Customer Service High School

***** ***** ******* 713-***-**** cell

Ct.

Houston, TX 77095 srwilturner@yahoo

.com

Shemeika Wilturner

Profile Licensed adjuster with over 10+ years of expertise in claims

management, investigation and resolution in accordance to legal

guidelines. Proficiencies in generally accepted accounting

practices (GAAP). Strong work ethics; known for accuracy,

attention to detail and timeliness in organizing and managing

variety of claim files as well as proven ability to develop

collaborative relationships with claimants and employers.

Experience December 1998 - March 2013 CHRISTUS Health Risk Management

Department Houston, TX

Senior Occupational Injury Claims Adjuster (November 2003 - March

2013)

Assisted in development and implementation of new non-subscriber

plan for 18,000 employees in 20 hospitals throughout Texas

Well-organized project management skills and an ability to work

independently; serve as a consultant to health care centers to

manage assigned claims with excellent customer service

Conduct investigation and analysis of occupational injury claims

Evaluation of Plan documents to determine compensability of claims;

analyze information gathered through investigation, prepare

findings reports and make recommendations

Determine premium rates required; actively manage payment of

medical and indemnity benefits and maintain appropriate cash

reserves necessary to ensure payment of future benefits

Interview or correspond with agents and claimants to correct errors

or omissions and to investigate questionable claims; determine need

for private investigators, nurse case managers, and vocational

rehabilitation

Assess the opportunities of modified duty and/or return to full

duty; make recommendation and discuss options with medical provider

and Health Care Center

Coordinate with nurse case managers and medical review director for

effective medical management

Coordinate with Human Resources regarding eligible FMLA benefits

when wage replacement benefits expire

Review claims for subrogation potential and manage recovery;

identify excess insurance exposure and place carrier on notice

Work with attorneys to defend company's position if claim is

contested; participate in preparation with defense attorneys in

litigation of claims

Assure data integrity by input of claims information in automated

system (Riskmaster 7.0)

Update department-owned SharePoint sites, and associated

permissions

Developed and organized regional Occupational Health and Safety

Conferences

Co-presented occupational health & safety materials with Human

Resources to employees in new hire orientation

Conducted on-site safety investigations/claim reviews

Assisted in the development/periodic updating of the organization's

safety manual

Served on organizational committees, Department Disaster Recovery

Committee, Fire Warden and Building Safety Committee

Facilitated organization's fire drills monitoring and ensuring

appropriate responses

Served on the appeals committee regarding denied claims

Manage Workers Compensation claims handled by a Third Party

Administrator in New Mexico

Accounts Payable/Receivable Specialist (July 2001 - November 2003)

Analyze, research, and process invoices to insure timely payment of

billings and settlements for professional and/or general liability,

workers' compensation and unemployment matters, transacting and

interacting with internal, external and third parties

Administer and maintain professional and/or general liability

claims information by initially reviewing and entering first report

of events which includes developing descriptions, coding, and

setting reserves. Requires frequent interaction and contact with

attorneys, adjusters, and risk managers

Manage all miscellaneous accounting activities for professional

and/or general liability, workers' compensation, and unemployment

matters which includes W-9 administration in compliance with IRS

requirements, voiding checks, and reconciliation, stop payments,

deposit and reconciliation of overpayments

Maintain data integrity of information system with entry of correct

codes for reserve changes, closures, reopens, and claim assertions

Create monthly financial statements and reports

Maintain and support team activities as requested to organize,

document, and monitor work processes and tasks

Provide support with special projects as necessary

Administrative Assistant (June 1999 - July 2001)

Maintain data integrity of information system with entry of

workers' compensation claim reports, write-offs, payments,

closures, reopens, and reserve changes

Interact with various workers' compensation representatives to

gather and maintain accurate information for payment and input into

systems' database

Reconcile monthly check register and loss run reports received from

third party administrators

Maintain organization and appearance of file room with proper

indexing of professional/general liability and workers'

compensation documentation

Review record retention guidelines to determine timetables for

transferring active records to be converted to microfilm or

scanning

Provide administrative support to Director, Litigation Managers,

and Office Manager with answering telephones, mail/fax

distribution, travel arrangements, expense reports, order supplies,

set-up meetings, and assisting with special projects

File Clerk/Receptionist (December 1998 - June 1999)

Maintain organization and appearance of file room with proper

indexing of professional/general liability and workers' comp

documentation

Receive and route all incoming calls appropriately

Maintain and update the departmental phone directory

Distribute visitor badges, greet guests and direct them to

appropriate location

Open, sort, and deliver mail to Director, Litigation Managers, and

Office Manager

Education

June 2007 Champions School of Real Estate Houston, TX

Real Estate Agent

August 2003 Dearborn Financial Institute Houston, TX

Texas Department of Insurance:

Workers' Compensation Adjuster License

1996-1998 Eisenhower High School Houston, TX

High School Diploma

1994-1996 Nimitz High School Houston, TX

Professional

Skills Excellent communication skills (written & verbal)

Excellent customer service skills

Strong knowledge of non-subscription claims handling

Windows XP- MS Word, Excel, PowerPoint, Outlook

WC Adjuster License

10-key by touch

RiskMaster 7.0

References Available Upon Request[pic]

Contact this candidate