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Workers Compensation Case Manager

Location:
Grapevine, TX, 76051
Posted:
September 26, 2023

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Resume:

Jesse Lopez

**** ******* *****, *** ***

Grapevine, TX 76051

Phone: 972-***-****

Email: adzzap@r.postjobfree.com

Profile

. I am a career minded, motivated employee who excels in all aspects of

claims adjusting, & technical supervision in multiple jurisdictions, with

emphasis in 3rd party claims recovery, claims litigation & litigation

management.

. I am a proven leader with excellent people & mentoring skills.

. I am eager to encompass, learn & conquer new challenges.

. I am focused on achieving all goals & objectives set by management.

. I am a loyal team player.

. I am dedicated to the pursuit of excellence in customer service for the

sole purpose of establishing long term customer relationships, both

inside & outside the company.

. I am Bilingual in the spoken & written Spanish. I am knowledgeable

regarding multiple Latin dialects & mannerisms'.

. W/C Licenses: Texas, Arkansas, Indiana & Oklahoma (License Information

available upon request).

Work Experience

10/06-Present Broadspire a Crawford Company

Senior Claims Specialist/Workers Compensation

. Dedicated to eight specific accounts in approximately eight

jurisdictions, Texas, Oklahoma, Illinois, Louisiana,

Indiana, Missouri, Arkansas and U.S. L & H / P & I - Jones

Act Seaman.

. Average case load - 180 - 200 files.

. 60% of my case load consists of litigated claims and / or,

are of a large loss nature due to catastrophic injury

resulting in a Permanent & Total status or death. My

remaining case load is made up of new losses in the multiple

jurisdictions as noted above.

. Of the 60% case load mentioned, approximately 95% of those

losses are reserved at or above account retention levels

thereby necessitating carrier correspondence on a 90 day

basis consisting of status updates with action plans to bring

files to closure.

. The U.S. Longshore & Harbor accounts I handle have on average

a Self-Insured Retention or Large Deductible Plan of $750K to

1 million per incident.

. I currently report to the following carriers for excess

coverage; Chartis/AIG, XL Specialty, ACE American, Zurich,

Old Republic, Liberty Mutual, Texas Guaranty Fund & The

Louisiana Guaranty Fund.

. Provide font line safety managers and supervisors with

continuing education regarding changes in the workers

compensation law: Clayton Homes, Trinity Industries (USL&H),

Boeing, SeaBoard Foods, Kaiser Aluminum, Sam Sung, Roll

Global - Paramount Citrus, and Tuesday Morning.

12/01-06/06 Federated Mutual Insurance Company

Workers Compensation Technical Supervisor

. Responsible for the technical supervision of four Claims

Adjusters, and two Nurse Case Managers.

. Maintained claims case load for six jurisdictions including

Texas, Oklahoma, Louisiana, Arizona, Mississippi, and New

Mexico (Resident State).

. Other responsibilities included scheduling continuing

education seminars for adjuster licensure.

08/97-12/01 Liberty Mutual / Helmsman Insurance & TPA Company

Senior Case Manager/Workers Compensation

. Responsible for the supervision of two teams consisting of

four Case Managers.

. Duties included the opening, settling, and closing of workers

compensation claims case load for four jurisdictions

including Texas, Oklahoma, Mississippi, and Colorado.

. Other responsibilities also included scheduling and

conducting yearly seminars on current events in workers

compensation for International Paper, MBNA, Morgan

Stanley/Dean Witter and 3M Account Managers.

. Worked closely with Liberty Mutual Team Managers to ensure

that the Case Managers were properly trained pursuant to

Liberty Mutual's Best Practices Guidelines for handling

workers compensation claims.

Jesse Lopez, Page Two

08/96-08/97 Gates McDonald (TPA)

Senior Case Manager/Workers Compensation

. Responsibilities included opening, settling and closing of

workers compensation claims in Texas and Oklahoma for a

dedicated account, Albertson's Food Stores.

. Other duties included coordinating and conducting quarterly

Continuing Education seminars for Albertson's front line

supervisors.

06/06 -10/06

06/95-08/96 Insurance Overload Systems

Contract Claims Adjuster/Workers Compensation

. Worked while looking for permanent employment.

03/93-05/95 AIAC/AIG/CHARTIS

Senior Case Manager/Hearing Representative/Workers Compensation

. Responsibilities included opening and closing workers

compensation claims for multiple accounts under Texas workers

compensation jurisdiction

. Other duties included the attendance of Benefit Review and

Contested Case Hearing as a hearing representative for AIG.

03/90-03/93 Insurance Overload Systems

Contract Claims Adjuster/Workers Compensation

Also worked during 8/06 - 10/06 while looking for employment;

. Responsible for opening, settling and closing of workers

compensation claims for insurance companies, and third party

administrators at a Sr. Claims Adjuster level. My experience

allowed me to handle multiple statutory jurisdictions

including U.S. L & H and Protection & Indemnity (P. & I.) -

Jones Act Semen, first and third party claims.

09/87-03/90 CIGNA Insurance Company

Workers Compensation Claims Examiner Trainee

. I was promoted to Claims Adjuster within my first year of

employment with CIGNA.

. Responsibilities included the opening, negotiating and

closing of statuary workers compensation and U.S. Longshore &

Harbor claims (U.S. L & H) / Protection & Indemnity (PI)

claims.

Education

01/77-05/78 St. Edwards University, Austin, TX

08/85-05/89 Houston Baptist University, Houston, TX



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