Claim Examiner

Karen DiTrapani

***** ***** **** **, ***********, NM 87113 – 505-***-****

Claim Examiner – Workers’ Compensation

Litigation Management/ Complex & Catastrophic Claims/Multi-Jurisdictional/National & Self Insured accounts/Risk Management/Risk Pool/ OCIP/ EDI Filings.

A highly motivated claim professional with twenty plus years of workers’ compensation claim handling. Strong communication, presentation and customer services skills. Ten years of New Mexico Workers’ Compensation claim experience. Currently hold an independent Workers’ Compensation Adjuster License in New Mexico. Multijurisdictional experience including Texas, Arizona.

New Mexico Career Experience

S&C Claims Service Inc., Rio Rancho NM, 2015 to March 2018.

Claim Examiner

Responsible for the BITCO Insurance Company and WCF of Utah Worker’s Compensation claims. Completes all aspects of claim investigation and adjusting including EDI filings. Manage litigation and Nurse Case Management services. Evaluate claims for any right of reimbursement and pursue to recovery. Responsible for complex and catastrophic claims. Work closely with employers regarding right of choice and return to work light duty programs. Utilizes paperless claim files on two separate computer systems. Prepares and presents claim status and large loss reports for Insureds’ claim meetings, both remotely and in person. Appear on behalf of the Employer/Insurer at Mediations. Negotiate settlements with the claimants and appear at the Lump Sum Hearings on behalf of the Employer/Insurer. Work closely with defense attorneys regarding litigated claims, settlement evaluations and risk exposure. Maintain appropriate opening to closing claim ratio.

York Risk Services, Albuquerque NM, 2013-2015

Senior Claim Adjuster

Responsible for 180 plus lost time claims utilizing three separate computer systems. Investigate all aspects of the workers’ compensation claim, negotiate settlements, maintained a one to one opening closing ratio. Appeared at the Workers’ Compensation Administration regarding claim Mediations, on behalf of the Employer/Insurer. Worked closely with defense and nurse case managers. Provided high level of customer services in response to multiple claim handling instructions. Prepared reports for client claim reviews

Mountain States Insurance Company, Albuquerque NM 2012-2013

Senior Claim Adjuster

Responsible for lost time claims, bill review and payment, and nurse case management oversite. Evaluation and resolution of long time claims with extensive medical treatment, non-work related conditions and medication abuse. Litigation management of complex claims.

Insurance Recruiting Services, Scottsdale Arizona, 2010- 2012

Claim Examiner

Contract positions in the State of New Mexico, handling workers compensation lost time and medical only claims with such clients as Gallagher Bassett TPA, and CNA Insurance Company.

Insurance Overload Systems, Albuquerque NM 2001-2003

Claim Examiner

Responsible for all facets of claim administration and investigation. In addition, prepared medical chronologies, summarized depositions and performed audits. Clients included CNA Insurance Company, Matrix TPA, Self –Insurance Food Fund and Allied Waste Industries.

New Mexico Association of Counties, Santa Fe, NM 1999-2001

Workers’ Compensation Claims Supervisor / Senior Adjuster

Supervisor of small staff, provided, training, file reviews, claim audits. Responsible for presenting claims status, Legal and legislative issues to insurance pool board members on a bi-monthly basis. Administered all litigated claims and attended mediations. Promoted to a supervisor within one year of hire.

Education & Professional Development.

Boston University Graduated Cum laude: Bachelor of Science in Sociology.

Associates Degree in Criminology.

Certified Mediator, UNM 2017

Certificate: Introduction to Motivational Interviewing 2017

Volunteer with the Cape Cod Literacy Tutor Program 2008-2009

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