David Diaz

916-***-****

**** ****** **** ****

Concord, CA 94520

aduhcz@r.postjobfree.com

Education:

James Monroe University

Bachelor of Science in Business Administration and International Relations

Certifications / Licenses:

Workers Compensation Claims Professional, WCCP

Self-Insurance Plans Certified, CA

Associate of Risk Management (enrolled since May 2020)

*Bilingual – Spanish & Portuguese

Experienced Lead for Team and Senior Claims Examiner with a demonstrated history of working in the insurance industry with a specialty in 4850 benefits to sworn public safety officers. Strong claims professional with a Bachelor of Arts (B.A.) focused in Economics and Political Science fr

COVID Executive Order 62-20 & Senate Bill 1159; Sullivan on Comp COVID19 Webinars Parts

1-11. Combined 22 hours of COVID-19 CEUs. Completed All Things Liens, Costs & Interpreters; Guide to Subro and 3rd Party Credit Issues. Liens, Copy Service Subpoena NonIBR and QME process expert.

Professional Summary

Workers’ Compensation Claims Professional with demonstrated skills in litigation management, complex claims handling involving MSA reductions, life pension, permanent total disability, death, COVID-19, idiopathic stroke, and asbestos exposures. Extensive claims handling experience with large-dollar reserves involving present proposed reserve increase to senior leadership within AmTrust. Strong presentation skills to large audience, having developed extensive original reference and training materials including color flowchart for post-termination defense, copy service Non-IBR process, SB . Technically strong combined with demonstrated leadership abilities and excellent interpersonal skills necessary to develop, nurture, and maintain positive relationships with individuals at all levels of an organization, including internal customers and outside business partners. In-depth knowledge of California Workers’ Compensation Laws, including experience modification calculation. Talented at conceiving and development of strategic initiative plans to create new processes. Skilled in evaluation and interpretation of medical reports, understanding of legal concepts, AMA impairment rating, and affirmative defenses. Possess a high level of flexibility and ability to build excellent rapports with the staff counsel, outside counsel and dedicated account, McKee/Black Bear Diner in successfully getting cases closed.

Professional Experience

AmTrust Financial Services, Concord, CA

(February 2019 to present)

Claims Team Lead

• Responsible for assisting unit manager train and monitor less-experienced examiners handling a carrier book of business. Mentored less experience adjusters in life pension wit COLA calculations, MSA reduction strategy, panel QME processes, AOE/COE determinations, WCAB settlements and procedures and COVID-19 rebuttable presumptions.

•Dedicated Lead Adjuster for Kalesta Heath Group COVID-19 Carve Out team of four adjusters and three supervisors providing file handling guidance and monitoring performance matrices.

•Prepared first-ever COVID Excel tracker spreadsheet. Developed first-ever process in structuring recorded statements with Kalesta primary HR contact. Responsible for identifying improvement opportunities through weekly emails and Kalesta Heath Group reporting roundtables to senior leadership.

•Handled catastrophic losses involving traumatic head injuries, spinal cord injuries, and multiple trauma injuries, including 100% cases under Ogilvie, Dahl and Leboeuf.

•Act as back up for the unit manger in his absence— provide mentoring and leadership to the claims department.

•Spearheading with upper management first-ever copy service billing mitigation process.

•Completed first-ever comprehensive copy service flowcharts for non-IBR medical-legal dispute and second bill review/IBR processes.

•Completed first-ever AmTrust proper petition for determination of a non-IBR medical-legal dispute.

•Completed first draft objection notice non-IBR medical-legal dispute.

•Assisted management in preparing open pending of 1500 files for state audits.

•Training new unit Claims Adjuster I, which included producing a comprehensive Quick Reference WC handbook for professional development.

•Volunteered to work mail and files of the adjusters that either departed or were off on leave, while still working own caseload.

•Voluntarily accepted transferred complex files from adjusters that either departed or were off on leave.

•Investigate, manage, and resolve claims in a timely, unbiased, and informed manner in compliance with AmTrust Claims Handling Guidelines.

•Consistently achieve 100 percent or better closing ratio.

AmTrust Financial Services (Long-term Contract Assignment)

(March 2018 to December 2018)

Senior Claims Examiner

•Responsible for thoroughly investigating new losses by conducting recorded statements, determining compensability on complex claims such as general-special employment and post-termination situation.

•Carefully verified coverage through careful investigation of location and employment status based on the policy.

•Issued timely DWC notices, promptly obtained and calculated wage-statements, administering of benefits for insureds in the foodservice, lodging, law firm, physician practices, construction, and manufacturing industries.

•Handled a dedicated national temporary staffing agency account employing over 2,000 temporary workers in California. Skillfully developed discovery to push coverage outside the cumulative trauma exposure through depositions enabling in obtaining tens of thousands of dollars in contribution from the prior or subsequent carrier.

•Handled a caseload of 150 files involving frequent catastrophic losses, including death claim, 100% permanent total disability, MSAs, and structure settlement analyses.

•Effectively established reserves on large losses by correctly assessing conditions under AMA Guides and applying apportionment.

•Handled all aspects of defense litigation to include filing Answers, Petitions for Dismissal, objections to QME specialty designations, and completing settlement documents, resulting in tens of thousands of legal cost savings to insureds.

LWP Claims Solutions (ProTemps – Long-term Contract Assignment)

(August 2017 to February 2018)

Senior Claims Examiner

•Responsible for investigation, administering of benefits, and resolution on a caseload of 170 indemnity files involving self-insured employers in the security, food service, health care, and agriculture industries.

•Handled public entity accounts such as Burlingame USD and the City of Rialto (Police & Fire), administering large-loss cases under the Education Code and Labor Code presumption and salary continuation statutes.

•Consistent achieved 100% closing ratio.

Risico Risk Management, Fresno, CA

(July 2017 to December 2017)

Senior Claims Examiner

•Responsible for review of all indemnity claims every 30 to 45 days to ensure file progression over a caseload of 150 + files involving dedicated County of Fresno and City of Fresno Police accounts under the statutory and ADR carve-out.

•Review medical reports for in relation to initiating, stopping, or denying benefits. Process a large volume of incoming mail in relationship with medical necessity requests for treatment and IMR requests or determinations. Review every 60 days all files for reserve adequacy throughout the life of the claim. Develop and manage claims through well-developed action plans. Prepare necessary state filings within statutory limits. Actively manage the litigation process. Determine benefits due under statutory and LC 4850; make timely claim payments and adjustments.

QLD Information Systems; Irvine, CA

(November 2016 to July 2017)

Senior Ombudsperson Program Director, Workers’ Compensation Claims

•Telecommuting full-time position overseeing the City of Los Angeles alternative dispute resolution (ADR) services for their workers’ compensation division and SEIU.

•Managed and provided oversight of the ombudsman working with internal City of Los

Angeles risk management personnel and Union employees to market, develop, and maintain

the ADR program to fairly settle workers’ compensation disputes over a total open pending caseload of 400 indemnity cases.

Keenan & Associates; San Jose, CA

(December 2013 to November 2016)

Sr. Examiner, School District Accounts

•Dedicated W/C senior examiner for Alisal USD and Orange USD, responsible for investigating and administering a caseload of 150 indemnity files towards resolution and closure under the Labor Code, Education Code, and Government Code sections relative to workers' compensation of public entity school districts.

•Responsible for setting appropriate reserves and keep excess carriers informed when losses potentially exceed the JPA self-insured retention levels.

AIMS; Santa Clarita, CA

(September 2010 – December 2013)

Claims Examiner

•Worked on the County of Los Angeles Account handling public safety officers’ indemnity claims. Administered a caseload of 135 claims for the County of L,A.

•Performed examiner du-ties including but not limited to the investigation of new claims, resolution of technically complex files, ensured appropriate reserves were set, sought recovery through subrogation and or contribution from third parties, and participated in account monthly file review.

Sedgwick CMS, Orange and Los Angeles, CA Long-term contract assignments

(July 2007 – September 2010) Claims

Examiner

•Responsible for caseloads of 180-210 indemnity files for self-insured and high-premium clients (Kmart/Sears Roebuck Co.; Boeing Aerospace; Kroger Grocery).

•Effectively managed Workers’ Compensation Claims from initial reporting to the conclusion. Monitored medical care and indemnity benefits, prepared for and attend claim reviews with clients, reviewed and evaluated claims for PD, medical exposures, and subrogation potential. Actively set up files and scheduled medical, medical-legal, and investigative appointments.

•Negotiated and settled claims with claimants, attorneys, and lien holders. Ensured the timely payments of claimants’ temporary, permanent and disability benefits.

References furnished upon request

Contact this candidate