acvq2w@r.postjobfree.com:acvq2w@r.postjobfree.com 916-***-****

OBJECTIVE: Obtain a challenging position in the Healthcare and Insurance industry, utilizing the skills and knowledge obtained as a California claims examiner in workers compensation.

PROFESSIONAL HIGHLIGHTS

Ten years plus experience in Workers Compensation insurance

State of California Self Insured Administrator Certification

Workers Compensation Claims Professional designation from Insurance Education Association

Continual education in Workers Compensation to validate certifications

Arizona Property and Casualty Insurance Adjuster License

EDUCATION

Sierra Nevada College, School of Business, Incline Village, Nevada

Bachelor Science Degree, Business Management 1985

CERTIFICATIONS

Workers’ Compensation Claims Professional (WCCP) 2002

Self Insurance Administrator Professional Certificate (SIP) 2002

Arizona Property and Casualty Insurance Adjuster License 2016

PROFESSIONAL EXPERIENCE

Insurance Recruiting Services, Phoenix, AZ 2014-2014

Sr. Claims Examiner

Temporary assignment with CCMSI in Scottsdale, Arizona adjusting highly exposed litigated and excess California claims.

CorrectCare Integrated Health, Sacramento, CA 2013 – 2014

Claims Examiner

Through the California Department of Insurance, as a claims examiner, determine pricing based upon the CMS.Gov Medicare Fee Schedule of medical billings for the State of California Department of Corrections.

Insurance Recruiting Services, Phoenix, AZ 2011-2011

Sr. Claims Examiner

Temporary assignments included Intercare Services in Roseville, California adjusting highly exposed litigated and excess California claims.

Sedgwick CMS, Oakland, CA

Sr. Claims Examiner 2009 – 2011

Administrate claims for the University of CA San Francisco Medical Center located in San Francisco, California. Performed all aspects of claims from initial investigation to closure.

Initiated and completed 3-point contact to obtain information to determine compensability and AOE/COE determination on the claim.

Set reserve levels appropriate to the financial exposure of the claim.

Indemnity benefit payments paid within timeframes and negotiated settlement offers based upon the PQME or AME reports per AMA Guides 5th Edition for ratings of Whole Person Impairment, as well as utilizing the Medicare Set Aside as necessary in settlement of claims.

Processed mail and updated claim information based on medical reports, and legal status reports as well as completing claim status reports for file reviews.

Processed medical and legal bills for payments.

Authorized requests for authorization of treatment from the PTP

Applied knowledge of Workers Compensation Laws, both statutory and judicial in adjusting workers compensation claims and in preparation for hearings with the Workers Compensation Appeals Board.

Barrett Business Services, Sacramento, CA

Sr. Claims Examiner 2008 – 2009

Administrate claims for the self-insured entity in California while performing all aspects of claims from initial investigation to closure.

Frank Gates Service Co./Avizent, Sacramento, CA

Claims Examiner 2005 – 2008

As a dedicated Third Party Administrator for Wal-Mart and Sam’s Club stores in California, managed claims through well-developed action plans to an appropriate and timely resolution. Assessed compensability and resolved claims within medical evaluations. Negotiated settlement of claims up to designated authority level.

Calculated and assigned timely and appropriate reserves to claims; monitors reserve adequacy throughout the life of the claim. Calculated and paid benefits that were due; approved and made timely claim payments and adjustments; and settled claims within designated authority level.

Broadspire, Sacramento, CA

Claims Examiner 2003 - 2005

Administrate claims within California, with some claims from Missouri and New Jersey. Most claims were from prior workers compensation TPA’s (i.e. Superior National). Reviewed and continued to administer claims through settlement and closure.

Inserve Insurance Corp., Sacramento, CA

Claims Examiner 2001 - 2003

Administrate claims for various small businesses including dedicated account (Tuff Shed, and Mary’s Pizza Shack)

Perform all aspects of claims from initial investigation to closure.

AR-CMI, Sacramento, CA

Claims Examiner 2000 - 2001

Administrate claims for client (Wal-Mart and Sam’s Club stores in California).

Perform all aspects of claims from initial investigation to closure.

SKILLS:

Microsoft Office

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