Claims Clerk Associate

Alicia M. Sellers

Sanford, Fl *****; 407-***-****

************@*****.***

Professional Profile

An analytical, detail and results oriented professional who works well under pressure and in sensitive situations. A reliable, dependable and hardworking individual with the ability to respond quickly to new instructions, situations, methods and procedures. An individual, who has strong multi-tasking skills, maintains unusually high output levels; demonstrates self-reliance and resourcefulness. An individual who has a keen awareness of time schedules, and deadlines.

Experience

Senior Medical Only Adjuster

June 2017- Current CCMSI Maitland, FL

Set up and manage medical files only in accordance with corporate claim standards and law.

Establish reserves and/or provide reserve recommendations within established authority levels under minimal supervision.

Investigate and adjust work comp claims in accordance with established claims handling procedures.

Review medical, legal and miscellaneous invoices to determine if reasonable and related to the ongoing claim.

Authorize and make payment of claims utilizing a claim payment program in accordance with industry standards and within payment authority.

Performs other duties that involves subrogation, liens, non-compliance, etc.

Review and approve related medical and miscellaneous invoices on designated claims.

Medical Only Adjuster

April 2014-June 2017 CCMSI Maitland, FL

communicates efficiently with the employer, employee and medical provider

complete investigation on Worker’s Compensation Claims by contacting the employer and employee to verify and obtain claim information that was reported

Established and monitor reserves for all active and ongoing medical treatment on the claim.

obtain and review medical records; monitor ongoing medical treatment

closed files when the employee has reached medical maximum improvement and no further treatment is anticipated

communicates efficiently with the employer, employee and medical provider

release payments to medical providers for services render to the injured worker

Claims Clerk

May 2013 – August 2014 CCMSI Maitland, FL

prepare and mail out Initial Workers Compensation Packets, state forms, appointment letters

Send out mail correspondence certified or express mail when needed.

setup diagnostic testing, physical therapy, and doctor referral appointments

scan, document, and distribute incoming legal correspondence, medical bills and medical reports.

create file copies, download onto disc and mail out to the appropriate attorney.

setup new incoming claims and assign it to the appropriate adjuster

request copies of police reports for liability claims

Claims Associate

August 2008- May 2013 Sedgwick CMS Lake Mary, FL

communicates efficiently with the employer, employee and medical provider

complete investigation on Worker’s Compensation Claims by contacting the employer and employee to verify and obtain claim information that was reported

setup new claims with diaries, reserves and updated data

process payments to employees to reimbursement for out of pocket expenses, and to vendors for services render

obtain and review medical records; monitor ongoing medical treatment

closed files when the employee has reached medical maximum improvement and no further treatment is anticipated

communicates efficiently with the employer, employee and medical provider

Claims Assistant

October 2007- August 2008 Specialty Risk Services Lake Mary, FL

filed various documents alphanumerically into Medical Only and Lost Time Adjusters’ filing cabinet

opened, sorted, and delivered mail to the appropriate Adjuster

coordinated and processed outgoing regular and express mail using appropriate mailing equipment

copied and collated documents from files according to the Adjuster’s instructions

processed payments to vendors, attorneys and injured workers

purged closed files and prepare them to be sent to storage

Education

Bachelor of Arts Degree in English Liberal Arts

August 2002- May 2006 Francis Marion University; Florence, SC

Certification

Florida Independent All Lines Adjuster License

References

References are available on request.

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