Sherrie Smith

**** ******** ****., ***** ****, TX. 78665 405-***-**** ad1bnh@r.postjobfree.com

Key Qualifications

Highly skilled claims manager; strong oral and written communication skills; proven track record of integrating process improvements to increase business profitability; extensive understanding of Oklahoma/Texas Workers Compensation statutes, case laws and claims adjudication; exceeds in leadership, training, and mentoring; experience in working with TPA’s, as well as health insurance claims processing.

Experience

RISK ANALYST RESOURCING EDGE OCT 2018 – MARCH 2020

·Responsible for seeing that all workers’ compensation claims are submitted in a timely fashion to insurance carrier.

·Monitor claims to make sure claims are being handled appropriately.

·Authorize reserves and settlements on claims.

·Attend claim reviews with carrier on a quarterly basis.

·Responsible for maintaining a good working relationship with clients, adjusters, injured workers and brokers.

·Responsible for running loss runs for clients when requested.

·Run loss analysis reports to determine trends for clients.

·Revised the incident report and claim reporting procedure for the company.

·Responsible for educating new clients on claim reporting and their responsibilities, as well as creating a physician panel list for each new client’s location.

CLAIMS MANAGER ROSCOE PROPERTIES SEPT 2017 – JULY 2018

·Responsible for the handling the insurance program for the company.

·Developed and implemented the incident report and claim reporting procedure for the company.

·Responsible for obtaining the necessary insurance for all new properties.

·Responsible in seeing that claims are submitted in a timely fashion to insurance carriers.

·Handles all subrogation for the company.

·Works hand in hand with Risk Management and Safety.

CLAIMS SUPERVISOR TEXAS MUTUAL INSURANCE COMPANY JAN 2015 – JAN 2017

·Supervised and monitored daily operations of claim processing in accordance with the Texas Workers’ Compensation Act, rules of the Division of Workers’ Compensation and internal procedures.

·Provided guidance to staff regarding claim handling timeliness and desired claim outcomes.

·Assisted staff with determining applicable coverage and compensability of complex and escalated claims.

·Performed claim file audits to determine accuracy and recommended corrections and action plans.

·Attended Benefit Review Conferences to provide expert claim guidance.

·Responded to escalated customer service issues and implemented resolutions.

·Identified process and customer service improvement opportunities and recommended solutions.

·Developed and implemented work schedules, policies, procedures, and workflows.

·Served as subject matter expert for process automation and other various projects in initiatives.

·Participated in personnel management including recruiting, retaining, coaching and mentoring employees.

·Ensured that appropriate polices, procedures, staffing and training were in place to provide for the effectiveness of the assigned operations.

·Developed and communicated performance and behavioral expectations, created training and development plans, provided regular feedback on employee performance and developed action plans as necessary to improve staff performance.

·Contributed to the development and implementation of division goals and objectives, policies, standards, procedures, and budgets.

·Developed and implemented actions and plans within the department which support customer service.

DIVISION SUPERVISOR COMPSOURCE MUTUAL INS CO MAY 2013 – DEC 2014

·Provided training, guidance and mentoring to new adjusters.

·Assigned legal assignments, and disseminate new claims to appropriate adjusters.

Monitor, evaluate, and deliver performance reviews and improvement recommendations.

WORKERS’ COMP ADJ LEVEL IV COMPSOURCE MUTUAL INS CO FEB 2003 – MAY 2013

·Investigated lost time and litigated claims for compensability.

·Directed pertinent medical care and ensured prompt and optimal treatment for injured workers.

·Communicated regularly with insured and medical providers, remained apprised of Medicare and ODG guidelines on all claims.

WORKERS’ COMP INDEM ADJ SPECIALITY RISK SERVICE (TPA SEPT 2001 – FEB 2003

·Investigated lost time and litigated claims for Third Party Administrator.

·Managed subrogation possibilities on claims.

·Maintained knowledge of Medicare guidelines, ODG guidelines, and Workers’ Compensation Laws.

WORKERS’ COMP FIELD ADJ AMERICAN INTERSTATE INS CO DEC 1998 – SEPT 2001

·Effectively processed claims that entailed: fact to face investigation of lost time and litigated claim.

·Directed pertinent medical care, ensured prompt and optimal treatment for injured employees.

·Managed subrogation possibilities.

·Maintained knowledge of Medicare guidelines, ODG guidelines, and Workers’ Compensation Laws.

CLAIMS ADMINISTRATOR HORTON INSURANCE AGENCY SEPT 1994 – MARCH 1995

·Liaison between agency, policy holder and insurance companies.

·Submitted claims to appropriate insurance companies for handling.

·Communicating with adjusters on claims once they were submitted.

·Review of reserves and payments on claim files.

·Prepared and presented presentation on risk management to policy holders.

BENEFITS ADMINISTRATOR WESTERN MERCHANDISERS AUG 1993 – SEPT 1994

·Effectively processed health insurance and workers’ compensation claims for self-insured employer with 5000 employees.

·Handled new employee onboarding and executive benefits.

HEALTH INSURANCE EXAMINER MD PHYSICIANS INSURANCE JULY 1992 – AUG 1993

·Effectively reviewed and processed health insurance claims for timely submission of payments to providers.

SUPERVISOR OF TPA DEPT CORPORATE SYSTEMS JAN 1992 – JULY 1992

·Supervised a team of bill processers.

·Reviewed reports for timeliness of payments.

·Reviewed reports for accuracy of ICD-9 and Procedure codes.

References

Ricardo Villarreal, Owner Christy Adkins, Owner

Optimal Rehab Working Rehabilitation Solutions

430 N.W. 10th. Street 1601 Medical Center Dr.

Oklahoma City, Ok. Edmond, Ok.

405-***-**** 405-***-****

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