Compensation Claims Client Support

KIMBERLY SINKS

California, Nevada 916-***-**** ********@*******.***

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CLAIMS ADMINISTRATION SPECIALIST

Workers' Compensation Claims Exposure Compliance Management Accomplished, results-driven Claims Administrator with extensive experience in worker's compensation claims, a superb training record that includes SIP Certification, and possesses a history of maximizing reserve savings and claims team productivity through the introduction of innovative process changes. Seeking a new challenge as a Claims Adjuster/Examiner that will offer long-term professional development opportunities with a dynamic and growing company.

Top-performing professional with 12 years of claims and reserve management experience and a reputation as the “go-to” for delivering best-in-class business and client support.

Thoroughly trained in worker's compensation claims management, medical claims coordination, and the best practices involved with ensuring ongoing organizational and claims processing compliance with state and federal regulations.

Unparalleled analytical acumen: a proven track record of successfully analyzing business, client, and compensability data to identify potential problems and develop collaborative strategies that minimize discrepancies.

Outstanding leadership and interpersonal skills that help build stronger relationships with key clients and business partners while also promoting a more rewarding and productive team culture.

Highly proficient with business technology and claims management systems including SIMs and Claims Connect.

Claims Analysis & Management Document Review & Investigation Claims Processing

Compliance Auditing Claims Adjusting & Reporting Team & Client Support

Insurance Products & Services Future Medical Claims Process Improvement

Analytical Expertise Creative Problem Solving Cross-Team Collaboration

Time Management Organizational Skills Client & Team Success CCMSI– Concord, California (2022-current)

Senior Workers Compensation Representative

Handles claims management from inception to resolution. Evaluates claim exposures and establishes reserves for handling costs and settlement. Completes initial contacts in a timely fashion and completes investigations to determine compensability. Maintain good relationship with clients and all parties involved with the claims. Major Accomplishments

Consistently score more than 90% on internal audits which includes completing contacts in a timely fashion and doing a thorough investigation when a new claim is received.

UNITED STAFFING ASSOCIATES – Los Angeles, California (2019 - 2021) Workers' Compensation Claims Administrator

Building an ongoing reputation for excellence in the investigation, evaluation, and resolution of claims and accident cases for one of the leading workforce services firms in California and Nevada. This involves extensive coordination with legal representatives and the Claims Adjustment team to resolve cases, detailed analysis of accident reports to determine and communicate further investigation needs, and helping to drive innovative legal strategy improvements via conference calls and face-to-face meetings with executives and stakeholders.

Major Accomplishments

Identified and streamlined a number of weaknesses in the analysis process for injury-based merit and financial impacts in collaboration with the management team.

Reorganized the case management process to facilitate the handling of a rolling case load of more than 130 claims. ESIS, INC. – Los Angeles, California (2018 - 2019) Workers' Compensation Claims Representative

Served in a mission-critical role focused on the investigation, analysis, and resolution of Worker's Compensation claims for one of the nation's leading providers of managed claims, integrated disability, and customized risk management solutions. This included extensive collaboration with claimants and adjusters while managing the indemnity benefit issuance and notification process. Also played a major part in coordinating investigation efforts with legal representatives and case managers to expedite the case resolution process and maximize the claimant experience.

Major Accomplishments

Recognized on multiple occasions for going above and beyond to work with difficult clients and identify strategies that ensure quick case resolution.

Streamlined a wide variety of administrative tasks to improve overall team performance including daily diaries, mail processing, and telephone correspondence.

C O R E S K I L L S A N D AB I L I T I E S

PR O F E S S I O N A L E X P E R I E N C E

K I M B E R L Y SI N K S – P R O F E S S I O N A L E X P E R I E N C E CO N T I N U E D . . . BETA HEALTHCARE GROUP – Roseville, California (2016 - 2018) Claims Examiner

Expertly handled all aspects of claims management from inception to resolution for the West Coast's largest provider of liability insurance to hospitals and medical professionals. This role involved direct oversight of closures and settlements, handling investigations with key stakeholders and other contacts to ensure claim compensability, and taking ownership the indemnity benefits approval process to ensure ongoing compliance with state and federal guidelines. Major Accomplishments

Spearheaded a new medical treatment investigation strategy that improved the process and saved more than $800K for the Workers' Compensation Medical Reserve.

Commended on numerous occasions for maintaining a closing ratio of almost 120% via diligent upkeep of claims and attention to report details.

Strengthened relationships with countless clients and professional partners to increase the organization's visibility. YORK RISK SERVICES – Roseville, California (2012 - 2016) Future Medical Examiner & Claims Assistant

Established a track record of success in a multifaceted role focused on the monitoring and resolution of specialized and sensitive Future Medical Claims for a major provider of insurance and loss adjustment services. This involved ongoing collaboration with medical professionals and claimants to ensure optimal medical and prescription treatment, extensive review of benefits such as Life Pension and Disability, and delivering best-in-class support to claim examination teams for key clerical tasks including bill and payment processing, document service, appointment scheduling, and maintenance of records and the claims system. Major Accomplishments

Recognized for outstanding attention to detail and sense of urgency when dealing with clients and claims, leading to a promotion to Future Medical Examiner in 2014.

Reorganized the daily mail and Diary handling process to minimize discrepancies and completion time. EARLIER PROFESSIONAL HISTORY

ATHENS ADMINISTRATORS – Claims Assistant (2011 – 2012) YORK CLAIMS – Claims Assistant (2008 - 2011)

E-REPUBLIC – Registration Coordinator (2006 - 2007) SIP Certified & Ongoing CEU Training

CA OFFICE OF SELF-INSURANCE PLANS (2014)

Workers' Compensation Claims Training Program

CA 10 (2010)

Medical Coordination of Workers' Compensation Claims Training Program CA 12 (2010)

Excellent References & Recommendations Available Upon Request C E R T I F I C A T I O N S & S P E C I A L I Z E D TR A I N I N G

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