Workers Compensation Insurance

Robert F. Balboni

*** ******* ******

East Bridgewater, MA 02333

508-***-**** ( ********@*******.***

Workers Compensation Claims Specialist, offering BS in Economics and proven

track record for exceptional service and diligence.

Education & Certifications

( Bachelor of Science in Economics; Bentley College

( Workers Compensation Adjuster License

( HIAA Group & Individual Life and Health Insurance Certification

Workers Compensation Highlights

. Managed nationwide self-insurance workers compensation program for a

billion dollar a year environmental services company improving

communication, reducing A/P aging, and improved closing ratio

. Negotiated and conveyed claim settlements within settlement authority

. Manage file inventory to ensure timely resolution of cases

. Create monthly loss allocation reports utilizing Risk Management

Information Systems

. Conducted 3 point investigation determining compensability and

subrogation opportunities

. Established timely and appropriate reserves

. Prepared state filings, maintained diary and effective file

documentation

. Investigated and disposed of medical-only workers compensation claims

in NY, PA, CT, MA, & IL

. Reviewed and processed medical bills for payment on reported & non-

reported claims and reimbursed claimants for out of pocket expenses

. Determined cases to be litigated and coordinated defense strategy with

legal counsel

. Calculated benefit rates for lost time claims prior to transfer

Clean Harbors Environmental Service; Norwell, MA

Claim Specialist, contract; 2009-2010

Massamont Insurance Agency; Boston, MA

Workers Compensation Adjuster, contract; 2008 -2009

MAC Risk Management; Canton, MA

Workers Compensation Representative, contract; 2006 -2007

Other Work Experience

Pharmerica

Brockton, MA

Admissions Representative, contract; 2007-2008

. Collected/reviewed resident information and relevant documentation

with facility admissions personnel to ensure accurate admissions and

re-admissions

. Worked with billing and collection staff to ensure accuracy of billing

information

. Monitored status of Medicaid eligibility securing financial

responsibility for claims

. Completed full benefit investigation via 3rd party insurance, hospice,

and Medicaid contacts

IFMG Securities, Inc.

Rockland, MA

Financial Consultant; 2005-2006

. Sold investment products including fixed and variable annuities,

mutual funds, 529 plans

. Serviced existing book of business by providing assistance with

withdrawals, general questions, and annual reviews

. Created and delivered branch training classes to improve referral

generation and produce high quality leads

Sovereign Bank

Boston, MA

Personal Banking Representative; 2003-2004

. Provided existing and prospective customers with consultative guidance

and execution across equity, fixed income, and insurance products

. Garnered high client satisfaction ratings through explanation of

market events, appropriate investment vehicles, and

diversification/risk reduction strategies

. Met all quota goals for appointment setting and revenue generation

while working in newly developed bank program

Quick & Reilly

Lincoln, RI

Premium Client Trading Representative; 2000-2002

. Delivered a significant contribution to the launch of a new 100+ seat

brokerage/client service call center

. Executed 70+ trades a day across equity, option, fixed income, and

mutual fund instruments for high net worth individuals

. Consistently achieved top-tier rankings in CSR performance metrics

(volume handled, query resolution, and accuracy rate

Previous Insurance Work Experience (1990's)

United HealthCare

Warwick, RI Account Renewal Representative

. Prepared and delivered commercial group health insurance policies for

small business accounts. Communicated demographic changes to underwriting

department and assisted with establishing new premium rates. Achieved a

retention rate of 93% and expanded enrollment. Participated in a contract

installation improvement initiative to reduce the amount of

administrative errors at groups' renewal date. Worked extensively with

direct and broker represented accounts in MA and RI.

Blue Cross of MA

Cambridge, MA Account Service Representative

. Communicated enrollment and underwriting guidelines, benefit information,

and policy design to benefit administrators. Experienced with several

product types including; Indemnity, PPO, POS, and HMO. Conducted group

presentations to employee groups regarding product design. Resolved the

highest level enrollment and claim problems and reduced the incidence of

these problems through plan sponsor and group member education.

Consistently received highest scores on quarterly survey.

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