Customer Service Medical

Pamela Runnfeldt

Email: *********@********.***

Address: *** *. ****** ******

City: Oak Park

State: IL

Zip: 60302

Country: USA

Phone: 708-***-****

Skill Level: Entry

Salary Range: $70,000

Primary Skills/Experience:

See Resume

Educational Background:

See Resume

Job History / Details:

Pamela M. Runnfeldt

842 N. Harvey Avenue

Oak Park, IL 60302

Home Phone 708-***-****

OBJECTIVE: Looking for a position that will allow me to work from home as an examiner in the Worker`s Compensation Field or as a Data Entry clerk to work remotely providing service to internal and/or external customers that will allow me to utilize my 20+ years of experience.

QUALIFICATIONS 20+ years of experience as a claims adjuster handling complex lost time, subrogation and litigated workers` compensation claims. Excellent interpersonal and customer service skills. A track record of successfully negotiating agreements with injured workers and petitioner attorneys. I handle claims from the state of Illinois, Wisconsin, Kansas, Missouri, Michigan, Minnesota, Tennessee and Indiana. I currently hold a Texas License, which qualifies me to handle up to twenty-one more states. I also have a non-resident Florida license.

EMPLOYMENT

1999-2012 Claims Examiner/Sedgwick CMS (A Third Party Administrator)

2005-2007 National/Local

Responsibilities:

Handling workers compensation claims and disability for the states of Illinois, Indiana, Tennessee and Wisconsin, taking recorded statements, determining compensability, establishing reserves, negotiating settlements, handling litigated and subrogated claims, leading file review meeting telephonically and traveling to lead offsite claims review meetings.

In handling the State of Wisconsin, my responsibilities include checking the Department of Workforce website at least 3 times a week, to make sure that all information is kept up to date. Making sure that benefits are paid within 14 days. Completing the WKC13 and WKC13A forms on initial lost time claims. Requesting WKC16 forms to be completed by treating doctors, once it is know that an employee is at Maximum Medical Improvement and or is discharged from treatment.

Accomplishments:

- Took on an account on short notice and brought the account up to speed.

2003-2005 SBC Medical Absence & Accommodation Resource Team

Responsibilities:

Handling workers compensation claims and disability for the states of Illinois, Indiana, Kansas, Missouri and Wisconsin, taking recorded statements, determining compensability, establishing reserves, negotiating settlements, handling litigated and subrogated claims, leading onsite file review meetings and traveling to lead offsite claims review meetings, verifying clinical findings and approving or denying claims.

In handling the State of Wisconsin, my responsibilities include checking the Department of Workforce website at least 3 times a week, to make sure that all information is kept up to date. Making sure that benefits are paid within 14 days. Completing the WKC13 and WKC13A forms on initial lost time claims. Requesting WKC16 forms to be completed by treating doctors, once it is know that an employee is at Maximum Medical Improvement and or is discharged from treatment.

Accomplishments:

Reduced penalties paid to the State of Wisconsin from the previous year.

Passed the Texas license examination, which qualifies me to handle 21 additional states.

Won second place in the closing contest twice.

Received five -You`re In Focus- awards from mangers, supervisors and peers.

1999-2003 Sedgwick CMS/National and Local

Responsibilities:

Handling workers compensation claims and disability for the states of Illinois, Indiana, Kansas, Missouri and Wisconsin, taking recorded statements, determining compensability, establishing reserves, negotiating settlements, handling litigated and subrogated claims, leading onsite file review meetings and traveling to lead offsite claims review meetings.

In handling the State of Wisconsin, my responsibilities include checking the Department of Workforce website at least 3 times a week, to make sure that all information is kept up to date. Making sure that benefits are paid within 14 days. Completing the WKC13 and WKC13A forms on initial lost time claims. Requesting WKC16 forms to be completed by treating doctors, once it is know that an employee is at Maximum Medical Improvement and or is discharged from treatment.

Accomplishments:

Won the Focus Performer Award.

Received 7 -You`re In Focus- awards from mangers, supervisors and peers.

Built positive relationships with newly launched accounts, including Tyco International, Verizon, Verizon Communications and Toyota.

Handled run off claims for Consolidated Freightways, while handling regular clients.

1995-1999 Claims Specialist/Alexsis Risk Management (Third Party Administrator)

Responsible for handling workers compensation claims in Illinois, Indiana and Wisconsin, taking recorded statements, determining compensability of claims, establishing adequate reserves, negotiating settlements, handling litigated and subrogated claims, paying medical bills, acting as a liaison with upper management and defense attorneys, reporting claims to excess carriers, leading claims review meetings onsite and traveling offsite.

In handling the State of Wisconsin, my responsibilities include checking the Department of Workforce website at least 3 times a week, to make sure that all information is kept up to date. Making sure that benefits are paid within 14 days. Completing the WKC13 and WKC13A forms on initial lost time claims. Requesting WKC16 forms to be completed by treating doctors, once it is know that an employee is at Maximum Medical Improvement and or is discharged from treatment.

1991-1995 Claims Adjuster/Chicago Housing Authority (Self-Insured Administrator)

Responsible for investigating claims, conducting interviews with injured workers, taking recorded statements, determining compensability of claims, establishing adequate reserves, negotiating settlements, handling litigation and subrogated claims, working with defense attorney reporting claims to excess carriers.

1988-1991 Claims Adjuster/Claims Overload, Inc. (Temporary Service Organization)

Worked as a temporary claims adjuster with several third party administrators and insurance companies

1986-1988 Claims Adjuster/Great American Insurance Co. (Third Party Administrator)

Responsible for investigating claims, taking recorded statements, determining compensability of claims, establishing adequate reserves, negotiating settlements, handling litigation and subrogated claims, working with defense attorney reporting claims to excess carriers.

1985-1986 Claims Representative/ Travelers Insurance Co.

Trained for adjuster position. Responsible for setting-up claims, establishing reserves, requesting medical reports, taking recorded statements and negotiating settlements.

Obtained medical Terminology Certificate

Attended Illinois Workers` Compensation continuing Legal Education course.

1984-1985 Auto Customer Service Representative/ Travelers Insurance Company

Responsible for setting up reports, rentals, appraisals and light typing.

EDUCATION

Taylor Business Institute

Illinois Workers` Compensation Continuing Legal Education

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