Claims Adjuster Customer Service

Leona Gould

479-***-**** ️ **********@*****.***

Professional Summary

Seasoned Senior Workers’ Compensation Claims Adjuster with extensive experience handling high-exposure, litigated, and multi-jurisdictional claims. Proven ability to investigate, evaluate, and resolve complex indemnity claims across various industries, including agriculture, transportation, retail, aviation, and hospitality. Recognized for building strong rapport with stakeholders and driving timely resolution of claims while ensuring compliance with state, federal, and local regulations. Skilled in fraud detection, training new adjusters, and managing claims in excess of $500K.

Core Competencies

Multi-Jurisdictional Claims (FL, IL, TX, PA, etc.)

Insurance Policy Analysis

Workers’ Compensation Law & Compliance

Early Intervention & Stakeholder Communication

Settlement Negotiation & Litigation Management

Claims Evaluation & Fraud Investigation

Training & Team Oversight

Customer Service & Employer Relations

Microsoft Office Suite Proficiency

Professional Experience

**Senior Claims Adjuster** - Lewisville, TX 03/2023 – Present

- Manage complex indemnity and medical claims across multiple jurisdictions.

- Initiate prompt investigations including employer/claimant contact, record review, and policy analysis.

- Maintain regular communication with employers, injured workers, and medical providers.

- Collaborate with legal counsel and attend mediations/settlement conferences.

- Mentor new team members and support training efforts.

- Frequently requested by agents and employers due to exceptional service.

**Senior Claims Adjuster** - Sedgwick Aurora, IL 04/2022 – 03/2023

- Handled full caseload of indemnity workers’ compensation claims.

- Conducted interviews, reviewed documentation, and ensured policy compliance.

- Negotiated settlements and collaborated with legal teams.

- Trained peers and improved team productivity.

**Claims Adjuster** - Walmart Home Office Bentonville, AR 09/2017 – 04/2022

- Managed high-volume claims including indemnity and medical.

- Issued benefits and authorized treatments.

**Child Support Investigator** - State of Oklahoma DHS Durant, OK 04/2016 – 08/2016

- Monitored court-ordered child support and enforced compliance.

- Conducted interviews and financial investigations.

**Cash Rewards Analyst** - Sam’s Club Home Office 05/2015 – 02/2016

- Managed rewards accounts for 23,000+ members.

- Tracked metrics and maintained program integrity.

**Child Support Investigator / Account Manager** - State of Arkansas DHS Lowell, AR 08/2011 – 10/2014

- Handled child support cases and ensured legal compliance.

- Managed records and reported to courts.

**Program Specialist / Investigator** - State of Arkansas DHS Fort Smith, AR 05/2007 – 08/2011

- Determined eligibility for public assistance programs.

- Maintained caseloads of 550–600 clients.

**Child Development Director** - Crayola Corner 08/2005 – 08/2007

- Directed daily operations and staff at a childcare center.

- Managed client billing and curriculum planning.

**Program Specialist / Investigator** - State of Oklahoma DHS 08/2000 – 08/2005

- Assessed eligibility and verified assets for state programs.

- Managed up to 600 cases monthly.

Education

Bachelor of Arts – Northeastern State University

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