Manager Management
Resume:
Sanja E. DuBois
Brooklyn Hts., OH 44131
Dear Prospective Employer:
Please accept this letter and resume as an expressed interest in joining your Organization. My employment objectives, educational background, experience and proven capabilities are reflected in the attached Resume.
I handle all aspects of Workers’ Compensation claims, including but not limited to, working closely with the various parties involved, (claimant, claimant’s attorney/union representative, Defense Attorney, BWC, excess liability, etc.), devising and implementing defense strategies, preparation and attendance at hearings, monitoring court cases, scheduling independent medical examinations, returning injured employees to gain employment, assuring Ohio Audit Compliance and whenever possible, bringing claims to final resolution by pursuing full and final settlement.
I would appreciate the opportunity to discuss my qualifications and potential value to your organization and to show you how I can effectively fulfill your current needs.
Thanking you in advance for your attention, consideration and forthcoming reply.
Sincerely,
Sanja E. DuBois, WCLA
Encl.
Summary of Qualifications
Paralegal… Account Service Manager/Office Manager (Self-Insured Companies)… Workers’ Compensation… Compliance Team Lead… Personal Injury… Risk Management… Short/long Term Disability… ISO 9000 certified… Safety & Prevention Training Meeting… Implementation of Transitional Duty Microsoft Excel… Microsoft Word… Microsoft Outlook… Corporate Systems… Microsoft Power Point
Educational Background
2 Associate Degrees: Paralegal and Court Reporting
Academy of Court Reporting, Cleveland, Ohio
Professional Designation: WC Law Associate
Seminars: SIGO, OSIA, The Greater Cleveland Safety Council, Safety & Training, Various in Workers’ Compensation Field, Return to-Work, Modified/Restricted duty, Motivational, Management Sales
Hold licensures in WV, CT, MI.
Professional Highlights
Specialty Risk Services/The Hartford /Sedgwick CMS 10/06 to present
Account Consultant
Analyze and process complex and/or technically difficult claims by investigating and gathering information to assist Self-Insured Employers in determining their position on the claim; manage claims through well-developed action plans to an appropriate and timely resolution.
Work to move claims toward closure which includes settlement whenever applicable
To ensure ongoing adjudication of claims within company standards, industry best practices and specific client service requirements; and to manage subrogation of claims and negotiate settlement.
Monitor reserve adequacy throughout the life of the claim
Monitor and review benefits due and payment calculations ensuring accuracy.
Prepare necessary state filing within the statutory limits.
Coordinate vendor referrals for additional investigation and/or litigation Management.
Use appropriate cost containment techniques including strategic vendor partnerships to reduce overall costs of claim for our clients.
Participate in claim recoveries including, but not limited to, Subrogation, Second Injury Fund Recoveries and Social Security offsets.
Communicate claim action/processing with appropriate parties including, but not limited to: Claimant, Client, State Agencies, Managed Care Organization, Plaintiff/Defense Counsel and appropriate medical contact.
Ensure claim file is property documented and claim coding is correct.
Maintain professional Client Relationships.
Assess Policy level status of clients; work in coordination with Clients’ Service expectations and assigned service personnel.
Maintains a quality assurance program to support the total performance management initiative and the delivery of quality claims service consistently.
Container Port Group, Inc. 4/05 to 10/06
Multi-State Workers’ Compensation Administrator
Responsible for the following:
• Complete administration or workers’ compensation claims in 10 states with 26 locations throughout the United States
• Participation in the Greater Cleveland Safety Council
• Acted as liaison to Attorneys, Insurance Companies and TPA, State/Federal Agencies and Employees to ensure Federal and State regulatory compliance were met in all 10 states
• Annually collected, distributed and ensured postings of all state required certificates and notices
• Coordinated and conducted the injury review process to determine and correct root causes for the prevention of future injuries
• Performed ongoing cost analysis to decrease workers’ compensation claims
• Development and administration of the Premium Discount Program and Compliance
• Administration of the Drug Free Workplace Program and Compliance
• Assisted in the Development of a new Drug and Alcohol Policy
• Conducted Drug and Alcohol Employee Awareness training for all locations
• Developed and implemented a stronger workers’ compensation system to effectively manage claims
• Evaluation of all job duties throughout the company for further safety, hazmat and other appropriate training
• Development of a new Safety Protocol Risk Manual and Program
• Research to stay abreast of workers’ compensation regulations, OSHA compliance, issues, trends and changes in this 10 state jurisdiction
• Initiated and compiled a Safety News Letter on a quarterly basis
Constitution State Services/St. Paul Travelers 9/99 to 4/05
Senior Resolution Claims Case Manager/Ohio Compliance Team Lead
Responsible for the following:
• Implementation of defense strategies for compensable workers’ compensation claims with litigating factors
• Bring complex claims to resolution
• Customize a workers’ compensation plan per Employer’s needs for effective claims management
• Implementing programs that reduce workers’ compensation costs
• Assisting client with complying with State Audit Compliance
• Work hand in hand with the Excess Carrier
• Coordination of physicians, legal counsel, private investigation, medical case management and Vocational experts, with the goal in mind to bring complex medical claims to resolution.
• Systematic evaluation of claims to ensure quality assurance and cost effectiveness
• Negotiate and Settle Complex Claims
• Identify and assure accurate reserving
General Electric Company/Marsh & McLennan Companies 4/97 to 9/99
Workers’ Compensation Administrator/Office Manager
• Complete administration and ease management of Self-Insured Workers’ Compensation claims on behalf of all GE Lighting Locations in Ohio
• Performed three-point contact, with claimant, physician, hospital and site management
• Devised and implemented defense strategies on behalf of all 17 Lighting plants
• Obtained appropriate documentation for defense of questionable/denied workers’ compensation claims
• Sent fee bills to bill re-pricing unit for compliance with state UCR
• Scheduled IME’s, the use of Private Investigators, Medical Claims Managers, and Counsel
• Coordinated with each of the 17 plants in devising and implementing return to work strategies
• Prepared and reviewed claims scheduled for audit by the Ohio Self-Insurance Auditors
• Quarterly review of claims for reserve appropriateness
• Review and preparation of claims for settlement
• Written and verbal communications with attorneys, claimant’s, providers and plant nurses
• Perform ongoing training for Support Staff and GE Nurses at all Lighting locations
Oswald Risk Management Services 2/94 to 12/31/96
Account Service Manager (11/94 to 12/31/96)
• Complete administration and case management of Self-Insured Worker’ Compensation claims
• Reviewing Self-Insured claims for compensability
• Devising and implementing defense strategies on behalf of multiple employers
• Approving and calculating compensation to claimants
• Reviewing medical bills and approving for payment
• Working with excess liability carriers
• Tracking claims using an electronic diary system
• Reviewing and complying with Industrial Commission orders
-File motions, appeals, reconsiderations and objections
-Apprise accounts of activities
• Completing SI 40’s and ICD-9 reports for all clients on an annual basis
• Preparing clients and attending State audits
• Conducting and Implementing Safety and Prevention training meetings
• Train groups from 8 to 50 people
• Develop customized training programs for clients’ needs
Hearing Representative Administrator (2/94 8/94)
Initially hired to fill a newly created position and develop it. Functions included:
• Complete file preparation of Workers’ Compensation claims, State Fund and Self-Insured claim files
• Scheduled the docket for an administrative hearings for 16 different Industrial Commission offices in Ohio
• Coordinated hearings, scheduled representatives and docket; continued or cancelled hearings
Melamed Friedman & Associates 5/92 2/94
Office Manager/Paralegal
• Managed the office, handled administrative functions and other matters in this Workers’ Compensation and Personal Injury law practice
• Complete handling of State Fund/Self-Insured Workers’ Compensation claims and Personal Injury Claims
• Computed charges; billed clients; collected on delinquent accounts
• Handled all bookkeeping functions (accounts receivable/payable)
• Coordinated benefits and completed special projects
Personal Strengths and Data
Proven Management, leadership, good communication and interpersonal skills
loyalty, confidentiality, enthusiastic, dependable, quick to learn and aggressive in approaches
Team player, dedicated, achieve goals
Multiple Client References and Commendation Letters Available Upon Request
Contact this candidate