Jesse C Lopez

**** **** **** ***** *****: 972-***-****

Arlington, TX 76012 Email: ad2tou@r.postjobfree.com

OBJECTIVE

I am a career minded, motivated employee, with over 30 years’ experience as an exclusive workers compensation adjuster, who excels in all aspects of workers compensation claims adjusting, and technical supervision, for multiple jurisdictions, with emphasis in 3rd party claims recovery, claims litigation management. I am a proven leader with excellent people mentoring skills. I am eager to learn and conquer new challenges. I am focused on achieving goals and objectives as assigned in a timely manner. I am a loyal and accountable team player, dedicated in the pursuit of excellent customer service for the purpose of establishing long term relationships, both inside and outside the company. I am bilingual in the spoken and written Spanish.

EMPLOYMENT HISTORY

Gallagher Bassett Claims Management Sr. Resolution Mgr Adjuster 05/31/2022 – 09/21/2023.

Multiple State Workers’ Compensation Adjuster (Colorado, Indiana, Illinois, Iowa, Minnesota, Michigan, Oklahoma, Louisiana, Mississippi, Arkansas, Missouri).

Responsible for opening and closing first party workers’ compensation claims, as well as recognizing and assigning 3rd party claims to Gallagher Bassett’s Subrogation department.

Settling litigated claims full and final, in addition to managing the defense counsel’s actions in order to present the injured worker and their attorney, and/or receive demand offers from the injured worker and their attorney to settle full and final.

I was licensed in all the states requiring a license.

Sedgwick Claims Management Sr. Claims Adjuster 12/2020 - 05/2022.

(Texas, Louisiana, Oklahoma, Mississippi & U.S. Longshore & Harbor).

Responsible for opening and closing first party workers’ compensation claims; in Texas, I resolve

loss of time claims to Maximum Medical Improvement (no settlements), and in other states where

allowed, pursuant to account instructions, I am to resolve the claims by full and final settlement.

I am currently licensed in Texas, Oklahoma, and Louisiana.

Multiple State Workers’ Compensation Adjuster and Federal Workers’ Compensation Adjuster (Texas, Louisiana, Oklahoma, Missippi & US Longshore & Harbor)

Responsible for opening and closing first party workers’ compensation claims. In Texas I would resolve claims by getting the injured worker to Maximum Medical Improvement. In the other states I was to resolve claims by full and final settlement, pursuant to the Insured’s Service Instructions.

I am licensed in Texas, Oklahoma, and Louisiana.

Contract Claims Services Inc, Sr. Claims Adjuster 07/2014 – 12/2020.

Federal Workers Compensation Claims Adjuster for the Department of Army, Non-Appropriated Fund. Responsible for handling federal workers compensation claims under an Extension of the U.S. Longshore and Harbor Workers Compensation Act.

Responsible for opening, settling when possible, and closing first and third-party workers’ compensation claims as soon as possible.

The nature of the account caused me to have to handle claims around the world.

Insurance Overload Contract Claims Staffing, Contract Claims Adjuster 09/13 – 07/2014.

Workers Compensation.

Responsible for opening, settling, and closing of workers compensation claims for insurance companies, and third-party administrators at a Sr. Claims Adjuster level

My experience allows me to handle multiple jurisdictions including the U.S. Long Shore & Harbor, as well as some Protection & Indemnity (P. & I.) - Jones Act Seman, first and third-party claims.

I am currently licensed in three states, Texas, Oklahoma and Indiana

Jurisdictions handled; States of Texas, Oklahoma, Louisiana & U.S. Longshore and Harbor.

AMS PEO Staff Leasing / Risk Management Claims Advocate 05/13 – 09/2013.

Workers Compensation.

Responsible for receiving and assigning coverage to workers compensation claims associated with the multiple PEO accounts we serviced, including our own, under both statutory & federal jurisdictions, Texas, Louisiana, Oklahoma, Indiana, Illinois, Mississippi, Arkansas & U.S. Long Shore & Harbor.

I would handle all medical only claims in-house to mitigate loss of time exposure by employing and enforcing our early return to work programs/procedures.

Once the occurrence of loss of time from work was eminent, coverage was verified and assigned to the claim, and the claim was forwarded to our respective TPA and/or carrier for further handling of the claim to conclusion.

Thereafter, I would establish diaries for all claim files handled by the TPA, Carrier & myself for the purpose of setting quarterly reviews with the assigned adjuster in order to confirm anticipated closure dates and/or establish strategic action plans which would bring the claim to conclusion.

Thereafter, I would provide written reports regarding my endeavors with our TPA’s and carriers to the Risk Mgr.

If necessary, further recommendations would be provided to TPA/Carrier regarding action that might serve to mitigate further financial loss.

I would establish and provide maximum settlement values and authority to the respective adjuster handling the loss in those jurisdictions’ where full and final settlements were allowed.

I was also responsible for completing loss runs and financial reports for accounts as requested.

Broadspire a Crawford Company, Senior Claims Specialist 10/06 – 04/2013.

Workers Compensation.

Dedicated to eight specific accounts in approximately eight jurisdictions, Texas, Oklahoma, Illinois, Louisiana, Indiana, Missouri, Arkansas and U.S. Long Shore & Harbor, some Protection & Indemnity - Jones Act Seaman.

Average caseload – 180 - 200 files. 60% of my case load consisted of litigated claims and / or, were of a large loss nature, made up primarily of new losses.

Of the 60% case load mentioned, approximately 95% of those losses required reserves at or above account retention levels thereby necessitating excess carrier correspondence on a 90-day basis consisting of status updates with action plans to bring files to closure.

As well, I provided front line safety managers and supervisors with continuing education regarding changes in the workers’ compensation law: Clayton Homes, Trinity Industries (USL&H), Boeing, Seaboard Foods, Kaiser Aluminum, Samsung, Roll Global – Paramount Citrus, and Tuesday Morning.

Claims Overload Staffing/Cambridge TPA Contract Adjuster 06/06 -10/2006.

The U.S. Longshore & Harbor accounts I handle had on average a Self-Insured Retention or Large Deductible Plan of $750K to 1 million per incident.

I reported to the following carriers for excess coverage; Chartis/AIG, XL Specialty, ACE American, Zurich, Old Republic, Liberty Mutual, Texas Guaranty Fund & The Louisiana Guaranty Fund.

Federated Mutual Insurance Company, Workers Compensation 12/01–06/2006.

Technical Supervisor

I was responsible for the technical supervision of four Claims Adjusters, and two Nurse Case Managers.

I was a working supervisor and maintained a claims case load for six jurisdictions including Texas, Oklahoma, Louisiana, Arizona, Mississippi, and New Mexico (Resident State).

Other responsibilities included scheduling continuing education seminars for subordinate adjuster licenses, including myself.

Liberty Mutual Insurance/Helmsman TPA Company, Senior Workers’ Compensation Case Manager 08/97–12/2001.

I was responsible for the supervision of two teams consisting of four Case Managers each.

Duties included the opening, settling, and closing of workers compensation claims case load for four jurisdictions including Texas, Oklahoma, Mississippi, and Colorado.

Other responsibilities also included scheduling and conducting yearly seminars on current events in workers compensation for International Paper, MBNA, Morgan Stanley/Dean Witter and 3M Account Managers.

I worked closely with Liberty Mutual Team Managers to ensure that the Case Managers were properly trained pursuant to Liberty Mutual’ s Best Practices Guidelines for handling workers compensation claims.

Gates McDonald (TPA), Senior Case Manager/Workers Compensation 08/96–08/97.

I was responsible for opening, settling and closing of workers compensation claims in Texas and Oklahoma for a dedicated account, Albertson’s Food Stores.

Other duties included coordinating and conducting quarterly Continuing Education Seminars for Albertson’s front line supervisors.

Claims Overload Staffing, Contract Claims Adjuster/Workers Compensation 06/95–08/96.

I worked as a contract workers compensation adjuster for multiple carriers/TPAs, while looking for permanent employment.

AIAC/AIG/CHARTIS, Senior Case Manager/Hearing Representative 03/93–05/95.

Texas Workers Compensation.

I was responsible for opening and closing workers compensation claims for multiple accounts under Texas jurisdiction.

Other duties included the attendance of Benefit Review and Contested Case Hearing as a hearing representative for AIG.

Claims Overload Staffing (Temp) Including AIAC/AIG/CHARTIS 03/90–03/93.

Workers Compensation Claims Adjuster

I worked for multiple carriers/TPA's while looking for full time work

My responsibilities as a contract adjuster for AIAC was opening, settling (Old Law Texas Claims)

Closing of workers compensation claims

Handled multiple statutory jurisdictions including U.S. Long Shore & Harbor, with some Protection & Indemnity - Jones Act Seaman, first and third-party claims.

CIGNA Commercial Insurance, College Intern 05/87-03/90.

I was placed in their Longshore and Harbor unit assigned to work maritime claims including, U. S. Long Shore & Harbor, Non-Appropriated Fund Instrumentalities Act, some Defense Base Act, and the State of Texas Workers’ Compensation claim as an adjuster trainee.

In my first year I reached the status of licensed adjuster.

My primary responsibilities were to investigate low level workers’ compensation claims under the Jurisdictions noted, up to and including full and final settlements with subrogation involvement.

Licenses

W/C Licenses: Texas, Oklahoma, Louisiana (License Information & Contacts available upon request).

Education

1983 – 1989 Houston Baptist University – Discipline Biology Chemistry / Economics Finance Senior Status – 145 transferable hours.

1977-1979 St. Edwards University – Discipline, Biology and Chemistry. Status – 45 transferable hours.

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