Claims Examiner Litigation
Resume:
Cameron Maria Calderon
Las Vegas, NV *****
925-***-**** (primary)
Email:************@*****.***
Objective:
Looking for a position within a company that is seeking a highly motivated, energetic and professional top key player. An ideal company will be one that utilizes my current knowledge and experience, while presenting me with new challenges that will enhance my well-rounded level of professional expertise. Salus Claims Management, 2021- current
Senior Claims Examiner
Maintain a caseload of senior level workers compensation claims. Dedicated to managing complex claims for a large local school district. Expertise includes investigation, compensability determination, medical utilization review determination, benefits administration, complex reserving, litigation management, COVID, apportionment and subrogation. Develop and manage concise action plans, coordinate return to work efforts, and comply with all Division of Workers Compensation rules and regulations. Experience with settlement negotiations, Medicare set aside, public agencies (4850), seasonal employees, asbestos claims as well as knowledge with regard to risk management and safety performance. Employers Insurance, 2020-2021
Supervisor
Duties: Supervise both Medical Only and Jr. Claims Examiners which consists of 5 Med Only and 3 Jr. Examiners. Managing and tracking Covid claims for employers, including investigation, determination and issuing benefits when appropriate.
Review files to ensure coding, investigation and all contacts are complete. Complete annual employee reviews. Experience handling self-insured; self-administered and insured claims. Expertise includes investigation, compensability determination, medical utilization review determination, benefits administration, complex reserving, litigation management, apportionment and subrogation. Develop and manage concise action plans, coordinate return to work efforts, and comply with all Division of Workers Compensation rules and regulations. Experienced with settlement negotiations, Medicare set aside, public agencies (4850); and adjusted claims for both Insured and Self-Insured entities. Some experience handling Utah and Colorado claims. Licensed in California (SIP) and Nevada, Vermont and Texas Sedgwick, 2019 - 2020
Team Lead
Duties: Supervise the Medical Only Unit which consists of 5 Med Only Examiners. Review files to ensure coding, investigation and all contacts are complete. Complete annual employee reviews. Experience handling self-insured; self-administered and insured claims. PG&E, 2016 - 2019
Senior Claims Examiner
The claims are self-insured; self-administered. Expertise includes investigation, compensability determination, medical utilization review determination, benefits administration, complex reserving, litigation management, apportionment and subrogation. Develop and manage concise action plans, coordinate return to work efforts, and comply with all Division of Workers Compensation rules and regulations. Experienced with settlement negotiations, Medicare set aside, public agencies (4850); and adjusted claims for both Insured and Self-Insured entities. LWP Claims Solutions, Inc. 2015-2016
Senior Claim Examiner
See duties noted below
Sedgwick CMS (Walnut Creek) 2013 - 2015
Senior Claim Examiner
Maintain a caseload of senior level workers compensation claims. Dedicated to managing complex claims for a large Public Agency Transportation account. Expertise includes investigation, compensability determination, medical utilization review determination, benefits administration, complex reserving, litigation management, apportionment and subrogation. Develop and manage concise action plans, coordinate return to work efforts, and comply with all Division of Workers Compensation rules and regulations. Experience with settlement negotiations, Medicare set aside, public agencies (4850), seasonal employees, asbestos claims as well as knowledge with regard to risk management and safety performance.
Athens 2011-2013
Senior Claim Examiner
Maintained a caseload of senior level workers compensation claims. Dedicated to managing complex claims for large accounts and duties same as noted for senior claims examiner. Tristar Risk Management 2000 - 2011
Senior Claim Examiner
Maintain a caseload of senior level workers compensation claims. Dedicated to managing complex claims for large accounts, Expertise includes investigation) compensability determination, medical utilization review determination, benefits administration, complex reserving, litigation management, apportionment and subrogation. Develop and manage concise action plans, coordinate return to work efforts, and comply with all Division of Workers Compensation rules and regulations. Experience with settlement negotiations, Medicare set aside, SIU and with conducting meetings on a quarterly basis with demanding clients to roundtable open claims and discuss risk management and safety performance for their multiple locations.
EDUCATION
Diablo Valley College
1994 — WCCA
1996 —WCCP
2002- Self Insurance License
CA, NV, TX, VT Licensed
Experience with UT, CO
SKILLS
- Excellent oral and written communication skills, including presentation skills
- PC literate, including Microsoft Office products, Excel, VOS systems, Juris systems, ACS/SIR
- Effective analytical and interpretive skills
- Strong organizational skills
- Good interpersonal skills
- Ability to work in a team environment
- Fundamental knowledge of the insurance industry, claims, and the insurance legal and regulatory environment.
- Possesses a functional and developing knowledge of the legal statutes
Contact this candidate