Customer Service Manager

Manuel Martin Del Campo ***Stonehurst Drive Altadena, CA91001

626-***-**** *******@***.***

WORK EXPERIENCE

Sept. 2014 - Present Segwick Insurance, Long Beach, CA Sr. Claims Examiner

May-2013 - August-2014 Acclamation Insurance Management Services (AIMS) Claims Supervisor

Supervise subordinate staff, ensure compliance with City of Los Angeles (Fire Sworn Account) policies and procedures.

Assess and evaluate claims settlement process; provide recommendations and approve settlements to the limit of established

authority.

Oversee, audit and establish procedures for outside firms and act as liaison between the City of Los Angeles and these firms.

Provide training and guide subordinate staff to ensure compliance with State rules and regulations.

Attend hearings and conferences to represent client at WCAB with en pro per cases.

Feb. 2012 - Apr. 2013, York Risk Services Group, Upland, CA Sr. Claims Examiner

Manage active caseload of high profile claims from inception to closure for multiple national accounts A u g . 2 0 04 - J a n . 2 0 12, M T A

Claims Supervisor

Supervise subordinate staff and ensure subordinate compliance with rules, policies and procedures.

Develop, oversee and evaluate claims settlement process; approve to the limit of established authority

Prepare written analysis and settlement recommendations for cases exceeding authority to County counsel and Board of

Directors.

Represent Metro at appeal hearings, settlement conferences and internal Labor Arbitrations.

Nov. 2004 - Aug. 2004, MTA Sr. Claims Examiner

Review and respond to all incoming legal/ medical mail on a timely basis.

Ensure all benefits are paid and issued in a timely manner.

Litigate & Investigate claims when necessary, maintain a professional level of customer service.

Review and adjust claims ranging from 100-125 files.

Maintain a 100% closing ratio on a monthly basis.

Aug. 2000 - Nov. 2004, Federated Department Stores Claims Examiner

Manage an active caseload of 150+ litigated/non-litigated files

Responsible for 24-hour contact/3 point contact with injured worker, employer, and physician

Facilitate the injured workers return to gainful employment/full duties

Implement aggressive, yet effective resolution plans focused on early case closure

Ensure that the initial incurred case value reflects the probable ultimate exposure

Ensure proper resources are assigned to the file based upon claim complexity and financial exposure

Issuance of indemnity payments, benefit notices, medical payments

Case reserve authority of $50k, settlement authority of $20k

1996-2000 Communication Specialist - U.S. ARMY (1996-2000)

Implement, establish and maintain communication systems

Prepare and conduct training for communication equipment

Handled all aspects of communication equipment including maintenance, implementation and support

1990-1996 Hertz Claims Management (Bierly and Associates) Jr. Claims Examiner/Claims Assistant

Responsible for processing all indemnity payments as well as all vendor bills timely and in accordance to the labor code

Updated vendor and claimant profiles to ensure payments went out correctly. Issued stop payments and check status of

outstanding checks

Assisted examiners with clerical duties, including making the initial contact with the injured worker and the employer

Obtained wages to calculate the injured workers' average weekly wage. Sent out initial notices to all interested parties

Monitored temporary disability payments

PROFESSIONAL

CA Self-Insured License

WCCP/WCCA

Bilingual English/Spanish (read, write, speak)

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