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Case Manager A Team

Location:
Rowlett, TX
Posted:
March 06, 2024

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Resume:

Confidential \ Personal Data

Tiffany N. Miller

**** ****** **. #****

Rowlett, TX 75088

ad35zl@r.postjobfree.com

QUALIFICATIONS:

Proficient with handling Workers’ Compensation (multiple jurisdictions) Proven ability to manage a team of adjusters

Excellent communication and leadership skills

Ability to interact with broker, insureds and internal customers Central zone point of contact for trucking

Central zone point of contact Amazon DSP

EXPERIENCE:

March 2022 - present – Regional Claims Manager - Amtrust Insurance

· Work with agents, insureds, and risk managers to tailor special handling of their large claims to ensure exceptional service.

· Conduct Claims Audits on assigned programs.

· Conduct onboarding meetings with insured and agent customers to review AmTrust Claims Department Structure, Philosophy and Protocols.

· Train agents and insureds clients on Self Service Claims & Claims Service Kit Portals.

· Conduct Claim Reviews and Annual Stewardship reviews with insured and agent clients.

· Liaison between Branch claims and underwriting to resolve claims issues. March 2019- March 2022 - Claims Manager - Amtrust Insurance

• Manage the day-to-day performance of a team of technical claim examiners

• Ensure compliance to the Claims handling Guidelines and excellent Customer Service

• Coach and develop staff to ensure each contributor works effectively as a team

• Informs leadership of current case status through regular communications and reports

• Ensures that all policies, procedures, and controls are followed

• Utilize all claims related tools/systems and reports to manage team results and performance

• Provide technical oversight through supervisor diaries, one on ones, claims reviews

• Ability to actively review work of others via file reviews

• Holds the team accountable to comply with best practices through mentoring

• Works with the team to manage the negotiation of claims settlements, ensuring timely and cost-effective claims resolution

• Maintains current knowledge of related laws and regulations and communicates to staff

• Defines team goals and communicates those goals to assigned staff. Motivates people to perform at the highest level

April 2014- March 2019 - Claims Case Manager III - Amtrust Insurance

• Investigate claims to determine whether coverage is provided, establish liability, and verify damages

• Developed and executed a strategic action plan, in order to bring claims to resolution

• Set and maintain proper reserves

• Determine settlement exposure and negotiate settlements.

• Communicated proactive claim updates with insureds and brokers November 2008-October 2013 - Claims Case Manager II - Liberty Mutual

• Manages, processes, and resolves claims assigned by Sr. Claims Case Manager.

• Evaluates compensability/liability/disability and settles claims within prescribed limits

• Investigated claims by communicates with policyholders/customers, and witnesses

• Confirms or denies coverage and advises policyholders as to proper course of action Confidential \ Personal Data

• Negotiates settlements with attorneys, claimants, and/or co-defendants February 2007- October 2008 - Sr. WC Claims Technician - Wausau Insurance

• Conducts investigation to secure essential facts from injured worker, employer and providers regarding workers' compensations through timely phone communication

• Verifies information from claimants, physicians, and medical providers to assess

• Maintains contact with injured worker, provider and employer to ensure understanding of protocols and claims processing and/or to confirm return-to-work date or medical treatment.

• Maintains accurate records and handles administrative responsibilities associated with processing and payment of claims

• Recognizes potential subrogation cases, prepares cases for subrogation and refers these cases to the Subrogation Units



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