Manager Medical
Resume:
Julie A. Waters
Walnut Creek, CA 94598
Phone: 925-***-****
**********@*****.***
Career Objective: To utilize my skills in a challenging position with
opportunities for advancement and development of personal
growth.
Experience:
July 2004 - Sept 2008 Cannon Cochran Management Services, Inc., Concord,
CA
Claims/Account Manager
Workers' Compensation Claims Manager
. Provide a working climate/environment in which personnel
are motivated to perform to full potential. Establish
mentorship programs to increase the overall level of
expertise and proficiency of Claims Department staff.
Ensure effective and timely communications. Oversee the
management of Claims Department workflow. Manage and
coordinate Claims Department interaction with Insurance
Carriers. Oversee the development and maintenance of
Claims Department employees' technical expertise.
Monitor internal and external customer or member service
claim questions, concerns, and related issues. Reviews
claim reports for claims accuracy
Account Manager
. Provide overall account support, in and out of office,
in conjunction with or on behalf of
Producers. Independently establish and maintain client
relationships and provide a high level of technical
service. Support Producer in a manner that will
effectively relieve them of the need to be closely
involved in the daily activities associated with the
service and maintenance of clients. Act as liaison to
accomplish timely and smooth implementation. Resolve
problems/claim issues in a effective and pleasant
manner. Complete initial QSP's or update existing
handling procedures to meet the client's needs.
July 2004 - Royal & SunAlliance, Walnut Creek, CA
November 1992 Workers' Compensation Supervisor
. Direct, control, monitor and provide technical and
supervisory guidance. Evaluate performance according to
established, corporate standards. Prepare performance
appraisals and recommends salary action for staff.
Participate in interview and hiring process and train
new employees assigned to my unit. Responsible for
claims management of claims, which may include special
handling instructions, Best practices and the Labor
Code.
November 1992 - Scott Wetzel Services, Concord, CA
May 1990 Workers Compensation Sr. Claims Examiner
May 1990 - Nationwide Gates, Concord, CA
July 1986 Workers' Compensation Sr. Claims Examiner
. Provide telephonic case management; Three point contacts
per Best Practice and/or per client service plans,
Initiate letters and State reporting forms per State
Regulations, including benefit notices, issue and or
approve indemnity, medical and mileage checks as
applicable to claims.
. Establish reserves to reflect claim exposure and
document rationale in notes.
. Aggressively pursue all claim resolution strategies
including working closely with Medical Case Manager to
facilitate return to work by jointly coordinating
medical and disability benefits, focus on permanent and
stationary reports, Panel, Defense and Applicant
Qualified Medical Reports, Agreed Medical Evaluations
etc.; Settle claim via Compromise and Release,
Stipulated Award or Findings and Award.
. Manage files with attorney representation and vocational
rehabilitation exposure
Work closely with customers
in connection with claim issues.
. Set up and investigate lost time and/or litigated
claims. Determine compensability, monitor medical
treatment for appropriateness; set reserves on claims
for most probable outcome; dispatch to appropriate
specialist when needed; maintain cost containment;
resolve claims with best possible results.
July 1986 - LJR Insurance Services, Emeryville, CA
April 1980 Workers' Compensation Claims Assistant to Claims Examiner
. Answer phones, set up files, input billing, sort and
file mail, send out notices/letters, set up doctor
appointments, assist and support six claim adjustors.
. Handled all Medical Only claims with no lost time.
Set up new files and monitor for closure or transfer
if lost time passed three days or employee on
modified duty for more than three months.
. Set up and monitored files with exposure up to
$10,000.00. Paid bills, set reserves, rate reports,
settle claims with no litigation.
. Set up and investigate lost time and/or litigated
claims. Determine compensability, monitor medical
treatment for appropriateness, set reserves on claims
for most probable outcome; dispatch to appropriate
specialist when needed; maintain cost containment;
resolve claims with best possible results.
Education: Self Insured Certificate
American Academy High School
DVICA
Fire and Casualty Agent Pre-License
References: Ms. Deborah Ancona 925-***-****
Mr. Arrieta 866-***-**** x1089
Ms. Julie Jarrell 260-***-****
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