Claims and Insurance Administrator

Yvette Lynn Price

Phone: 214-***-**** Email: ************@*****.***

LinkedIn: http://www.linkedin.com/in/yvette-price-87039745/

Claims Adjuster Claims Examiner Insurance Administrator

Experienced Licensed Adjuster specializing in Non-subscribed Workers Compensation Insurance. Extensive knowledge of minor to catastrophic work injury claims and motor vehicle claims for cars and Heavy trucks.

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Professional Summary

15+ years of experience

Monitor and setting with high reserves of 100K or more

Experience with paying claims and verifying CPT codes

Excels at heavy caseloads of 200 – 300 consecutively

Experience handling automobile, workers comp, property, general liability and environmental claims

Expert in investigating, analyzing, and resolving issues.

Skill Set

Manage, Process and resolve claims

Investigate, analyze, evaluate and negotiate claims

Communicate with policy holders, witnesses, and claimants to gather information regarding claims

Implement and coordinate the most effective management techniques to mitigate loss and expense payments

Knowledge of all aspects of each claim, including informal hearings, arbitrations, and small claims litigation

Heavy Call Volume

Experience with Catastrophic claims

Facilitate quarterly claim reviews

Conflict Resolution

Preparation of loss run reports

Relationship management

Time management to meet deadlines

Strong interpersonal skills

Proactive issue resolution/mitigate risks

Work History & Experience

Employbridge- Irving, TX (2018-2019)

Senior Claims Consultant

Employbridge is the largest staffing company in the US with three decades of proven success. More importantly, it's the backbone behind the nation's leading workforce experts.Directly responsible for making sure staffing had reported workers compensation injuries for states: Kentucky, Maryland, Michigan and Nevada.

Verify workers compensation injuries have been reported by staffing agency to insurance carrier

Experience explaining benefits to injured worker

Customer service experience handling various calls from injured workers. clients, adjusters and physicians

Verify accident form, medical documents and witness statements have been submitted

Attach all pertinent documents to electronic accident file.

Took inbound calls from injured workers, adjusters and staffing locations regarding claims.

Made outbound calls to injured workers, adjusters, physicians and attorneys regarding claims

Make sure reserves are properly set

Handle medical billing issues, denials and appeals

Set diary to review open claims for progress, closure or update on litigation

Work with adjusters and attorneys to settle litigated files. Authority of up to $50,000

Gibson Energy, LLC – Mesquite, TX (2013 - 2018)

Insurance Administrator

Asses the Gibson Energy insurance coverage and possible exposure to financial risk due to liability claims. Process insurance claims such as workers compensation on behalf of the company, maintain all records related to claims, have good contacts with all operating firms and branches to procure relevant documentation when needed.

Report motor vehicle, corporate work injury and property damage claims to insurance carrier.

Review claim reserves and claim handling

Create and maintain folders for all motor vehicle and spillage incidents.

Create and maintain monthly claim loss run reports.

Maintain legal files for pending lawsuits (motions, judgements, legal correspondence).

Maintain quarterly litigation file used to monitor activity of all litigated claims

Collect necessary documents as requested for all legal discoveries.

Report and monitor worker’s compensation claims for company employees

Track tractor/ trailer, occupational accident and worker’s compensation premiums for over 300 owner operators.

Charge back deductibles and administrative fees to owner operators for preventable accidents.

Conduct weekly orientation for new owner operator independent contactors.

Request certificates of insurance on behalf of Gibson to meet access carrier agreement requirements

Request certificates of insurance for owner operations for banking/finance requirements.

Work with corporate office in Calgary on various tasks including insurance renewal.

Review incoming contracts and verify insurance requirements are met

Send out proof of insurance to all owner operators and Gibson field employees annually.

Caprock Claims Management – Dallas, TX (2006 - 2013)

Claims Adjuster

Caprock Claims Management is a third-party administrator that specializes in non-subscriber claims for various business throughout Texas. Directly responsible for approximately 200-300 open claims at any given time. Claims can range from minor to catastrophic. Responsible for the investigation, management, negotiation, and resolution of claims in accordance with policy provisions, compliance, best practices and jurisdictional requirements, including the input of claim data and guiding insureds and claimants through the claim process and recognizing life events, customer’s needs and provide advice to deliver appropriate solutions.

Investigates report of injuries submitted. Contact employer and employee.

Experience explaining benefits and policies to injured employee and client.

Customer service experience handling calls from clients, physicians, injured workers

Maintain claim data in computer data base and update as needed.

Contact provider for treatment plan, work status and office notes.

Set diary to review open claims on a monthly basis

Authorize pre-certifications for surgery, therapy, work hardening/ work conditioning.

Set reserves for each claim and review reserves monthly.

Scan and attach any pertinent information to file a claim (nurse case manager notes, office notes, etc.)

Authorize treatment for injured workers,

Assign nurse case managers to claims if necessary.

Review medical bills submitted for claims if necessary.

Review medical bills submitted for claims and process for payment.

Instrumental in helping to maintain a 0.05% error ratio in claims department.

Resolve any billing issue.

Assist employers with questions regarding ERISA based policy

Run loss run reports for employers as requested

Review claims for closure

Notify carrier of any large loss claims (claims that will exceed over 25K)

Compose subrogation letters to send to at fault insurance companies.

Education, Licenses & Certifications

Texas Worker’s Compensation Adjuster’s License 2005

Public Administration and Psychology Courses Washburn University, Topeka, KS

Psychology Courses Emporia State University, Emporia, KS

Cigna Fraud Training 2011

Software Proficiencies

Microsoft Office

TMW

WLT

AS400

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