Christine M. Cormier

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

Tacoma, WA 98405

adyff4@r.postjobfree.com

253-***-****

Objective: To pursue a professional and rewarding career. Work Experience:

Claims Examiner

Sedgwick-Seatac WA

2022-present

• Analyze complex or technically difficult workers' compensation claims to determine benefits due.

• Work with high exposure claims involving litigation and rehabilitation.

• Ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements.

• Identify subrogation of claims and negotiate settlements. Claims Officer II

King County-Seattle, WA

2017 to 2022

• Manage complex Workers' Compensation claims, including investigating, taking statements, calculating time loss payments, reserving, and reviewing medical records to ensure county compliance with relevant laws, administrative orders, and policies and procedures.

• Communicate with employees in a timely, positive manner to explain benefits and decisions.

• Initiate and coordinate early return to work, light duty, and alternative work assignments.

• Assist in coordinating compliance of county offices with Americans with Disabilities Act (ADA) requirements.

• Interact with physicians, vocational rehabilitation counselors, attorneys, supervisors, administrators, and employees with issues related to Workers' Compensation.

• Interact and direct the work of external nurse case managers and vocational rehabilitation counselors, including selection and case assignment.

• Communicate and negotiate with the Washington State Department of Labor and Industries on determinations, allowances, denials, closures, re-openings, and permanent disability awards.

• Prepare claims for litigation and participate in subrogation matters.

• Maintain professional knowledge and remain current on all applicable federal, state, and local statutes, codes, and ordinances governing the administration and management of Workers' Compensation.

Claims Examiner

Sedgwick - Seatac, WA

2013-2017

• Manages workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.

• Develop and manage workers compensation claims' action plans to resolution, coordinate return-to- work efforts, and approves claim payments.

• Approve and process assigned claims, determine benefits due, and manage action plan pursuant to the claim or client contract. Communicate claim action with claimant and client.

• Ensure claim files are properly documented and claim coding is correct.

• Maintain professional client relationships.

Claims Associate

Sedgwick -Seatac, WA

2012-2013

• Set up and enter new claims into claims management system.

• Adjusts medical-only claims under supervision.

• Processes workers compensation claims determining compensability and benefits due, monitor reserve accuracy, and files necessary documentation with state agency.

• Communicate claim action/processing with claimant, client, and appropriate medical contact.

• Process routine payments and prescriptions and status reports for lifetime medical claims and/or defined period medical claims.

Claims Assistant

Sedgwick, WA-Seatac, WA

2011-2012

• Input and review notes/diaries in claims management system as instructed.

• Processes mail; manages filing, faxing, and photocopying.

• Review, prepare, create, and/or sends letters, reports, and forms.

• Answer and initiate telephone calls.

• Provide customer service as required.

Education:

Bates Technical College

Tacoma, WA

1991-1992

Pierce Community College

Lakewood, WA 98499

1990-1991

Curtis Sr. High School

University Place, WA 98466

1987-1990

Skills:

Microsoft Access Proficient in HIPAA and OSHA reporting Query Self Insurance Claims Administrator-Certified Microsoft Word Medical Terminology

Microsoft Excel Claims Processing-Facets/CPS System/Juris/SIR Customer Service/Call Center Type 60+ words a minute CPT and ICD-9 Coding

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