Claims Assistant Examiner

Kiesha L. Martin

*** ****** ***** ********, **** 43213 C: 614-***-**** E: **********@*****.***

Delivering comprehensive and diverse experience minimizing costs and improving performance of workers’ compensation programs. Career complemented with business administration degree.

Professional Experience Achievements

Sedgwick Managed Care Ohio - 7/2018 – present

Client Services Representative

Responsible for the medical management program for over 200 clients in various industries that participate in the Ohio state fund. Assuring customer satisfaction and retention by conducting regular meetings, providing trending reports, Bureau of Workers Compensation updates and specialized trainings. Dedicated to simplifying the managed care process by helping employers control cost, client education and safety management programs.

Leads implementation efforts for new clients; conducts onsite stewardship meetings; identify reporting needs; monitor client satisfaction;

Participates in business strategy regarding client satisfaction, retention and growth; facilitates product and brand development;

Contributes to growth efforts during the Bureau of Workers’ Compensation MCO open enrollment;

Works with multiple services lines to enhance overall client utilization;

Acts as primary client contact with focus on maintaining and improving overall customer satisfaction;

Identifies issues that impact consistency and customer satisfaction;

Assists with identifying office level service trends and establishes plans for service improvement;

Identifies and solicits cross selling opportunities;

Conducts training opportunities for clients, prospects, vendors and claims staff;

Matrix Claims Management – Dublin, Ohio 2012 to 2018

Senior Account Executive

Leads and conducts operations analyzing complex/technically challenging workers’ compensation claims, coordinating and advising on strategic decisions, and facilitating actions enabling optimum claims results; role places significant focus on identifying potential issues, reducing client workers’ compensation program expenses, and ultimately lowering insurance premiums.

Utilizes experience to serve large, more complex clients;

Aggressively implements strategies for return-to-work on all lost-time claims;

Pursues risk strategies to control and/or lower claims costs that impact a client’s experience modification e.g. handicap reimbursements, lump sum settlement, fraud recognition, etc.;

Provides consultative assistance to clients regarding rating plans e.g. Group rating, Self-insurance, Retrospective rating, etc.;

Assists and advises client(s) on BWC employer discount programs, payroll classification and reporting information;

Meet regularly with client(s) to perform a complete claims review, review employer modification, and develop risk strategies to control or reduce future premiums;

Creates and provides claims management reports to client e.g. claims costs, employer rate projection, claims loss runs, etc.; and

Provides timely updates to employer on workers’ compensation laws and rules.

Sedgwick Claims Management Services, Inc. (Sedgwick CMS) – Columbus, Ohio 2008 to 2012

Claims Examiner – Ohio Specialty Operations

Ensured adjudication of claims within company standards, industry best practices, and client requirements; investigated and accumulated information determining employer claim position; reviewed medical documentation and witness statements; coordinated vendor referrals for investigation and litigation; created plans of actions and maintained claims through action process; determined and approved claim status; monitored and reviewed benefits and payment calculations; prepared state filings; organized actuarial/settlement issues.

Trained and oversaw performance of 2 associates, including claims examiner and claims assistant (responsible for evaluating lower-level workers’ compensation claims and ensuring adjudication of claims within standards and best practices);

Performance recognized with Values in Actions rewards for exhibiting company core values

Demonstrated risk management expertise and confidence providing clients with insight into workers’ compensation solutions; includes comprehensive and detailed claim reviews and recommendations maintaining low claims costs and premiums;

Lowered and maintained overall cost of claims for clients through effective use of cost containment techniques, including development and use of strategic vendor partnerships;

Improved overall efficiency and performance through initiation of time study of claims examiner duties; identified administrative functions able to be performed by claims assistants and ultimately enabled claims examiners to focus on more pertinent tasks;

Assisted sales teams land several clients through presentation of claims team role, claims management processes, and overall benefits of utilizing claims management solutions; and

Utilized communications skills to present claim action/processing with claimants, clients, state agencies, managed care organizations and medical contacts.

Education

Ohio Dominican University – Columbus, Ohio

Bachelor of Science in Business Administration, 2011

333 Lemery Drive Columbus, Ohio 43213 C: 614-***-**** E: **********@*****.***

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