Customer Service Workers'
Resume:
Sharon R. Jackson
**S Zinnia Circle
Henderson, NV 89015
SUMMARY: Twenty five years of progressive experience in claims handling and management in the insurance industry to include comprehensive knowledge in the supervision and coordinaUon of claim staff and funcUons within the claims area. SKILLS: Extensive knowledge of technical and Supervisory aspects of workers' compensaUon claims management, customer service with client maintenance and retenUon, provide direcUves in the area of workers' compensaUon case law, regulaUons and industry related procedures. Good analyUc and negoUaUon skills. Experience using Microso] Word, Word Perfect, Microso] Office, Stars, Excel, OvaUon, Juris, LUA, AIC400, and various office equipment.
EDUCATION:
Eldorado High School Las Vegas, NV June 1987
Courses: Business
CerUfied Claims Professional - Claims College
AIC – Enrolled
LICENSES: State of Nevada Hearing license, State of Texas Adjuster license, Advance Workers' CompensaUon CerUficaUon, Supervisor CerUficaUon, Arizona out of state cerUficaUon
EXPERIENCE:
BerkleyNet
Team Lead Mar 17 to Apr 24
Supervises all technical aspects of claims to include coverage invesUgaUon, disability benefits management, medical management, file management, subrogaUon, reserving and file management. Provide team technical training and claims handling guidance and direcUon. Review reserves and sejlement amounts over the Claims RepresentaUve authority level for approval. Ensures claims are clearly and adequately documented, and ensure claims data is captured and coded correctly within the the claims management system. Provide team support, leadership and moUvaUon to promote a high level of performance. Establish team performance goals and objecUves in alignment with business plans. Establish team performance goals and objecUves in alignment with business plans. Directs team toward achievement of established goals and objecUves. Performs claims quality reviews in compliance with audit requirements and quality standards on a monthly and quarterly basis. IdenUfy and alert senior management to claims trends or issues. Resolves escalated policyholder and claimant issues related to specific claims. Conducts regular coaching and performance feedback discussions. Establishes performance and career development plans in collaboraUon with team members, management & HR. Assures claims representaUves are properly licensed or cerUfied in assigned jurisdicUons. Partners with HR and management on engagement strategies to improve employee engagement, job saUsfacUon, and create a psychologically safe work environment. Administers all company personnel policies and addresses d revolves personnel majers with the support of management and HR. Conducts interviews of prospecUve claims representaUve candidates and provides feedback to assist senior management with hiring decisions. Maintains and demonstrates knowledge of the Workers’ CompensaUon Act, adjudicaUon process, and regularly compliance framework in assigned jurisdicUons. Ajends and parUcipates in claims reviews with senior management and defense ajorneys. Coordinates and leads special projects or processes as assigned by senior management. ConUnuously strives to improve companies product and business results through innovaUon. Obtain and maintain adjuster license in mulUple jurisdicUons. Senior Claims Examiner Jan 16 to Mar 17
Conduct invesUgaUons, make liability/compensability decisions, evaluate losses, negoUate sejlements and manage an inventory of commercial property/casualty claims involving bodily injury or property loss. Handle caseload of high exposure and more complex claims requiring an advanced understanding of claims handling. Service as primary contact with policyholders/customers and establishes working relaUonship with customers. Respond to all types of general customer issues/problems. Conduct claim reviews and may periodically contact customers to determine needs and level of saUsfacUon. IdenUfies and assesses training needs for team and communicates to Team Manager. Homemaker Nov 12 to Nov 15
I have been a homemaker and caretaker for my disabled spouse. AIG/CHARTIS
Senior Claims Examiner Apr 12 to Nov 12
Conduct invesUgaUons, make liability/compensability decisions, evaluate losses, negoUate sejlements and manage an inventory of commercial property/casualty claims involving bodily injury or property loss. Handle caseload of high exposure and more complex claims requiring an advanced understanding of claims handling. Service as primary contact with policyholders/customers and establishes working relaUonship with customers. Respond to all types of general customer issues/problems. Conduct claim reviews and may periodically contact customers to determine needs and level of saUsfacUon. IdenUfies and assesses training needs for team and communicates to Team Manager. SEDGWICK
Senior Claims Examiner Aug 11 to Apr 12
Conduct invesUgaUons, make liability/compensability decisions, evaluate losses, negoUate sejlements and manage an inventory of commercial property/casualty claims involving bodily injury or property loss. Handle caseload of high exposure and more complex claims requiring an advanced understanding of claims handling. Service as primary contact with policyholders/customers and establishes working relaUonship with customers. Respond to all types of general customer issues/problems. Conduct claim reviews and may periodically contact customers to determine needs and level of saUsfacUon. IdenUfies and assesses training needs for team and communicates to Team Manager. XCHANGING
Senior Claims Examiner/Office Manager Apr 11 to Jul 11 InvesUgate, evaluate and adjust assigned claims. Provide oversight of medical, legal and damage esUmates related to claims. NegoUate any disputed bills or invoices for resoluUon. Authorize and make claim payments. NegoUate sejlements. Provide direct handling of liUgated and complex claims. Review and maintain personal diary on claims system. Ajend Board MeeUngs and training sessions with clients. Ajend and parUcipate at hearings, mediaUons and informal legal conferences. Provide assistance to all personnel. Prepare newslejer arUcles. Provide reports and oversight of informaUon to excess/reinsurance carriers. AVIZENT
Senior Claims Examiner Nov 10 to Mar 11
Conduct invesUgaUons, make liability/compensability decisions, evaluate losses, negoUate sejlements and manage an inventory of commercial property/casualty claims involving bodily injury or property loss. Handle caseload of high exposure and more complex claims requiring an advanced understanding of claims handling. Service as primary contact with policyholders/customers and establishes working relaUonship with customers. Respond to all types of general customer issues/problems. Conduct claim reviews and may periodically contact customers to determine needs and level of saUsfacUon.
LIBERTY MUTUAL
Senior Case Claims Manager Feb 08 to Jan 10
Guides a team of claims case managers who conduct invesUgaUons, make liability/compensability decisions, evaluate losses, negoUate sejlements and manage an inventory of commercial property/casualty claims involving bodily injury or property loss. Assist Claims Team Manager with assigning new claims to team members, providing technical direcUon, monitor caseloads, accountability for team's performance, including quality of work, producUvity and level of customer service. Handle caseload of high exposure and more complex claims requiring an advanced understanding of claims handling. Service as primary contact with policyholders/customers and establishes working relaUonship with customers. Respond to all types of general customer issues/problems. Conduct claim reviews and may periodically contact customers to determine needs and level of saUsfacUon. IdenUfies and assesses training needs for team and communicates to Team Manager. Provide ongoing training and guidance to team members regarding technical complexiUes of assigned work. Provides input to Team Manager regarding personnel performance of team members. May recommend appropriate personnel acUon and assist team members with preparing objecUves. CCMSI
Claims Supervisor Oct 01 to Feb 08
Review, assign and provide supervision of all claim acUvity to ensure compliance with internal claims standards, client specific handling instrucUons and in accordance with applicable state laws. InvesUgate, evaluate and adjust assigned claims. Provide oversight of medical, legal and damage esUmates related to claims. NegoUate any disputed bills or invoices for resoluUon. Authorize and make claim payments. NegoUate sejlements. Provide direct handling of liUgated and complex claims. Provide educaUon, training and assist in the development of claim staff. Review and maintain personal diary on claims system. Responsible for client saUsfacUon to include supervision of all claim acUvity, Ajend Board MeeUngs, conduct file review meeUngs and training sessions with clients. Ajend and parUcipate at hearings, mediaUons and informal legal conferences. Complete performance appraisals, objecUve goal sepng and ajainment of claim staff. Remain current on all legislaUve acUvity at both federal and state levels, industry and market trends to ensure that all staff members are appropriately informed and understand the impact of these developments. Develop, revise and implement work flow processes to ensure efficiencies and provide oversight of individual caseloads. Assist in hiring, training, monitoring and discipline of claim staff. Provide assistance to all personnel. Prepare newslejer arUcles. Provide reports and oversight of informaUon to excess/reinsurance carriers.
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