Customer Service Management

Lourdes P. Williams

***** ********** ******, ******, ** 91335

Home 818-***-****

OBJECTIVE:

Seeking a position as a Workers' Compensation Supervisor/Sr. Adjuster where

previous abilities and experience will be of mutual value and allow for

continued professional growth.

Qualifications:

Highly experienced in all phases of Worker's Compensation, including

updated training of current Labor Law changes, effective organizational

skills, bilingual (English and Spanish), collaborates well with personnel

at all levels including clients and vendors, great

interpersonal/supervisory/managerial skills, superior analytical and

negotiation tactics, have knowledge of legal liabilities, general insurance

policy coverage and. Create/Enforce time management strategies to meet

critical deadlines including daily diaries, effective with evaluation

processes, financial and managerial decision making. Experienced with

litigations, presentations, SIU, office procedures and strong leadership.

Skills

Microsoft Office including, Word, Excel, Power Point, Internet, Email,

Calendar, GWEO, Access, Transcription, typing 55+ wpm, Recorded Statements,

Training, Presentations, Team leadership, Interoffice Client/Vendor

relationships, Fraud tactics, supervisor/managerial management, document

handling, clinical processes, litigations, financial management, daily

diaries and effective time management skills.

Work Experience:

04/09 - Present Sedgwick CMS Senior Claims Examiner

Maintain case load of 150 files. Determine coverage as

related to policies in effect prior to Insurer's insolvency.

Any file open with liens as a remaining issue is handled

by the Adjuster. Regularly review legal calendar for WCAB Hearing or

DOR filed due to the inability to resolve and make a timely

decision on whether to obtain a defense counsel to

negotiate or to proceed to hearing. As an Examiner I act

as CIGA's representative in matters relating to CIGA's obligations under

the California Insurance Code Article 14.2 section

1063et seq. (covered claims only). Prepare files for 6

month audits. Ensure utilization of CIGA's MPN providers.

09/07 - 03/09 Tristar Risk Management Claims Supervisor

Under minimal supervision managed

and directed activity of claims unit ensuring

high-quality results and management of claims in

compliance with state laws and company

procedures.

Directly Supervision of examiners and clerical staff.

Including monitoring attendance job performance,

evaluations and disciplinary issues.

Conducts and documents in-house and outside educational

sessions. Responsible for

coordinating the initial triage process. Makes initial.

Identification of issues, resource identification and

final decision on where the file will be managed.

Provides expert understanding of Life Care plans, MSA's,

Rated age, disability Ratings pre 2004 and AMA.

12/05 - 04/07 AIMS Claims Supervisor

Active participation establishing/creating AIMS Procedure

Employee Manual.

Proficiently interviewed and help recruit over 60 employees

while taking over the LA

County account of (12,000 files).

Provide high quality, high impact customer service care

Appointed as an SIU Supervisor.

Developed and led the wining team for closings/production

for the last year.

Trained Technical personnel and file room clerks.

Maintained and provided monthly evaluations of direct

employee's.

08/03 - 12/05 Hazelrigg Risk Management Claims Supervisor

Supervised and trained teams of four Claim Adjusters and

two Claims assistants.

Coordinated all (MSC) Mandatory Settlement Conferences.

Maintained company standards of all required DWC and Rehab

notices.

Active participation in development of MPN for employer

Proficient in dismissal techniques utilizing Labor and

Insurance Codes.

Coordinate training and seminars reflecting changes in

Workers' Compensation law.

Ensure prompt and accurate delivery of all benefits.

Coordinated monthly meetings of an Early Return to Work

Program.

12/00 - 8/03 ACE/ESIS Sr. Workers' Compensation Examiner

Dedicated to the Orange County Fire Authority Account

Acting supervisor in the absence of the Unit Supervisor.

Attended Mandatory Settlement Conferences, Lien

Conferences, Trials, and Rehabilitation Conferences.

Interfaced daily with employers, doctors, Attorneys and

injured workers as well as trained/obtained subrogation

recovery issues.

Worked effectively with Risk Management/Underwriting

Departments.

04/98 - 12/00 Travelers Insurance Senior Claims Examiner

Dedicated to the MTA account Managed and controlled an

inventory of 250 files of which 70% were litigated.

Attended Mandatory Settlement Conferences, Lien

Conferences, Trials and Rehabilitation Conferences.

Participated in various settlement projects, including

bulk/structured settlements.

Claim reviews and extensive customer service.

Attained company standards in closing percentage.

Managed accounts with specialized handling instructions.

03/91 - 03/98 Helmsman Management/Liberty Mutual Senior Claims

Case Manager

Dedicated to the LAUSD Account

Handled a caseload of 200 files of

which 85% were litigated.

Attended Mandatory Settlement Conferences, Lien

Conferences, Lien Trials, and Rehabilitation Conferences.

Selected to provide training for

newly adopted Junior Examiners.

Unit contact person for direction

and guidance on high loss/catastrophic injuries.

Full responsibility for the

financial and legal results on each file, 800 in the unit

Extensive employer contact and

public relations.

Worked closely with Risk Management

and Underwriting Departments.

Accomplishments:

. Successfully led the investigation of several medical group providers

with unethical billing practices, resulting in a reinstitution of

thousands of dollars back to our client and leading to the persecution

of the medical group by the District Attorney's office.

. Achieved three "take nothing judgments" as a Claims Adjuster.

Judgments of this scale are very hard to obtain in the insurance

industry when the injured is favored by judicial system.

. Certificate awarded for direct participation and diffusion of the "Why

on Monday Program". This program is currently utilized by most

Industrial clinics today when releasing patients back to work after a

period of disability. The transition is easier for the injured worker

when he/she returns to work for a short week and then he/she has a

weekend rest before returning to his/her full schedule.

. Appointed Special Investigate Unit Supervisor. Awarded this

positional duty as a result from past positive judgments received and

workers compensation disciplines.

. Successfully passed OBAE and SAS 70 Audits.

Insurance Designations:

. Experienced Claims Adjuster Designation

. SIP Certificate

. IEA Certificate in Workers' Compensation Claims Administration

. Certified Professional Disability Management CPDM.

. Workers' Compensation Reserving Practices and Theory.

. IEA accelerated Training For Workers' Compensation Claims Examiners

. Leadership and Supervisory Skills.

Education: University Mexico City, Mexico Major -

Psychology

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