Sr. Workers Compensation Adjuster/ Team Lead
Resume:
Tammy A. King
Phoenix, Arizona
*********@*****.***
QUALIFICATIONS
Senior Work Comp Adjuster/Team Lead
Arizona Adjuster License 6741520
Customer Service Oriented
Excellent Technically
Strong Interpersonal Skills
Excellent Organizational Skills
WORK EXPERIENCE
Sr. Workers Compensation Adjuster
1/2023 – 4/2024
Temporary Employee for various employers
Managed a full caseload of Arizona lost time and CAT claims for large national accounts. Handled workers’ compensation claims for insureds and self-insured employers. Responsible for subrogation. Obtained recorded statements. Investigated claims for AOE/COE. Established appropriate reserves for the lifetime of the claim. Worked with Nurse Case Managers, private investigators, and attorneys. Maintained close contact with employers to ensure a return to work was in place. Directed all litigation and ensured costs and direction of legal was appropriate. Reported claims to excess insurance carriers. Coordinated IME’s, including letter to the IME doctor. Issued all appropriate state forms. Knowledge of reporting to Medicare Section 111. Extensive customer service for national accounts. Presented claims at monthly or quarterly claim reviews depending on who the client was. The caseload comprised many clients, anywhere from being a tech company to agricultural business and every other industry.
Banner Health (Self-Insured Employer}
8/2018-10/2022
Sr. Claims Examiner / Team Lead
Managed a caseload of Arizona lost time work comp claims including catastrophic (CAT) losses. Responsible for investigation, subrogation, litigation, and negotiation of work comp claims (Arizona jurisdiction). Interaction with Risk Management, as well as external and internal customers. Investigated claims by obtaining recorded statements of the parties involved. Gathered police reports, risk management reports, witness statements, surveillance film if applicable to make final determination on compensability of claims. Worked closely with Return-to- Work Coordinator to ensure placement as soon as possible. Referred and managed litigation and ensured appropriate legal plan of action was in place. Responsible for overseeing compliance of claims of 5 adjusters. Responsible for ensuring all files were properly reserved for lifetime exposure. Implemented training program for 3 new adjusters. Presented at quarterly claims reviews (internally). Effectively managed Medicare Section 111 settlements. Also managed oversight of claims of being administered by a Third-Party Administrator for Colorado claims. Attended quarterly claim reviews for Colorado claims. Ensured timely reporting to excess carriers on applicable claims.
Aerotek Tempe, AZ
2/2017-to 5/2018
Claim Review Specialist III
Aerotek is a staffing and recruiting company. Adjusted claims for those contractors employed by Aerotek. Handled a caseload of 260 lost time claims being administered by a Third Party Administer (ESIS). Responsible for California, Washington, Colorado, Arizona, and New Mexico claims. Oversaw the workers’ compensation program and responsible for training the Aerotek field offices pertaining to workers’ compensation matters. Attended seminars in various states. Attended claim reviews in California quarterly. Responsible for being proactive in managing litigation and settlement of pending files. Travel required.
York Risk Services
Phoenix, AZ
2/2015- to 3/2017
Sr. Workers Compensation Representative
Managed a full caseload of Arizona lost time and CAT claims for large national account (The City of Phoenix) . Handled workers’ compensation claims for insureds and self-insured employers. Responsible for subrogation. Obtained recorded statements. Investigated claims for AOE/COE. Established appropriate reserves for the lifetime of the claim. Worked with Nurse Case Managers, private investigators, and attorneys. Maintained close contact with employers to ensure a return to work was in place. Directed all litigation and ensured costs and direction of legal was appropriate. Reported claims to excess insurance carriers. Coordinated IME’s, including letter to the IME doctor. Issued all appropriate state forms. Knowledge of reporting to Medicare Section 111. Extensive customer service for national accounts. Presented claims at monthly or quarterly claim reviews depending on who the client was. The caseload comprised many clients, anywhere from being a tech company to agricultural business and every other industry.
Banner Health (Self- Insured and Administered Employer)
Mesa, Arizona
2/2008 to 11/2013
Sr. Claims Representative
Handled a full-time caseload of lost time workers’ compensation claims for self-insured employer. Cases were of medium complexity to catastrophic. Responsible for subrogation and litigation management. Obtained recorded statements. Investigated claims for AOE/COE. Established appropriate reserves for the lifetime of the claim. Granted settlement authority to resolve disputes. Worked with NCM, private investigators and attorneys Reported claims to excess insurance carriers. Coordinated IME’s. Issued all appropriate state forms. Worked with vocational specialists. Knowledge of reporting to Medicare Section 111. Banner is the 2nd largest employer in the state of Arizona
Gallagher Bassett (TPA)
Scottsdale, Arizona
1/2005-2/2008
Sr. Claims Workers Compensation Representative
Handled lost time workers’ compensation claims caseload for large national clients Including extensive service and performance agreements. Handled claims from the inception to the conclusion. Obtained recorded statements. Made determination on compensability of claims. Prepared files and handled all subrogation aspects of claim. Required extensive one on one contact with clients including weekly claim reviews for some clients. Reported claims to excess carriers. Paid medical bills as appropriate. Completed monthly status reports on all open claims. Clients included construction accounts, hospitality, hospital, restaurants, auto dealers, and a wide variety of many other types of industries. Reviewed appropriate catastrophic cases for Medicare-Set-Aside agreement. Worked with vocational specialists.
Education
Ajo High School
Workers’ Compensation Claim Law Associate
College at Glendale Community College 2012-2013
Arizona Adjusters License
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