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Customer Service Medical workers' comp claims adjuster cook

Location:
Los Angeles, CA
Posted:
June 26, 2017

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Resume:

Kellie D. Martin

***** ********* ***., ****** ****, CA 90230

310-***-****

I am a Workers’ Compensation Claims Adjuster with an approximate 2-year gap in employment. I was laid off from an organization in 2014 where I would have otherwise been responsible for a substantial hospital account, however, it did not materialize. In 2015 I began volunteering in an office, all the while pursuing jobs. In 2016 I became ill, but am currently in much better health and I am actively getting back into the workforce.

Employment History:

Sprouts Farmers Market / Baker 9/1/16 – present

Los Angeles, CA

Job Duties:

-Responsible for baking of all product, including breads, muffins, pies, cookies and various pastries

CA Claims Management Services / The Ultimate Lien Solution

Torrance, CA 2/24/14 - 8/27/14

ACE/ESIS

Chatsworth, CA 5/13/13 - 12/18/13

Intercare Holdings Insurance Services

Pasadena, CA 11/4/11 - 5/8/13

Graiwer & Kaplan

Los Angeles, CA 12/15/09 - 10/15/11

Sedgwick Claims Management Services

Pasadena, CA 3/1/07 - 12/8/09

Integrated Claims Administrators

Torrance, CA 1/18/05 - 2/25/07

Cambridge Integrated Services

Pasadena, CA 6/1/99 - 1/14/05

Job Duties:

-Intake of new losses, consisting of phone interviews and formulation of an action plan per company protocol and client guidelines

-Calculation and facilitation of benefits and benefit notices

-Timely provision of medical treatment within client’s Medical Provider Network, as well as processing of necessary expenses, all based upon the CA Official Medical Fee Schedule

-Reserve establishment, including a synopsis of current and future costs for an assessment of the projected case exposure

-Satisfaction of outstanding lien matters by way of demand solicitation, negotiation and resolution

-Disability rating of medical reports to determine the level of permanent disability, conceivable return to pre-injury occupation, anticipated future medical care and to place an overall value on the case

-Engaging in routine large-loss reviews with the client to discuss all relevant issues and to reach a cost-effective settlement for all involved parties

-Preparation of files for defense counsel appearing before the Judge at the WCAB, to include all significant documents and exhibits

Skills:

Capable of handling an advanced and varied caseload and providing quality customer service, multi-tasking, excellent communication skills, excel in a team-oriented environment, thorough and consistent, able to meet deadlines and work under pressure, pay close attention to detail, resourceful and a self-starter.

Education and Training:

• CA Self-Insured Certificate / WCCP / Adjuster Designation, as well as Associates Degree in Culinary Arts



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