Worker's Compensation Customer Service

Expertise in worker's compensation claims with a comprehensive understanding of the law, regulations and claims procedures. Detail oriented and effective at undertaking independent research and analysis associated with worker's compensation claims in multiple states. Adept at multi-tasking and meeting statutory and regulatory deadlines. Team oriented and accomplished in excellent customer service.

Licensing and Awards

Licensed Independent Adjuster Worker's Compensation in Texas, Oklahoma, and Minnesota

Maintains CEU credits to comply with yearly licensing regulations

Chosen by CorVel Corporate office as the ACE IT Spotlight of Excellence Award Winner in 2021

Education

The University of Kansas

BA in Business/Organizational Communication

Coursework emphasis on Intercultural Communication and Cultural Diversity Studies

Work Experience

Dec 2022-present Worker’s Compensation Claims Representative- Sedgwick

Manages a busy desk for complex medical claims for the City of Austin

Responsible for all Medical claims for the City of Austin Fire departments as well as other City departments

Handles lifetime hearing loss claims for first responders

Calculates Reserves for lifetime hearing aids and other claims

Adept at reviewing medical information and investigating claims to determine accurate compensability and coverage

Follows best practices and client service instructions to manage claims to resolution and timely closure

Conducts Claim Reviews, sets diaries and provides exemplary customer service to claimants, clients and providers

Aug 2022-Dec 2022 Resolution Manager- Gallagher Bassett

Manages the grievance process to review, investigate, document, process, negotiate, and resolve disputed litigated claims

Interacts extensively with various parties involved in the claim process

Present Claim Reviews to clients to update them on status and bring to resolution

Evaluate and Settle complex claims to determine coverage, compensability, liability, subrogation, and the setting of appropriate reserves

Pays and evaluates all medical, lost time wages, and legal bills

Authorize or deny appropriate PT, diagnostics, case management, and surgeries

Calculates PPD exposure and issues TTD and Settlement checks

Nov 2020-Aug 2022 Work Comp Claims Specialist– CorVel Corporation

Investigate Claims, confirm coverage, make provider, employer and claimant contacts to verify incident details and injured body parts, set reserves for 100 plus new claims per month in multiple states within 24 hours of the First Report of Injury. Responsible for 100 plus corporate clients, following their individual account instructions, including all Minneapolis Public Schools

Maintain and update claim files with incoming work status, medical and legal documents

Create and send out correspondence to hospitals, lawyers, claimants, employers and audits to comply with all state regulations

Maintain large volume of claims with Action Plans and Closing at MMI. Document and Pay Legal, Medical and Vocational invoices with reserves from claim files, approve or deny provider billing

Calculate Mileage rates per state and reimburse claimants

Answer and direct incoming claim questions from providers, employers and claimants for several states, document medical notes and follow work comp law in each state

2018-Apr. 2020 Communications Specialist – Route 66 RV Network

Responsible for handling client concerns and inquiries

International liaison between Dealerships and Executives

Leader in marketing and client relations through Constant Contact marketing services

Leasing Manager – Tomahawk Creek Tech Space

Event coordinator for Client Outreach and Promotional Events to recruit renters for state-of-the-art Technology and Innovation Space

Manages leasing contracts and sales

Lead in marketing and client relations

2011 HR Consulting Project – The JDL Group

Conducted candidate interviews for hiring of HR Executive

Collaborated with internationally renowned, board certified IO Psychologist on hiring decisions

Conducted data analysis on psychological profiles for candidates to build on-boarding and management strategies

1994-1999 HR Generalist – A&E

Leader in human capital management and recruitment; Conducted on-boarding and Training for new hires

Handled employee benefits, administrative work, and led annual benefits training sessions

Worker’s Compensation Policy expert and hiring manager

1993-1994 Customer Service Representative – A&E

Worked closely with architects and engineers to coordinate Reprographic projects

Liaison between the clients and blueprint operators

Technical knowledge of digital color copying and scanning projects and management of project

Vault

Innovated customer service protocol to provide more on-demand service for clients

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