Worker s Compensation
Resume:
Lorna McFadden-Williams
New Orleans, LA 70125
504-***-****(home)/504-***-****(cell)
Professional Experience:
Summit Holdings (AIG)-Baton Rouge, La
February 2018-present
Senior Claims Specialist
Investigates and maintains claims:
oReviews and evaluates coverage and / or liability.
oSecures and analyzes necessary information (i.e., reports, policies, appraisals, releases, statements, reports or other documents) in the investigation of claims.
Works toward the resolution of claims files, and may attend arbitrations, mediations, dispositions or trials as necessary.
May affect settlements / reserves within prescribed limits and submit recommendations to supervisor on cases exceeding personal authority.
Conveys moderately complex information (coverage, decisions, outcomes, etc.) to all appropriate parties, maintaining a professional demeanor in all situations.
Ensures that claims payments are issued in a timely and accurate manner.
Ensures that claims handling is conducted in compliance with applicable statutes, regulations and other legal requirements, and that all applicable company procedures and policies are followed.
May provide guidance and assistance to lower level positions and other functional areas.
Investigating losses. Analyzing coverage, determining compensability and benefits. Establishing reserves and negotiating settlements. Conducting meetings on the phone with insureds and claimants.
Preparing large loss reports to both internal and external audiences. (Attending settlement conferences as assigned.) Working closely with defense attorneys and other vendors including medical case management, surveillance, etc.
CCMSI-Metairie, La
December 2014-January 2018
Claims Representative
Responsible for time and appropriate filing of stated required forms to insure compliance.
Investigation of claims with store, claimant, medical provider and available witness
Correspond via telephone and e-mail to physicians, hospital, employee’s and attorney
Proactively manage, finalized and control an inventory of cases.
Handled medical and lost time files
Determined the value of injury and liability exposure
Review, investigate, analyze and adjuster workers’ compensation claims in accordance with current law and regulation.
Excess Carrier Reporting
Authorized medical treatment within pre-established authority levels
Establish claim reserves an authorized payment within reserves authority limits
Authorized payments of medical bills, temporary and permanent disability, and death benefits
Claims Management Inc. –Carrollton, TX
August 2006-November 2014
Workers Compensation Claims Supervisor-Non-Subscription and Worker Compensation
Experience in supervision various litigation and managing Non-Subscription Program
Exceptional ability to analyze worker compensation plan and make recommendation
In-dept. knowledge of employment laws, procedures and regulation.
Developed and ensure compliance to compensation policies and procedures
Manage employee injury cases and overall investigation claims for various parties.
Assisted various departments in preparing budges and monitoring expenditures and make all settlement.
Prepared staff reports an associated correspondence to be submitted to management.
Assist in training adjusters with claim handling procedures
Excellent skills in medical and technical terminologies
Determined the value of injury and liability exposure
Performed audits on workers compensation claims and ensured compliance to claims services procedures
Administered daily activities of claim professionals and ensured optimal level of services.
Developed locate operating processes and implies same for quality claim sercises.
Managed all operation according to established standard and productivity.
Ability to review and approved a variety of insurance and liability claims
Conducted investigation process as need to improved risk management
Promotes and supports company policies procedures, mission, values and standards of ethics an integrity
Identifies and recommends process improvement to improve business results
Claims Management Inc. –Carrollton, TX
Worker Compensation Claims Specialist/Adjuster
August 2006-March 2012
Investigation of claims with store, claimant, medical provider and available witness
Correspond via telephone and e-mail to physicians, hospital, employee’s and attorney
Assist in training adjuster with claim handing procedures
Handled medical and lost time files
Determined the value of injury and liability exposure
Conducted investigation process as need to improved right management
Responsible for time and appropriate filing of stated required forms to insure compliance.
Education
Southern University at New Orleans
Social Work
Phillip Jr. College
Associated Degree-Accounting
Licensed
Texas
Louisiana
Alabama
Certification
Certified Worker’s Compensation Professional
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