Workers Compensation Claims Adjuster
Resume:
Melinda Long
Senior Workers Compensation Claims Examiner 702-***-****
Professional Licensure
-SIP (California Self Insurance Certification) License – June 2003
-Completed LEAD training-Sedgwick University-November 2015
Experience
Intercare Rocklin, CA/Remote
Claims Adjuster III
Conduct prompt and thorough investigations of case facts and circumstances
-Currently handle an indemnity/lost time caseload of 100% California workers compensation Self Insured claims for the County of Sonoma with approximately 140 claims, including 4850 claims.
-Interpret and apply appropriate statutes and regulations in determining compensability, Permanent Disability, and move claims to settlement resolution as well as review all policy details upon receipt of claims.
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
Employers Insurance Glendale, CA/Remote
Sr. Claims Examiner 11/2021-7/2022
Conduct prompt and thorough investigations of case facts and circumstances
-Currently handle an indemnity/lost time caseload of 100% California workers compensation carrier claims with approximately 160-175 claims.
-Interpret and apply appropriate statutes and regulations in determining compensability, Permanent Disability, and move claims to settlement resolution as well as review all policy details upon receipt of claims.
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
AmTrust/Contract temporary position Irvine, CA/Remote
Claims Adjuster 9/2021-11/2021
Conduct prompt and thorough investigations of case facts and circumstances
-Handled an indemnity/lost time caseload of 100% California workers compensation carrier claims of approximately 160-175 claims.
-Interpret and apply appropriate statutes and regulations in determining compensability, Permanent Disability, and move claims to settlement resolution
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
JT2 Integrated Resources Oakland,CA/remote
Claims Adjuster 12/2020-9/1/2021
Conduct prompt and thorough investigations of case facts and circumstances
-Currently handle an indemnity/lost time caseload of 100% California workers compensation claims for a group of school districts in Central California (15 districts) with a case load of approximately 165 indemnity claims.
-Interpret and apply appropriate statutes and regulations in determining compensability, Permanent Disability, and move claims to settlement resolution
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
Broadspire Folsom, CA
Sr. Workers’ Compensation Adjuster 3/2020-11/2020
Conduct prompt and thorough investigations of case facts and circumstances
-Currently handle an indemnity/lost time caseload of 100% California workers compensation claims for a national communications company with approximately 160-175 claims.
-Interpret and apply appropriate statutes and regulations in determining compensability, Permanent Disability, and move claims to settlement resolution
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
Corvel Folsom, CA
Contract Worker/Adjuster 12/2019-2/2020
Conduct prompt and thorough investigations of case facts and circumstances
-Currently handle an indemnity/lost time caseload of 100% California workers compensation claims for a large retail rganization, handling approximately 140 claims at a time.
-Interpret and apply appropriate statutes and regulations in determining compensability, Permanent Disability, and move claims to settlement resolution.
LWP Claims Services Sacramento, CA
Contract Worker/Adjuster 10/2019-12/2019
Conduct prompt and thorough investigations of case facts and circumstances
-Handle an indemnity/lost time caseload of California, Oregon, Washington, Georgia, and Florida claims
-Interpret and apply appropriate statutes and regulations in determining compensability, Permanent Disability, and move claims to settlement resolution
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
York Insurance Services El Dorado Hills,CA
Contract Worker/Adjuster 9/2019-10/2019
Conduct prompt and thorough investigations of case facts and circumstances
-Currently handle an indemnity/lost time caseload of 100% California workers compensation claims for a large retail rganization, handling approximately 140 claims at a time.
-Interpret and apply appropriate statutes and regulations in determining compensability, Permanent Disability, and move claims to settlement resolution
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
Gallagher Bassett Services, Inc. Sacramento, CA
Sr. Resolution Manager 2/2019-9/2019
-Conduct prompt and thorough investigations of case facts and circumstances
-Currently handle an indemnity/lost time caseload of 100% California workers compensation claims, approximately 160-170 files
-Interpret and apply appropriate statutes and regulations in determining compensability
-Analyze case facts to establish timely and accurate case reserves
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
-Negotiate settlements and liens
Sedgwick Claims Management Services, Inc. Roseville, CA
Sr. Workers Compensation Adjuster-Kaiser Program 9/2013-11/2018
-Conduct prompt and thorough investigations of case facts and circumstances
-Currently handle an indemnity/lost time caseload of 100% California workers compensation claims for a large healthcare organization, handling approximately 140 claims at a time.
-Interpret and apply appropriate statutes and regulations in determining compensability, Permanent Disability, and move claims to settlement resolution
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
Intercare Holdings Insurance Services, Inc. Rocklin, CA
Sr. Workers Compensation Adjuster 10/2011-9/2013
-Conduct prompt and thorough investigations of case facts and circumstances
-Currently handle an indemnity/lost time caseload of 100% California workers compensation claims for a large public entity, handling approximately 130 files at this time.
-Interpret and apply appropriate statutes and regulations in determining compensability, Permanent Disability, and move claims to settlement resolution
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
Gallagher Bassett Services, Inc. Las Vegas, NV / Sacramento, CA
Sr. Workers Compensation Claims Representative 10/07-10/2011
-Conduct prompt and thorough investigations of case facts and circumstances
-Currently handle an indemnity/lost time caseload of 100% California workers compensation claims, approximately 160-170 files
-Interpret and apply appropriate statutes and regulations in determining compensability
-Analyze case facts to establish timely and accurate case reserves
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
-Negotiate settlements and liens
Southern Nevada Functional Restoration Program Las Vegas, NV
Operations Manager 1/2006-9/2007
-Schedule and obtain authorizations for all patient appointments with all staff
-Maintain patient records
-Maintain business accounting records
-Responsible for marketing to insurance carriers and physicians statewide
-Responsible to adhere to the Nevada Revised Statutes which apply for medical providers in the workers’ compensation field
-Oversee the entire program for all patients and a staff of physicians, psychologists, and therapists during a 4-week class
-Ensure that patients receive the proper treatments and are in compliance with the program guidelines
Employers Insurance Company of Nevada Reno, NV / Henderson, NV
Claims Examiner II 3/2004 – 12/2005
-Conduct prompt and thorough investigations of case facts and circumstances
-Interpret and apply appropriate statutes and regulations in determining compensability
-Analyze case facts to establish timely and accurate case reserves
-Apply knowledge of medical procedures, disabilities, and likely duration to determine accurate estimate of claim cost
-Audit physician reports of P.P.D. evaluations to ensure their accuracy in accordance with AMA Guidelines
-Evaluate, prepare, and present cases of possible permanent total disability to the Permanent Total Disability Council
Claims Management Inc. Rancho Cordova, CA
Workers' Compensation Claims Examiner 10/2002 – 3/2004
-Manage and adjust a caseload of up to 175 open indemnity files
-Assigned to two municipality accounts, City of Walnut Creek and City of Concord (including labor code 4850).
-Handle all aspects of files -- litigation, vocational rehabilitation, and permanent disability and reserving
-Travel to represent company at all meetings with clients, vendors and regulatory agencies
-Give direction to claims assistants to insure proper claims progression
-Negotiate settlements
Workers' Compensation Claims Assistant 5/2001 – 10/2002
-Set up new indemnity and medical-only claims
-Pay and monitor temporary/permanent disability and rehab payments to claimants.
-Process medical bills for payment
-Execute legal file and serves to the WCAB
-Calculate monthly trusts owed from clients
Education
Whittier College Whittier, CA
Victor Valley Community College Victorville, CA
Mojave High School Hesperia, CA
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