Compensation Claims Event Manager

Phone: 860-***-**** DIANNA J. DONNELLY, A.C.A. adwmyv@r.postjobfree.com

Public Profile: http://www.linkedin.com/pub/dianna-donnelly-a-c-a-b-s-occ-health-safety/31/585/247

Insurance professional with progressive experience working with large corporations as well as third party administrators. Multi-line insurance expertise and multi-jurisdictional state experience. Assigned to complex clients with premiums of $1m or greater. Developed proven ability to quickly assimilate into new organizations, demonstrate proficiency, and make immediate financial contributions.

AREAS OF EXPERTISE

Workers’ Compensation HIPPA, ADA, FMLA Risk Management/Loss Prevention

Long Term Disability Medical Billing/Coding Multi-Jurisdictional Claims Law

Commercial Liability Safety & Health, OSHA Process Improvement

Auto Liability

PROFESSIONAL EXPERIENCE

FUTURECOMP/USI INSURANCE, Meriden, CT 2015-Present

TPA Specialist III

Key Accomplishment: Settlement of large loss claims aged over 10 years with reserves between $500,000-$1m. Responsible for more than 160 manufacturing companies and municipalities. Attend new business presentations and successfully obtained new client. Report to board of directors, supervisor medical only staff.

SEDGWICK CLAIMS MANAGEMENT SERVICES, Hartford, CT 2013-2015

Sr. Workers Compensation Adjuster III (Boca, FL) 2007-2010

Key Accomplishment: Provide staff with training materials to decrease response time to handle multiple jurisdictions. Placed on company contact list. Provided with bonus by client for providing exceptional client service.

Acquired new account by assisting marketing with presentations, promote client services and products.

Determine subrogation potential on injuries sustained via auto/general liability, manufacturing equipment being used in the plants.

Provide medical adjusters and nurses with training in multi-jurisdictional statutes.

Perform claim reviews, develop plans of action and complete excess carrier reports.

DD Claims Consulting and Assisting LLC 2011-2013

Claims Manager/Owner

Key Accomplishment: Recently established LLC

24/7 Emergency contact availability to investigate losses.

Assignments received by third party investigative firms, attorneys and insurance carriers to attend hearings, provide emergency response to accident scenes and thoroughly investigate, take statements, photographs with immediate analysis and reporting.

Assist small businesses with their financials, recommend business process improvement, record-keeping analysis, scheduling techniques, marketing strategies and provide training resources.

Review small business contracts to insure state compliance, licensing and meet OSHA safety standards.

Obtain necessary records and/or documents in order for clients to be prepared for court appointments and presentations.

Temporary Agency (6 month Contract Assignment), Norwalk, CT 2010 to 2011

Claims and Risk Management Consultant

Key Accomplishment: Reduced open claims from 260 to 180 within contract period, with proven reduction in reserves for the subsidiaries nationwide.

Formulate strategic plans with subsidiary, third party administrator and defense counsel to control risk and cost control with regard to losses incurred nationwide.

Review, monitor and evaluate complex or sensitive claims; provide guidance and direction to claims administration staff and TPA; review and facilitate resolution of claim issues or conflicts involving customers; participating in negotiations.

Consistently drive TPA performance including, but not limited to, program development, quality of overall claim handling, prompt resolution, and reserve accuracy. Visible and accessible to TPA and insurance carriers for questions, authorization requests, communication of adverse trending, face to face training and claims reviews.

Ensure that claims are appropriately identified for claims roundtable discussions and drive coordination of same.

Point of contact for pre-mediation reviews.

Serves as liaison with various casualty cost management programs and vendors, including: managed care, pharmacy, Special Investigation Unit, return-to-work, Medicare.

Act as second level event manager in the case of a natural disaster or catastrophic occurrence, including coordinating on-site field response.

Serves as an expert resource for claim and cost management issues within Risk Management within the organization.

ARTHUR J. GALLAGHER RISK MANAGEMENT SERVICES, INC., Hartford, CT 2006 to 2007

Claims Manager

Key Accomplishment: Managed the insurance reserves for Captive Members with a return of $5m. Developed client handbooks to facilitate program communication.

Responsible for high reserve workers’ compensation, commercial general liability and property losses.

Oversight for safety practices, accident and workers’ compensation claims investigations, accident reporting procedures, compliance monitoring, recordkeeping effectively reducing risk, increasing safety awareness and managing costs while optimizing productivity.

Review and improve company standards in order to prevent and eliminate perils and comply with state and federal OSHA standards.

Review and approve all claim settlements proposed by Insurance carriers/TPA.

Effectively develop and implement policies, procedures and claim handling instructions for TPA’s.

Manage vendors/attorneys for independent medical examinations, investigation, litigation and vocational rehabilitation.

Implement new loss cost management tools and return-to-work programs to further reduce losses and effect modification factors.

Provide settlement authority to handling adjusters and provide authority for vendor assignments.

Ensure proper response in the various cost management programs and vendor relationships including: property restoration, salvage, disaster response resources and accident scene investigation.

Participate in the development of safety and health policies, practices and procedures throughout a network of companies in compliance with governmental regulations including Federal, State and Local laws and regulations.

WEBSTER INSURANCE, Vernon, CT 2002 to 2006

Sr. Workers Compensation Account Manager

Key Accomplishment: Review claims, adjust reserves based on the assessment of probable liability, financial responsibility and exposure which resulted in a decrease in the amount of $600,000 within six months of handling account.

Adjust claims for two largest municipalities and hospitals in Connecticut to include all heart and hypertension claims.

Perform presentations and workers' compensation training as directed by risk management.

Process workers’ compensation claims determining compensability and benefits due on long-term indemnity claims; monitor reserve accuracy and file necessary documentation with state agency.

Develop and manage workers’ compensation claims action plans to resolution, coordinate return-to-work efforts and approve claim payment. Communicate claim action/processing with claimant and clients.

Manage subrogation of claims and negotiate settlement.

Communicate claim action/processing with claimants and clients.

Investigate industrial accidents, injuries or occupational diseases to determine causes and preventive measures.

EDUCATION

Multi-line Claims Licenses: CT, RI, ME, NH. Handle MA. Previously handled WI, GA, TX, CA, LA, SD, ND, NV, NY, PA, MI, NE, SC, NC, FL, MI, VT, KY, DE, MD, NE and WY

Columbia Southern University-Occupational Health & Safety-attended

University of Central Florida, A.C.A.-11/17/2008

Completed a 3-week claim representative school for ITT Hartford, Interpreting Medical Reports, Introduction to Property and Liability Insurance and Personal Auto Coverage. Knowledge in maritime law (Jones Act).

Maintain CEU’s in accordance to state licensing. Strong communication, negotiation, and presentation skills; well-developed analytical and problem solving abilities; and strong proficiency in Microsoft Office and Insurer/TPA claim management systems.

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