Workers' Compensation

Objective

Secure a position as a Workers’ Compensation Support – Agency Liaison with an industry leader who expects exceptional performance. Allowing to contribute to the continued growth and success of the organization, while reducing workers’ compensation costs.

Experience

TriNet HR III, Inc., Remote, CA September 2016 to Present

Workers’ Compensation Claims Analyst

• Perform thorough review of claims for proper strategy and reserving of indemnity claims

• Make recommendations to the TPAs and participate in adjuster training when weaknesses are identified

• Communicate with claims adjusters to assist in determining causation and possible subrogation opportunities along with develop strategies and document a clear plan of action to bring the claims to closure

• Ensure claims adjusters adhere to Best Practice claims management and Workers’ Compensation regulations

• Audit the TPAs and claims against Best Practices

• Employ proper techniques to mitigate claims expense including, but not limited to: control for medical overutilization, reduce litigation expense, and proper use of other vendors to avoid costs to the claim without value to the claim outcome

• Review monthly loss runs and claim trends to identify opportunities to reduce average claim costs

Gallagher Bassett Services, Inc., Corona, CA October 2014 to August 2016

Senior Claims Adjuster

• Provide proper judgement and decision making to analyze a claims exposure, to determine the proper course of action, and to appropriately settle the claim

• Complete the investigation, determination and evaluation of coverage

• Interact extensively with the client, employers, account manager, and defense counsel throughout the claim process

• Demonstrate complete knowledge of the claim file process through presentation of actions and responses to client questions

• Manage the litigation process

• Clearly communicate concise action plans, and present plans for moving the claim to resolution

• Ensure claim files are properly documented and claims coding is correct

• Calculate and assign timely the appropriate reserves to claims, and monitor reserve adequacy throughout the life of the claim

• Train and mentor new hires and recently promoted colleagues

• Process claims consistent with clients’ and corporate policies, procedures, and Best Practices

Sedgwick CMS, Ontario, CA June 2010 to September 2014

Senior Claims Adjuster

• Analyze and process workers’ compensation claims by investigating and gathering information to determine the exposure on the claim

• Manage claims through action plans to an appropriate and timely resolution

• Calculate and assign timely the appropriate reserves to claims, and monitor reserve adequacy throughout the life of the claim

• Process workers’ compensation claims determining compensability and benefits due, monitor reserve accuracy, and file necessary documentation with the state agency

• Develops and manages workers’ compensation claims action plans to resolution, coordinates return-to-work efforts, and approves claim payments

• Approves and processes assigned workers’ compensation claims, determines benefits due, and manages action plan pursuant to the disability claim or client contract

• Calculate and pay benefits due; approve and make timely claim payments and adjustment

• Communications claim action/processing with claimant and client

• Ensure claim files are properly documented and claims coding is correct.

• Manage the litigation process

• Train and mentor new hires and recently promoted colleagues

• Support the organization’s quality programs

Claims Assistant - Workers’ Compensation

• Prepare and mail Notices of Offer of Regular/Modified Work to the WCAB, the claimant and all necessary parties

• Complete all benefit notices and mail to all parties in a timely manner

• Input and review notes/diaries in claims management system as instructed

• Set up medical appointments, and mail all medical documentation

• Prepare legal referrals and subpoenas

UPS Cartage Services, Inc., Ontario, CA August 2003 to June 2010

(formerly Menlo Worldwide Forwarding)

Operations Supervisor

• Responsible for supervising and directing 20 drivers for deliveries, pick-ups, and dock duties

• Prepare documents for audits and conduct safety trainings

• Liaison for OSHA audits

• Enter invoices in the Oracle system, assign Requisition and PO numbers and forward to appropriate department for payment

• Work Oracle PO Closure report for any open invoices

• Calculate all daily revenue, shipments, and weight, enter totals into excel spreadsheet and forward the Daily Operations Report to the District Office

• Discuss Workers’ Compensation issues with employees and update information on the IEP Report

• Maintain DOT (Department of Transportation) board, send updated medical reports to UPS Health and Safety Department and forward renewed driver licenses to the Field Safety Department

• Contact shippers/consignees/third parties regarding required legal documents for international shipments and custom clearance

• Forward necessary documents for legalization

• Complete Certificate of Origin and/or Shipper’s Letter of Instructions as needed

• Train new customer service agents on all duties

• Provide rate quotes and schedule pick-ups for domestic and international shipments

• Sent pre alerts regarding priority shipments

• Worked TINU, Gemini, Edits, Data Quality, and Incomplete reports

Citrus Municipal Court, West Covina, CA June 1987 to October 1995

Judicial Assistant (Courtroom Clerk), Deputy Clerk III, II, I

• Judge’s assistant within both traffic and criminal courtrooms

• Trained Deputy Clerk I’s and II’s

• Assisted Judge, District Attorneys, Public Offenders, Detectives, and Probation within the courtroom

• Conducted the orientation for jurors, called panels for courtrooms, excused jurors from serving

• Completed and forwarded custody/release papers to county jail

• Swore in jurors and witnesses, accepted and registered evidence, read verdict, and poled jurors

• Completed paperwork for drug rehabilitation, counseling, and local jail commitments

• Updated felony and misdemeanor cases with proceedings

• Notified probation office, state, and/or DMV of sentences and/or counseling

Education

Self-Insurance, May 2011

Workers' Compensation Claims Administration, April 2011

Workers’ Compensation Claims Professional, September 2011

California State University of Fullerton, Brea, CA

69 units completed, June 1987

Citrus College, Glendora, CA

Associates Degree in Business, December 1998

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