Resolves high complexity auto claims involving multiple vehicles, pedestrians, commercial vehicle and

significant injuries.

• Assesses complex coverage issues including excess, co-primary, under/uninsured motorist, and

commercial policy.

• Completes investigations to resolve coverage and liability disputes, identify fraudulent activity, pursue

subrogation opportunities, and request formal policy denials when appropriate.

• Evaluates plaintiff demands by reviewing all medical records, prior loss histories, liability and causation.

• Determines proper values for cases and exhibit a professional negotiation style when reaching

settlement.

• Handles initial stages of litigation and/or arbitration when settlement is not reached and case is deemed

defendable.

Claims Generalist Intermediate Iselin, NJ June 2006 – May 2008

• Display knowledge and assurance when explaining injury handling processes to unrepresented injured

parties, which includes NJ PIP, UM/UIM, Workers Compensation, and NJ Threshold.

• Review injury claim value and decide settlement range by assessing parties’ credibility, nature and

consistency of treatment, manner of impact, and degree of property damage.

• Interpret commercial policies and business contracts to determine what coverage’s apply to specific

damages.

• Manage repair process which includes labor/refinish operations and part replacement, while reviewing

requests for supplemental repair orders.

Claims Generalist Associate Allentown, PA June 2004 – May 2006

• Investigate and determine the extent of company liability and casualty coverage concerning loss and

damages so appropriate indemnification can be obtained.

• Correspond with, or interview insured’s, claimants, medical specialists, agents, police, witnesses, and

legal professionals to compile information and direct proper file handling.

• Estimate cost of repair and replacement to damaged property, judging whether a vehicle should be

declared a total loss, obtain titles, and dispose of salvage.

EDUCATION: Lock Haven University of Pennsylvania, Lock Haven, Pennsylvania

Bachelor of Science in Criminal Justice, GPA 4.0 May 2004

Bachelor of Arts in Sociology, GPA 4.0 May 2004

Honors: Dean’s List, University Honors, Phi Kappa Phi Honors Society

American Educational Institute

Legal Principles Program October 2006

Courses: Contracts, Tort Concepts, Tort Theories & Defenses, Agency, Bailment’s, Damages, and

Subrogation



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