VIKKI LANEY

● 407-***-**** ● adbttt@r.postjobfree.com

Claims Case Management

Workers Compensation Claims ● Medical Management

Performance Overview

Experienced Senior Claims Examiner with proven ability to analyze the claims exposure, determine the proper course of action and bring claims to resolution within established guidelines in an expeditious manner. Demonstrates ability to gain customer trust and secure a win-win result. Builds strong partnerships with internal and external partners within the company structure. A persuasive communicator and assertive negotiator for litigated claims.

Core Competencies

* Claim Investigation * Drug Utilization Reviews * MSA allocations

* Timely Payment of Benefits * EDI Compliance * Excess Communication

* Resolution Plans * Litigation Management * Medical Terminology

* Reserving * CAT claims * Settlement Negotiation

* FCM Coordination * PTD/PTDS Administration * Customer Service

State Admissions

Licensed with the State of Florida.

Education

High School Graduate

Valencia Community College

Professional Experience

YORK RISK SERVICES

December 2019 to July 2019

Manager: Sandra Raphael-Chin

Senior Claims Adjuster: Handling all aspects of workers compensation claims from beginning to end. Licensed in State of Florida, Georgia and Tennessee with case count of 90 to 100.

ARTHUR GALLAGHER BASSETT

July 2018 to November 2019

Manager: Heidi Greene

Senior Claims Adjuster: Handling all aspects of workers compensation claims from beginning to end.

Licensed in State of Florida, South Carolina, North Carolina & Tennessee with case count of 100 to 110.

WORKERS COMPENSATION INDEPENDENT CONSULTING

June 1 2016 to June 2018

Senior Analyst – Self-Employed

Review claims to provide insight and strategies on how to bring file to a closure. Communicate with clients on continued exposure and the importance of evaluating claim early for settlement purposes. Clients would consult for further direction of medical management. Whether it is a future medical care plan, approaching a doctor with a specific dialog in an effort to clarify causal relationship to the work injury or exhausting IME etc. Work with employers on return to work program while on modified duty. Explaining the importance of contact with injured employee early on and continued contact throughout disability. Provide strategies of cutting cost early on to eliminate rising cost of claims and keeping ones modifier down.

BROWN & BROWN / USIS 08/12/1992 to 07/05/2015 (23 years)

Manager: Teresa Snapp & Prior to 1998 Manager: Julia Harmon Wilson

Sr. Claim Adjuster: Performed all aspects of daily claim handling from beginning to end. Stay in compliance with statutory, regulatory and ethic requirements, Maintained five active accounts, two of which were elite accounts that required daily communication with hands on approach and customer service. Communicate with legal counsel for quick resolution of pending issues, identify exposure and settle quickly to reduce continued exposure. Maintain a closure ratio. Identify subrogation, fraud and direct vocational / field case management involvement. Travel as necessary.

JOHNS EASTERN COMPANY, INC 8/1989 to 04/1991

Manager: Beverly Adkins

Claim Adjuster (part time)

Started in a created position when hired. All new claims came in directly to me and I determined if claim was to be a medical only or lost time case. All lost time cases were investigated / documented with a three point contact by myself and then assigned to adjuster handling that specific account. If subrogation a possibility a field adjuster was assigned immediately to investigate & preserve equipment, placed all parties on notice to protect insured. I held this position for 6 months and promoted to new position as:

SDF Litigation Specialist / Sr Adjuster (Fulltime)

Created a unit for Special Disability Trust Fund Recoveries. Determine preexisting conditions/presumptions, secure knowledge affidavit with employer and work directly with fund until acceptance offer made by fund and accepted. Filing of SDF-1 and posting recoveries of received checks from fund.

GENERAL ADJUSTMENT BUREAU 08/1987 to 07/1989

Manager: Hayden Schultz

Claims Adjuster – general duties of an adjuster

FRED S. JAMES INC 07/1986 to 07/1987

Manager: Jim Slokum

Claims Adjuster – general duties of an adjuster

HEWITT COLEMAN & ASSOCIATES 04/1980 to 07/1986

Manager: Ron Cohn

Lead Supervisor / Sr. Claims Adjuster

Started as Claims Adjuster trainee and promoted to Claim Adjuster within a year handling Florida claims. Handled all aspects of claims from beginning to end under the direction of my mentor for six months. Investigate and pursued SDF, subrogation, and assigned field case management as needed. I was a strong and persuasive communicator bringing claims to a quick resolution with results. In addition, I handled Georgia and Alabama claims. My last two years, I was a claims supervisor reviewing claims providing direction/recommendations. Contact with clients quarterly to provide a return to work strategy or resolving the claim to reduce continued exposure. Assisted with training program within the unit and provided case law updates.

References / Recommendation letters - upon request.

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