Laura Wegner

*** * ********* *****

Columbia City, Indiana

260-***-****

EXPERIENCE

October 2012- Present- Grinnell Mutual Reinsurance Company, 4215 Highway 146, Grinnell, Iowa 50112. Field Claims Adjuster; Multi-line Auto, Injury, Homeowners, Property, Casualty handler, Litigation Specialist. Work from my home office as a field adjuster handling all lines of insurance. Inspections in covered counties and outside as requested. Mediator for Indiana & Ohio claims.

Responsibilities:

Resolve injury claims according to applicable law and policy provisions.

Prepare evaluations based on evidence provided by direct claimants and attorneys in the form of received demands. Negotiate bodily injury settlements to successful conclusion.

Conduct investigation including interviews, recorded statements, securing public records, and obtaining documents.

Negotiate and communicate effectively with body shops, attorneys and customers and vendors.

Evaluate and conclude claims consistent with CG (Claims Guidelines) and Department of Insurance Regulations.

Subrogation

Medical Terminology

Maintain mail, diary and phone calls in a timely manner.

Recognize possible fraud and perform basic fraud investigation.

Recognize and document subrogation opportunities.

Denies coverage where coverage does not exist. Resolve injury claims according to applicable law and policy provisions.

Handle all aspects of claims; auto, property, homeowners, casualty, med pay, attorney represented settlements & unrepresented settlements. Multi-lined handler.

Prepare evaluations based on evidence provided by direct claimants and attorneys in the form of received demands. Negotiate bodily injury settlements to successful conclusion.

Conduct investigation including interviews, recorded statements, securing public records, and obtaining documents.

Negotiate and communicate effectively with body shops, attorneys and customers and vendors.

Medical Terminology

Maintain mail, diary and phone calls in a timely manner.

Recognize possible fraud and perform thorough fraud investigation.

Recognize and document subrogation opportunities.

Ability to work independently with little to no supervision.

Outstanding time management skills, organizational skills and prioritize issues and tasks

Litigation Specialist; attend requested litigations to resolve prior to court proceedings, when applicable. Indiana and Ohio.

December 2013-December 2015 (Second full-time job) Lutheran Hospital of Indiana, 7600 West Jefferson Blvd, Fort Wayne, Indiana 46804. Switchboard Operator, 3rd shift.

Responsibilities:

Answer Lutheran Hospital Switchboard for inside and outside callers

Answer The Orthopedic Hospital line

Answer “55” Emergency line & handle all codes/emergencies as required

Contact Lutheran Hospital on-call staff for inside and outside callers

Overhead paging, radio paging, text messaging, etc.

Review Emergency procedure each shift

Review FastCommand Procedures each month- (emergency disaster protocols)

Edit Physician directories

Edit PA/Rounding RN directions

Proof Read complete on-call sheets

Create TOH Log on pc

Create daily on-call sheets

Create stroke alert sheets

Update Emergency procedures on pc as directed

Replace hard copies of all directories. EP book and other physicians & associate directories as needed.

June 2011- October 2012- Standard Mutual Insurance Company, 1028 South Grand Avenue West, Springfield, IL 62704 Claims Adjuster; Multi-line Auto, Injury, Homeowners, Property, Casualty handler, Workers Compensation

RESPONSIBILITIES

Resolve injury claims according to applicable law and policy provisions.

Prepare evaluations based on evidence provided by direct claimants and attorneys in the form of received demands. Negotiate bodily injury settlements to successful conclusion.

Conduct investigation including interviews, recorded statements, securing public records, and obtaining documents.

Negotiate and communicate effectively with body shops, attorneys and customers and vendors.

Evaluate and conclude claims consistent with CG (Claims Guidelines) and Department of Insurance Regulations.

Subrogation

Medical Terminology

Maintain mail, diary and phone calls in a timely manner.

Recognize possible fraud and perform basic fraud investigation.

Recognize and document subrogation opportunities.

Denies coverage where coverage does not exist. Resolve injury claims according to applicable law and policy provisions.

Handle all aspects of claims; auto, property, homeowners, casualty, med pay, attorney represented settlements & unrepresented settlements. Multi-lined handler.

Prepare evaluations based on evidence provided by direct claimants and attorneys in the form of received demands. Negotiate bodily injury settlements to successful conclusion.

Conduct investigation including interviews, recorded statements, securing public records, and obtaining documents.

Negotiate and communicate effectively with body shops, attorneys and customers and vendors.

Medical Terminology

Maintain mail, diary and phone calls in a timely manner.

Recognize possible fraud and perform thorough fraud investigation.

Recognize and document subrogation opportunities.

Ability to work independently with little to no supervision.

Outstanding time management skills, organizational skills and prioritize issues and tasks

March 2009 – May 2011 Commerce West Insurance Company, 1555 Fiesta Blvd, Gilbert, Arizona Claims Specialist III, Casualty Unit CWIC; Special Project: Exclusive Florida file handler

RESPONSIBILITIES

Resolve injury claims according to applicable law and policy provisions.

Prepare evaluations based on evidence provided by direct claimants and attorneys in the form of received demands. Negotiate bodily injury settlements to successful conclusion.

Conduct investigation including interviews, recorded statements, securing public records, and obtaining documents.

Negotiate and communicate effectively with body shops, attorneys and customers and vendors.

Evaluate and conclude claims consistent with CG (Claims Guidelines) and Department of Insurance Regulations.

Subrogation

Medical Terminology

Maintain mail, diary and phone calls in a timely manner.

Recognize possible fraud and perform basic fraud investigation.

Recognize and document subrogation opportunities.

Denies coverage where coverage does not exist.

Ability to work independently with little to no supervision.

Outstanding time management skills, organizational skills and prioritize issues and tasks

August 2007- March 2009 Bristol West Insurance Company, 8222 South 48th Street, Phoenix, Arizona 85044 Senior Claims Representative, Arbitration Specialist, Legal Principles Claim Specialist

RESPONSIBILITIES

Resolve claims according to applicable law and policy provisions.

Conduct investigation including interviews, recorded statements, securing public records, and obtaining documents.

Negotiate and communicate effectively with body shops, attorneys and customers and vendors.

Evaluate and conclude claims consistent with CG (Claims Guidelines) and Department of Insurance Regulations.

Maintain mail, diary and phone calls in a timely manner.

July 1992- August 2007 Safeco Insurance Company, 500 N Meridian Street, Indianapolis, Indiana 46204, Field Adjuster (worked from my home) Senior Claims Representative, Intermediate Unit Manager, Trainer

RESPONSIBILITIES

Resolve claims according to applicable law and policy provisions.

Conduct investigation including interviews, recorded statements, securing public records, and obtaining documents.

Negotiate and communicate effectively with body shops, attorneys and customers and vendors.

Medical Terminology

Evaluate and conclude claims consistent with CG (Claims Guidelines) and Department of Insurance Regulations.

Maintain mail, diary and phone calls in a timely manner.

Manage total loss claims.

Recognize possible fraud and perform basic fraud investigation.

Recognize and document subrogation opportunities.

Manage complex litigation.

Demonstrate CUDA compliance.

Perform other duties as assigned.

Assisted in SIU duties as files warranted “special Investigation” skills.

Fill-in manager with full duties of assigning, assisting and training of others in the concept of claims handling.

Scene investigations

Subrogation

Addressing issues with claim load, management and desk management keys in intern management duties as well as in trainer capacity.

Provided technical guidance to other team members on a daily basis.

Resolved complaints, problems, and coverage questions which came into unit; during intermediate unit manager position.

Provided ongoing training and employee development to team members and effectively delivered communication of corporate/department policies and procedures.

Skills:

Detail-oriented with strong organizational skills, able to work well under deadlines in a changing environment and perform multiple tasks effectively and concurrently.

Computer skills and experience using estimating systems like CCC, Mitchell, ADP

Ability to be a self-starter and work independently

Special investigation skills in assisting in background checks, written and excellent communication skills in securing verbal and recorded statements.

Ability to manage relationships with both internal and external customers.

Medical Terminology

Ability to work effectively independently and within a collaborative team oriented environment using sound judgment in decision-making.

High proficiency with Microsoft Office products (Outlook, Excel, PowerPoint, and Word) and claims related software programs.

Basic- Advanced knowledge of medical treatments and understanding of low impact injury claims & special investigation skills (SIU).

Complete investigation of claims and discovery of facts for each claim.

Diary logging

Skills & Knowledge

In-depth knowledge of appropriate insurance principles and laws for line of business handled, recoveries offsets and deductions, claim and disability duration, cost containment principles including medical management practices and Social Security and Medicare application procedure as applicable to line of business

Excellent oral and written communication, including presentation skills

PC literate, including Microsoft Office products

Analytical and interpretive skills

Strong organizational skills

Good interpersonal skills

Excellent negotiation skills

Ability to work in a team environment

Ability to meet or exceed Service Expectations

Provides guidance, leadership, and/or analytical support for special projects.

Excellent organizational skills and the ability to work under pressure

10- key @ 9,000-10,000 key strokes

Knowledge of insurance policies and coverage, claim payment procedures, and familiarity with medical terminology

Ability to maintain confidentiality

Multi-lined trained and have worked multi-lined streamline for over 30 years.

30+ years in the insurance industry

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EDUCATION

1982-1984 Indiana Vocational State College, 8400 S Anthony Blvd, Fort Wayne, Indiana 46802

Degree: Associates Medical Secretarial Sciences.

AEI Designation - Legal Principles Claims Specialist (American Educational Institute)

Currently working on next level to SCLA designation- Continuous

Salary Requirements Upon Request

Contact this candidate