Medical Manager

Nellie G. Hayes

**** *. ****** **, *******, Az. *5297 248-***-**** **********@*****.***

Objective To obtain a position with a company that utilizes my current skills and

expertise in Workers’ Compensation Law. In addition, allowing me to

continue expanding skills in other areas, with advancement on the quality

and merits of work in the specific fields of interest.

Professional

Achievement Texas Workers’ Compensation State License

Arizona Workers’ Comp Claims Basic Training

Achievements Certificate of Completion

Michigan Workers’ Comp Claim Basic

Certificate of Completion

Michigan Worker’s Comp Investigation

Certificate of Completion

Middleton Real Estate School

Certificate of Completion

Skills Excellent oral, written and communication skills, including presentation and

interpersonal skills. PC literate, including Microsoft office products/office

Equipment, communicate effectively with Employees, Insured’s, Clients,

Agents and Legal counsel, able to work in team environment, excellence

negotiating skills and a team player.

Work History 3/23/20 - present

Sentry Insurance

Workers’ Compensation Claim Representative I

Investigate moderate to complex medical only claims for Multi- States,

National and Non-National Account. Determined compensability Monitor

medical treatment/ management, establish/maintain accurate reserves, complete

timely State notices to the Division/Commission. Communicate claim

action/processing with injured worker, client, and appropriate medical contact.

Maintain professional client relationships and ensure ongoing adjudication of

claims with company standards and industry best practices.

7/25/11 – 1/2/20

Banner Health

Workers’ Compensation Adjuster

Direct full investigations and evaluate moderate to high level claims.

Determine and ensure appropriate treatment and disability benefits, in

accordance to the Arizona state statute, company standards, and best practice.

Assign, coordinate, monitor cases for medical management, IME’s, background

checks, verbal/recorded statements of claimants, witnesses, managers, and

other experts as deemed appropriate. Determine coverage, compensability, and

reportable claims. Explain claim handling process and questions to injured

employee. Refer and manage legal notices, and correspondence to appropriate

defense counsel. Identify settlement opportunities and negotiate reasonable

cost effective settlement offers. Establish and maintain action plans, reserves,

recognize cost drivers and data element. Identify early subrogation potential.

3/24/08 - 7/22/11

SCF Arizona/Copper Point

Sr. Claim Adjuster

Investigate moderate to highly complex claims. Issue benefits, monitor medical

treatment/ management, establish/maintain accurate reserves, complete timely

State notices to ICA, negotiate compromise and settlements with legal.

2006 - 10/06

Insurance Overload Temp Agency

Claim Adjuster Multi-States/Medical

Adjust and investigate medical only and loss time claims, determined

compensability. Monitor reserve accuracy and filing of state forms.

Communicate claim action/processing with injured worker, client, and

appropriate medical contact. Maintain professional client relationships and

ensure ongoing adjudication of claims with company standards and industry

best practices.

2003 - 7/05

Sedgwick CMS

Claim Examiner III Michigan Jurisdiction

Investigate moderate to complex claims for large Self-Insured Program.

Coordinate Sickness & Accident benefits to issue benefits, monitor medical

treatment and issue payment of all related medical bills. Establish and

maintain accurate reserves. Attend monthly client meetings. Direct and assist

defense counsel. Negotiate lump sump sum settlements and other legal

resolution of claim file with client. Complete necessary State forms.

Ohio, Indiana, Kansas & Wisconsin, Adjust and investigate medical only and

minor loss time claims, determine compensability. Monitor reserve accuracy

and filing of State forms. Communicate claim action/processing with claimant,

client, and appropriate medical contact. Maintain professional client

relationships and ensure ongoing adjudication of claims with company

standards and industry best practices.

2001 - 9/03

Meadowbrook Insurance Group

Claim Supervisor

Coordinate, direct and oversee the activity of a six person claim adjusting unit

in strict adherence to company procedures and expectations. Train, direct and

motivate staff to meet performance and audit goals. Collaborate, with

management on hiring and termination of employees, administer employee

disciplinary actions, appraisal and salary adjustments.

1994 - 5/01

Travelers Insurance

Sr. Claims Representative

Investigate moderate to highly complex claims, thoroughly and detailed.

Determine investigation strategy to resolve future liability. Issue benefits,

monitor medical treatment and establish/maintain accurate reserves. Completed

necessary reports to Insured/Risk Manager. Direct defense counsel. Negotiate

lump sum and structural settlements. Attend all levels of Hearings, third party

conferences and monthly/quarterly claim file reviews. In addition, attend

weekly teleconferences. Keep daily attendance, absences and vacation schedule

for the unit.

Education 1975 - 1978

Berwick High School, Berwick, Pa.

1/98 - 2/98

Middleton Real Estate School, Southfield, Mi.

9/03 - 3/06

Baker College, Auburn Hills, Mi.

6/06 - 7/06

Madonna University, Livonia, Mi.

Associates/CDA in Child Development

References Melanie Elias Debbie Allen Tammi Trotter

Burns & Wilcox Amerisure Co. Copper Point

Farmington Hills, Mi. Farmington Hills, Mi. Phoenix, Az.

248-***-**** 800-***-**** 602-***-****

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