Customer Service Claims Adjuster
Resume:
Ilonna Merchant, CWCP
**** ********** *****, *** ****
Lithonia, Ga 30058
**************@*****.***
Professional History:
MCIM: Bradenton, Fl, (October 2016-Present)
Senior Claims Adjuster
Remote
Responsible for handling claims from beginning to end; responsible for 24 hour/3 point contact on all claims and investigating thoroughly; responsible for determining compensability; pay diary, file state form; calculate average weekly wage/compensation rate/total partial disability/permanent partial disability; negotiate settlements with chosen counsel; prepare information for claim reviews, complete all status reports; prepare large case reviews and present them to clients. Jurisdictions: GA, PA
FFVA Mutual: Maitland, FL, (October 2014-October 2016)
Out of State Sr. Claims Manager
Remote
Work closely with loss control and underwriter; attend marketing/pre-inspection visits; complete presentations with employers and agents to confirm claims concepts are understood and followed; coordinate and execute investigation, disposition and settlement of complex litigated and non- litigated claims from receipt to conclusion with little supervision; evaluate claims and suits through contact with insureds, claimants, witnesses and experts; set reserves and authorize payment and negotiate settlements within authority limit; oversee legal defense and medical management; work with attorneys, account representatives, agents, doctors and insureds; oversee 4 Ga adjusters living in Fl; participate in customer service calls and court appearances; provide superior customer service and claim handling, travel as needed.
Jurisdiction: GA
KeyRisk Management: Alpharetta, GA, (September 2008 to October 2014)
Senior Claims Professional
Responsible for handling claims from beginning to end; responsible for 8 hour/3 point contact on all claims and investigating thoroughly; responsible for determining compensability; pay diary, file state form; calculate average weekly wage/compensation rate/total partial disability/permanent partial disability; set up independent medical exams; negotiate settlements with chosen counsel; prepare information for claim reviews, complete all status reports; prepare large case reviews and present them to upper management as well as clients in-person, claims 101 presentations for very big clients. Jurisdictions: TN, Al, GA (majority GA and AL)
Wausau Insurance: Atlanta, GA, (August 2004 to September 2008)
Senior Case Claims Manager
Responsible for being the Team Lead for a team of 7adjusters; responsible for being the Team Manager back up; responsible for completing quality control diaries on team members claims to ensure best practices were met and to ensure the state laws were followed; responsible for assigning all claims to the team members within the allocated jurisdictions and providing direction on how to handle; responsible for leading team meetings to confirm team metrics were met; responsible for completing settlement evaluations and approve settlement authorization for all team members; responsible for completing all financial notes and confirming all claims are reserved properly; responsible for preparing large loss reports to accounts as well as managers; responsible for attending settlement mediations and trials; responsible for a case load of 100 files as a Case Manager. Jurisdictions: Al, GA, VA
AIG Claims Service: Atlanta, GA (February 2002 to August 2004)
Sr. Claims Representative Specialist II
Responsible for handling claims from beginning to end; responsible for 24 hour/3 point contact on all claims and investigating thoroughly; responsible for determining compensability; pay diary, file state form; calculate average weekly wage/compensation rate/total partial disability/permanent partial disability; set up independent medical exams; negotiate settlements with panel counsel; determine subrogation potential and pursue; prepare and present information for claim reviews.
Jurisdictions: MA, VT, ME, CT, RI, NH
R&SA, Atlanta, GA, (August 1997 to February 2002, originally started in PA office and transferred to the GA office)
Associate Claims Specialist
Responsible for 24 hour/3 point contact on all claims and investigating them thoroughly, pay diary, filed state forms, calculated average weekly wage, compensation rate, permanent partial disability, handled claims up to 20 weeks lost time until after transfer to GA office handled files until closure, set up independent medical examinations, put together and compiled claims kits for insured, negotiated settlement with in-house counsel and presented information for claims reviews. Jurisdictions: PA, GA, Al
Education:
Risk Management Inc.
Resident Agent Life License
States include: GA, PA
Risk Management Inc.
Workers Compensation Certification License
States include: PA, GA, Al, RI, CT, MA, VT, ME, NH, TN
ICM School of Business, Pittsburgh, Pennsylvania
Associates in Specialized Business Degree in Secretarial Sciences (Legal)
January 1997 GPA 3.6
Oakwood College, Huntsville, Alabama
Majored in Communications
September 1991-May 1994 GPA 3.0
References available upon request
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