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Workers Compensation Professional

Location:
Middletown, DE
Posted:
March 13, 2019

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Resume:

Susan C. Leventis

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

Middletown, DE 19709

ac8rrx@r.postjobfree.com

Cell: 302-***-****

Seasoned, accomplished Workers Compensation Professional as both an adjuster and a supervisor. Self-Insured and third part administration give me a well-rounded skill set to supervise any WC program. Motivated critical thinker with a passionate tenacious claims management style. Highly organized with the ability to prioritize tasks, meet critical deadlines provided exceptional customer service. The ability to work with a diverse work force and all levels of management. Strong focus on compliance while maintaining the highest degree of integrity has contributed to my long term success.

WORK EXPERIENCE

CorVel Corporation – Workers Compensation Claim Supervisor

February 2017 – present – Baltimore, MD

Responsibilities:

-Oversee the handling of all aspects of the claims assigned to the unit including reserving, communication, documentation, evaluation, negotiation and settlement

-Ensures all claims eligible or ineligible for payment conform to quality, production standards, and specifications

-Ensures claim processing is consistent with applicable policies, procedures and department guidelines

-Analyzes and approves workers compensation claims

-Completes regular quality audits of staffs work, records results and counsels staff to bring work to or above standards

-Prepares regular periodic reports and monitors system reports to ensure adherence to corporate and regulatory standards

-Establishes and executes controls to assure that the quality of the work meets or exceeds standards

-Reviews and analyzes processes, procedures, and workflows to identify opportunities for process improvement and efficiency

-Manages personnel administration including employee evaluations and salary administration

York Risk Services Group Carneys Point, NJ

Claim Manager - Workers Compensation Claims April 2014 – February 2017

-Manage a team of 12-15 adjusters

-Review monthly loss runs

-Participate in audits

-Train and mentor new adjusters, staff critical claims, manage and approve reserves, lead weekly team meetings, monthly claim review, quarterly and yearly performance reviews for all claims staff.

-Managed all litigation, active role in all Management Team meetings and responsible for quality customer service for all state agencies.

-Oversee all aspects of a claim from investigation, compensability decisions, hearings, mediations, depositions, treatment, early return to work, vocational assistance, to claim closure.

-Team with HR to manage labor issues, supervisor training, accident investigation training, prepare reports, participate in director reviews, claim reviews, oversee internal and external audits, manage and approve all financial reserves, provide feedback and guidance to all levels of management and ensure compliance for all State regulatory agencies

Patriot National Insurance Conshohocken, PA

Senior Workers Compensation Claims Adjuster July 2010-April 2014

Completes 3-point contact on new claims within 24 hours in order to obtain information necessary to make a compensability decision, investigate claims to determine an injured worker’s entitlement to Workers’ Compensation benefits. Administers indemnity and medical benefits for valid Workers’ Compensation claims and manages a caseload of claims from inception to closing or settlement.

-Establishes appropriate reserve levels based on financial exposure and updates reserves upon receipt of new information

-Properly pay indemnity benefits payments and Awards. Issue state-mandated benefit notices within the required timeframes.

-Annotates, categorizes and addresses incoming mail on a daily basis.

Patriot National Insurance, Conshohocken, PA

Workers Compensation Specialists June 2009 – July 2010

Analyze claims to determine appropriate benefits in accordance with policy provisions. Collaborated with insurance representatives and claimants to substantiate coordination of benefits order. Prepared and maintained accurate documentation to support legal subrogation claims and work compensation intervention files. Adhered fully to all HIPAA compliance guidelines. Used MS Excel to track and monitor claims progress, settlement and litigation status, and file closure.

Daniel Hutchinson Law Firm, Woodbury, NJ

Workers compensation Legal Assistant, June 2007 – June 2009

Completed various forms such as accident reports, trial and courtroom requests, and applications for clients.

-Draft and type office memos, schedule and make appointments, receive and place telephone calls.

-Attend legal meetings such as client interview/depositions and take notes.

-Prepare and process legal documents and papers such as summonses, subpoenas, complaints, appeals, motions and pretrial agreements.

-Assist attorneys in collecting information such as employment, medical and other records.

-Make photocopies of correspondence and documents

-Mail, fax, or arrange for delivery of legal correspondence to clients, witness and court officials Organize and maintain law libraries, documents and case files.

ACE USA Insurance Company Philadelphia, PA

Surety Bond Claims specialists March 1996 – May 2007

-Supported supervisor along with staff of 5 Surety Bond Adjusters.

-Provided outstanding customer service to inbound callers requesting medical and activity claim status.

-Administrative duties - Submitted the payroll for all employees, paid general bills for the company, bank deposits and all filing.

General Accident Insurance Company – Philadelphia, PA

Executive Assistant September 1986 – February 1996 (Property/Casualty/Surety Bonds/Claims)

-Entered Data from new business applications into system and ordered reports using windows.

-Reviewed cancellation and nonrenewal notices.

-Provided customer service answering telephone credit hotline.

-Utilized Kodak imager to microfilm mail and insurance claim documents.

-Created log to document receipt of new business down payment checks.

-Travel Arrangements

-Expense Reports

-Supported accounting department, claims department and mail department.

-Administered customer service answering telephone with 15 incoming lines, giving general claims information and transferring calls to other department extensions

Education/Licensing

State Insurance Adjuster licenses for NY, DE, VT, ME, NH, CT, WV, PA, NJ, MD. References available upon request

Peirce College – Associates degree in Business Administration

Saint Maria Goretti High School

Current jurisdictions: PA, NJ, DE, MD, NY



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