Legal Assistant

-->

Cell

***********@*****.***

Objective

To obtain a long-term position with a well-established company, which also provides benefits and the opportunity for advancement.

Work Experience

Legal Assistant

12/18/2008 - Present Adams & Jordan, A Professional Corporation, GA

Assisting attorneys with a variety of duties related to legal documents, research, compiling documents for litigation cases, maintaining legal files, fielding phone calls, scheduling appointments and performing other duties related to secretarial responsibilities.

Workers' Compensation Claims Examiner III

01/22/08 - 02/21/10 Sedgwick CMS (TPA - Self-Insured/Self-Administered), Atlanta, GA

Analyze and process worker's compensation claims by investigating and gathering information to determine the exposure on the claim, negotiate settlement of claims up to designated authority level and make claim payments, process complex or technically difficult claims, calculate and assign timely and appropriate reserves to claims and continue to monitor reserve adequacy throughout the life of the claim, develop and manage claims through well developed action plans, prepare necessary state filings within statutory limits, actively manage the litigation process, determine benefits due; make timely claims payments and adjustments, coordinate vendor referrals for additional investigation and/or litigation management, use appropriate cost containment techniques including strategic vendor partnerships to reduce overall cost of claims for our clients, manage claim recoveries of all types, reports claims to the excess carrier, frequently communicate claim activity and processing with the ill or injured party and the client, maintain professional client relationships, and finally maintain a quality assurance program to support the Total Performance Management initiative and the consistent delivery of quality claims service.

Workers' Compensation Claims Examiner

06/30/2003 - 08/10/2007 S.C.R.M.A. (TPA - Self-Insured/Self-Administered), Upland, CA

Effectively managed a caseload of 120 to 250 workers' compensation files, including very complex claims; Initiated and conducted investigation in a timely manner; Determined compensability of claims and administered benefits, based upon state law and in accordance with established Company guidelines; Managed medical treatment and medical billing, authorizing as appropriate; Referred cases to outside defense counsel, directed and managed as appropriate; Communicated with claimants, providers and vendors regarding claims issues; Computed and set reserves within Company guidelines; Settled and/or finalized all claims and obtained authority as designated; Maintained a diary system for case review and documented files to reflect the status and work being performed on the file; Communicated appropriate information promptly to the client to resolve claims efficiently, including any injury trends or other safety related concerns; Involved loss control staff when appropriate; Adhered to all Company policies and procedures; Conducted face to face quarterly file reviews with the client, defense counsel; Other duties as assigned.

Administrative Assistant / Office Manager

05/20/01 - 12/17/02 Belco Electric, Inc. (Electrical Engineer), Yorba Linda, CA

Performed administrative duties for executive management. Responsibilities included screening calls, making travel and meeting arrangements, preparing reports, financial data, payroll, and customer relations. Computer and internet research, interpersonal skills, project coordination, worked with all levels of internal management and staff, as well as outside clients and vendors and maintained office when executive management was out.

Workers' Compensation Claims Assistant

9/2000 - 05/18/2001 S.C.R.M.A. (TPA - Self-Insured/Self-Administered), Upland, CA

Assisted Claims Examiners in all job duties. Performed administrative and complex clerical work in processing and controlling medical expenses related to Workers Compensation. Work involved considerable internal and external contacts, difficult non-routine tasks and access to confidential information. Judgment and initiative were exercised frequently in answering verbal and written communications and in interpreting and applying company-wide policies and procedures.

Worker's Comp Claims Exam Trainee

10/1998 - 8/2000 GAB Robins North America, Inc. (TPA), Ontario, California

Training to handle all aspects of workers' compensation claims from receipt to conclusion, including litigated, non-litigated and life-time worker's compensation claims. Learning to investigate claims to secure information, arrange settlement of claims based on fact, multi-tasking and proper documentation and correspondence on all claims.

Claims Service Representative

8/1995 - 10/1998 CNA Insurance Company, Glendale, California

Medical Only Worker's Compensation claims handler for California and Arizona claims. Processed non-contracted provider claims accurately and in a timely manner, meeting established Department and Company guidelines for quantity, turnaround time and accuracy; Generated correspondence to request missing information necessary to complete claim payment, and appropriate letters for denied claims; Determined level of reimbursement based on established criteria, provider contract, or plan provisions; Entered necessary coding information into computer system to process claims in accordance with established system criteria and department guidelines, meeting necessary deadlines and regulatory requirements; Documented provider claims/system to support payments and decisions.

Administrative Secretary

5/1995 - 8/1995 Prime Care Medical Group, Corona, California

Composed correspondence, reports, forms and other documents independently or from transcribing machines, notes, or general instruction from manager; proofread material and corrected grammar, spelling, and word usage; received and screened calls and directed them to the appropriate party for disposition; interpreted routine administrative matters and explained procedures to others; made appointments, coordinated meetings, and scheduled conference rooms for medical staff/supervisors; established filing system for medical contractual records,, purchase orders and equipment inventory; maintained and controlled confidential employee or departmental files; scheduled facility and office equipment maintenance; and developed computerized spreadsheets and databases to enter information and generate reports.

Transcription Secretary

6/1994 - 9/1994 CRR, Inc., Riverside, California

Transcribing all reports, letters, resumes, etc., for vocational rehabilitation insurance services, communication skills, maintaining system updates, answering telephones, and filing.

Secretary

2/1988 - 6/1994 Krueper Engineering, San Bernardino, California

Preparing materials, maintaining records, organizing schedules as needed, contacting clients and customers, setting up of new cases, communication skills, transcribing, typing, answering telephones, and other numerous tasks. Most importantly, discretion and confidentiality was utilized at all times.

Personal Lines Claims Assistant

2/1986 - 8/1986 Scott Wetzel Insurance Company, Brea, California

Setting up new claims, paying bills, transcription, 10-Key, taking recorded statements, computer processing, handling minor liability claims, typing, and assisting the adjusters in any way possible.

Claims Data Processor

10/1984 - 2/1986 Blue Shield Insurance, Colton, California

Processing Medical and Medicare Claims, and 10-Key.

Personal Lines Claims Processor

6/1983 - 10/1984 Aetna Insurance Company, San Bernardino, California

Setting up new claims, closing out files, computer processing, answering telephones, typing, mail and filing.

Certified Nurses Aide

1/1983 - 6/1983 Parkside Convalescent Hospital, San Bernardino, California

Assistance to patients with daily living tasks, under the supervision of a registered nurse. Worked closely with patients, and was responsible for basic care services, such as bathing, grooming, feeding, daily vital signs and assisted nurses with medical equipment. Also gave patients important social and emotional support and provided vital information on the patient's condition to head nurses.

Cashier/Stocker

6/1982 - 1/1983 Sav-On Drugs Store, Fontana, California

Price checking, cashiering, and stocking shelves.

Education

6/1982 Fontana High School, Fontana, California

Certification

Complete High School and achieved my Diploma. Also complete nurses training while in high school and received my certification as a Certified Nurses Assistant.

Workers' Compensation Self-Insured/Self-Administered, Los Angeles, CA

Certification

Obtained my Self-Insured/Self-Administered Certificate to handle Third Party Administered Workers' Compensation Claims.

Skills

Microsoft Office, Transcription, Typing approximately 65+ WPM, 10-Key, Communicative Skills, Office Equipment, etc.

References

Available Upon Request

Contact this candidate