Aisya Carroll

Cell Phone Number: 973-***-**** E-mail: ac8kud@r.postjobfree.com

EDUCATION

New Jersey Institute of Technology, Newark, NJ

Bachelor of Science in Business Administration minor in Marketing in August 2007

Adjuster’s License in AR, CT, DE, FL, GA, ID, IN, KY, LA, ME, MI, MN, MS, NC, NH, NM, NV, NY, OK, OR, RI, SC, TX, VT, WV, WY

EXPERIENCE

May 2018 – Present Gallagher Bassett

Senior Litigation Resolution Manager Mechanicsburg, PA

Manage over 150 claims for third party administrator with thousands of clients for commercial auto, slip and falls, personal injury protection, property damage, bodily injury, litigated claims and general liability claims for several states.

Investigates, evaluates, disposes and settles the most complex claims and highest exposures with minimal supervision up to $1 million.

Review and process investigation, determination and evaluation of coverage, liability and damages, and the setting of proper reserves.

Processes claims consistent with clients' and corporate policies, procedures and "best practices" and also in accordance with any statutory, regulatory and ethics requirements.

Demonstrate ability to comply with carrier reporting and threshold requirements.

Review reserves for claims and determine if reserves are appropriate and determine next steps for adjusters or claims being processed.

Reviews files with complex claim issues and assign defense counsel to resolve and settle claim.

Review settlement offers as well as make settlement offers to claimants and plaintiff’s counsel.

Determine if defense counsel is needed on claims that will lead to litigation.

Review and recognize claims and pursue excess insurance recoveries.

Train new hires and coach current employees in regards to the processing of claims.

Review medical records along with depositions, status reports from defense counsel, demand packages from plaintiff counsel, and several other court documents to determine next steps on claims.

Develops departmental goals and objectives in order to forecast higher results for the adjusters in unit.

Works productively in a remote environment.

May 2017 – May 2018 Sedgwick CMS

Claims Adjuster Marlton, NJ

●Manage over 350 claims for third party administrator with thousands of clients for auto, personal injury protection, medical claims, property damage, bodily injury, litigated claims and general liability claims for several states

●Review medical records and medical bills to determine if the injuries are related to the accident

●Reviewed IME reports to determine if there were any pre-existing conditions

●Reviewed ADL’s to determine if the claimant would be eligible for essential services, wage loss services

●Conduct investigations and research to determine if claim is payable

●Conducted legal research, social media research, and background checks

●Create letters to inform claimants, attorneys, and/or legal guardian of status of claim

●Communicate with email using Microsoft Outlook, make phone using Avaya with clients, attorneys, paralegals, doctor offices, claimants, independent adjusters, appraisers, and more

●Prepare documents using Microsoft Word for ligated claims that need to be prepared for arbitration, settlement hearings, and court appearances

●Oversee and train new hires with the system Juris, Educate new hires on Personal Injury Protection and how to read medical records that are received by fax with SIR mail

●Reviewed and analyzed reports with from Excel

●Processed and handled claims with HIPPA compliance and state jurisdiction regulations

● Works productively while being remote.

August 2015 – May 2017 Farmers Insurance

Medical / Personal Injury Protection Representative Mount Laurel, NJ

●Managed over 250 personal injury protection claims and litigated claims

●Reviewed IME reports to determine if there were any pre-existing conditions

●Consulted with clinicians and medical directors for additional treatment plans for injuries

●Reviewed medical bills and medical records; Review ICD-9 & ICD-10 codes and HCPCS codes

●Reviewed ADL’s to determine if the claimant would be eligible for essential services, wage loss services

●Reviewed ISO reports for previous claims in regards to worker’s compensation, disability, and social security.

●Conduct investigations and research to determine if claim is payable

●Conducted legal research, social media research, and background checks

●Performed a social security search to determine if the person was receiving Medicare.

●Identify claims for subrogation, prepare claims for arbitration, prepare claims for settlement, review claimant statements, physician statements, witness statements, and more

●Create letters to inform claimants, attorneys, and/or legal guardian of status of claim

●Created Reservation of Rights letters to non compliant claimants

●Reviewed and analyzed reports with from Excel

●Processed and handled claims with HIPPA compliance and state jurisdiction regulations; worked productively while being remote.

May 2015 – July 2015 Sweeney & Sheehan

Paralegal Westmont, NJ

●Handled over 250 cases for the support of one attorney, without the assistance of a secretary or legal assistant.

●Reviewed IME reports to determine if there were any pre-existing conditions

●Drafted pleadings, memorandums, petitions and subpoenas for attorney to be sent out to courts, attorney’s and doctor offices

●Conducted legal research, social media research, and background checks

●Used the court judiciary website to schedule, reschedule courts and or postpone court dates.

●Used avaya phone system to make outbound and receive inbound calls from doctors, attorney’s, paralegal, courts, medical directors, insurance companies and more

●Review medical records and create summary for attorney review and created follow up requests as needed

●File documents in order of priority.

●Input billing invoices for hours worked along with paying bills

●Maintain the billable entries for time worked

●Created discovery requests and responses

●Processed and handled claims with HIPPA compliance

●Draft letters to inform claimants, attorneys, and/or legal guardian of status of claim

May 2011 – May 2015 Prudential

Disability Claims Manager Roseland, NJ

●Handled over 3,000 Long Term Disability claims for over 100 clients along with litigated claims

●Review medical records to determine if the claimant is still considered disabled.

●Approves or denies claims in accordance with established procedures.

●Research each claim to insure Workers compensation, Social Security, and Pension offsets are applied correctly.

●Conduct investigation with ISO reports to determine if a claimant is receiving worker’s compensation and social security disability

●Conducted legal research, social media research, and background checks

●Reviewed claimants ADLs to ensure they were not able to return to work.

●Worked on project for director to recoup overpayments for the company for the individuals that were receiving worker’s compensation that did not report it. Recouped over $800,000

●Reviewed ICD-9 codes to make decisions on claims to determine if someone is disabled

●Reviewed IME reports to determine if there were any pre-existing conditions

●Created Reservation of Rights letters to non compliant claimants

●Processed complex claims with worker’s compensation

●Processed claims with claimants that returned to work part time and re-calculated benefits as a result

●Reviewed and analyzed reports with from Excel

●Create letters to inform claimants, attorneys, and employers

●Processed death benefits to beneficiary

●Trained New hires the DCMS system and how to process the claims

●Processed and handled claims with HIPPA compliance

●Works productively while being remote

SKILLS

Proficient in Microsoft Office, Internet Explorer, Lotus Notes, Avaya, Juris, Retirement Benefits, Workers Comp Benefits, Social Security, Medicare, Mediciad, Disability Benefits, HIPPA, Medical Records, EFT, ICD-9 & ICD -10, HCPCS codes, 75 wpm, attention to detail, great organization skills, ability to work remotely and still be productive, ability to multitask well, ability to work well in a team environment, excellent oral and written communications

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