Customer Service Workers Compensation

Addie Lester, CPCU

*** ****** ******, ******, ** 19070

Email: **********@*****.*** – phone: 484-***-****

Summary

Workers Compensation Professional

Dedicated insurance professional with 12+ years of experience investigating and processing workers compensation claims for the states of Pennsylvania and New Jersey. Excels in investigating, determining compensability, verifying coverage and processing indemnity payments and medical bills. Effectively manages multiple, high-priority projects, and takes pride in providing exemplary customer service.

Key Skills

Claims Handling and Investigations

Risk Assessment and Mitigation

Recognition of potential subrogation

Claims Reports and Documentation

Policy Interpretation

Confidential Records Management

Experience

TRISTAR RISK MANAGEMENT – Philadelphia, Pennsylvania

Senior Claims Examiner – 06/19 – Present

Effectively manages a caseload of 125 to 150 workers’ compensation files, including very complex claims; Initiates and conducts investigation in a timely manner; Determines compensability of claims and administer benefits, based upon state law and in accordance with established Company guidelines; Manages medical treatment and medical billing, authorizing as appropriate; Refers cases to outside defense counsel. Directs and manages as appropriate

CompServices, Inc. – Philadelphia, Pennsylvania

Supervisor, 04/16 to 08/18

Manage day to day activities worker’s compensation claims unit; review initial injury reports for assignment; maintain open dialogue with adjusters regarding compensability concerns; review adjuster files for compliance with state laws and CSI objectives; ensure files are reserved properly to reflect their exposure; ensure files are prepared for claim reviews and settlement conferences; ensure good customer service for our clients as well as our internal and external customers.

Senior Claims Adjuster, 09/07 to 04/16

Investigated, determined compensability, and processed claims under the correct city disability program. Prepared claims for review and settlement negotiations.

Documented and reserved claims for their ultimate exposure.

AIG Claims Services – Essington, Pa

Claims Adjuster, 10/94 - to 09/07

Investigated workers compensation claims for compensability in the states of New Jersey and Pennsylvania. Verified appropriate coverage. Approved medical treatment and services. Authorized payment of lost time wages. Recognized potential 3rd party claims and referred to the subrogation unit for pursuit of our liens. Provided direction to the medical case managers and assign attorneys for litigated matters.

Education

Activities

Bachelor of Science in Business 5/81 Widener University -- Chester, Pa

Associate of Arts in Leadership 5/07 Harcum College, -- Bryn Mawr, Pa

Bachelor of Arts in Organizational Leadership Eastern University, -- St. Davids, Pa

Chartered Property Casualty Underwriter December 2017

Co-Founder of Chester Township Cougars youth football and cheerleading program. Former scholastic Coordinator Del-Val League Youth Association. Founder/Manager of ICYAA of Chester travelling baseball team. Coordinator of MLK day of service activities for Providence Baptist Church.

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