Gini Summers

1-740-***-**** adx7wq@r.postjobfree.com

Summary: Over 20 years of progressive responsibility primarily focused on Workers Compensation Claims adjusting, Independent Medical Examinations, FMLA, Disability Fitness for Duty Examinations, Medical File Review services, Risk Analysis and providing outstanding customer service.

Professional Experience:

Workers Compensation Claims Analyst (Contractor)

Robert Half Legal (Wendy's Corporate) Columbus area

September 2018 to November 2018

Claims Analyst responsible for the investigation of new claims including contacting all involved parties and TPAs. Documentation of records. Provides direction regarding claim handling, return to work, and monitors active diaries to achieve timely development and deposition of files.

Private Home Health Caregiver

Self-employed, Delaware Ohio

Aug 2017 - Present

Responsible for total care of a disabled, pre-surgical, MVA patient with muliple neck herniation(s) superimposed on failed back syndrome and other health and mental conditions.

Workers Compensation Specialist

CCMSI, Columbus area

Oct 2017 – Dec 2017

Responsible for the investigations, settlement negotiations and litigation management when necessary for assigned workers compensation claims of varying degrees of complexity.

Workers Compensation Specialist (Contractor)

The Jacobson Group (ESIS), Columbus area. May 2017 – Sep 2017

Contracted Full-time Ohio Workers Compensation Specialist at ESIS a Chubb Company. Processed Ohio lost time worker's compensation claims from initiation through closure.

Obtained injury statements from claimants and parties of the claim.

Consulted with lawyers, employers and physicians to get expert injury evaluations.

Worker's Compensation Specialist (Contractor)

Nesco Resources (EXPRESS) May 2016 – Sep 2016

Worked as a contractor for Express Home Office Assisting employees with their work related injuries from the 1st report of injury through the injury investigation. Provided explanations of the WC claims process to associates in multiple jurisdictions (multi-state). Reviewed and processed bills. Worked with the 3rd party administrator who administered the WC claims. Provided oversight on behalf of the client.

Sr Self-Insured Claims Adjuster, Workers Compensation (Contractor)

Jacobson Group (ESIS) Feb 2015 – Dec 2017

Senior Claims Representative

Contract position as a Self Insured Claims Representative with Ohio TPA. Responsible for handling assigned claims from initiation to an appropriate and timely resolution/ closure including all investigations, settlement negotiations and litigation management where appropriate.

Worked as a Senior Adjustor responsible for analyzing and processing complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim.

Interviewed claimants and witnesses to gather pertinent information.

Handled and processed a variety of state generated forms, including: C-86 motions; C-9 treatment plans; C-92/C-256 applications for determination of permanent partial impairment.

Consulted with lawyers, EHS/safety personal, employers and physicians to get expert evaluations.

Examine medical records and statements for causality.

Developed thorough action plans to proactively manage disability and disputed claims issues.

Reviewed, authorized or denied incoming requests for treatment or service based on claim allowance and national disability guidelines.

Calculated wage(s) and issued payment of compensation, scheduled loss, impairment and settlement as appropriate

Prepared and maintained computer claim files in a paperless environment/

Senior Account Manager

Community Choice Financial, Inc. June 2014 – Feb 2015

Contacted customers who were delinquent in the repayment of their loan and or lines of credit and obtained payments, commitment agreements or established a repayment plan. Followed set policies and procedures when determining suitable collection solutions under federally set fair debt and collection practices.

Risk Management Specialist Worker's Compensation

Iforce. Oct 2013 – Feb 2014

In partnership with the risk management team, developed, implemented and monitored facility safety programs with specific emphasis on employee safety and OSHA compliance.

Investigated any safety or loss-related incident and prepared detailed reports concerning matters investigated. Administered job safety program: audits/inspects job site to detect and correct safety hazards. Assisted in developing strategies to improve loss and safety results. Worked with outside agencies (e.g., federal, state and local law enforcement, OSHA, etc.). Assisted in development and implementation of a loss prevention training program.

Account Executive Worker's Compensation

AdvoCare Group/ Benefits 1 Group Dec 2012 – Jun 2013

The AdvoCare Group is a family of companies specializing in Workers Compensation, Vocational Rehabilitation and Third Party Administration (TPA) functions, Litigation Support, Group Health, Wellness and related services.

Business Development Manager Independent Medical Examinations Worker's Compensation

Gateway Management Services. Jul 2002 – Oct 2011

Developed plans and procedures necessary to gain and retain clientele.

Created and coordinated senior management presentations regarding Independent Medical Examination (IME) Scheduling services for Third Party Administrators (TPA). Employer and Legal Counsel for workers compensation and disability claims.

Reviewed and developed synopsis of medical records for physician review.

Claims Examiner III, Self-Insured Worker's Compensation

Comp Management, Inc. a Sedgwick CMS Company. May 2007 – Mar 2010

Senior Adjuster responsible for Analyzing and processing complex or technically difficult claims by investigating and gathering information to determine the exposure on the claim.

Set reserves for medical, legal and vendor exposure.

Managed claims through the establishment of well-developed action plans to an appropriate and timely resolution.

Compensation Determination, Calculation and payment for assigned Self-Insured clients with inclusion of Risk assessment and claim management

Coordinated subrogation and vendor use for dedicated clients.

Led client meetings and claims reviews.

Self-Insured and Dedicated Account Claims Examiner for Employer TPA.

Reviewed claims for treatment and billing authorization, Calculated reserves, compensation and settlements.

Prepared accounts for litigation and audits, medical review and IME utilization.

Education:

Akron Institute of Herzing University, Akron, Ohio,

Associates Degree in Medical Administration and Medical Assisting

University of Akron

Business Administration coursework

Additional Training, Certifications, or Licenses:

Ohio Worker’s Compensation Rules and Regulation expertise; Claim Management: Safety and Risk Management Professional; Compensation Determination, Calculation and payment; First-Aid certification, Treatment/ Action Plan Training; MCO/ADR clinical review; ICD-9/ICD-10 Training & CPT Training; Medical Treatment Authorization and payment; Settlement Negotiation; IME Services

Associations: OSIA (Ohio Self Insured Association) COSIA (Central Ohio Self Insured Association) SWOSIA (South Western Ohio Self Insured Association)

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