Experienced Workers Compensation Claims Professional

Alice Maguire

Norwood, PA *****

&, 510-***-****

@] Dragonfly7 **@*****.***

Professional Summary

Experienced Insurance Claims Professional with over 20 years in workers' compensation, casualty, and property insurance. Proven expertise in claims investigation, medical-only and regulatory compliance, and stakeholder communication. Certified in Workers' Compensation for Pennsylvania and New Jersey with extensive multi-state claims experience.

Core Competencies

• Workers' Compensation Claims Management

• Medical-Only

• Subrogation

• Casualty & Property Insurance

• Claim Investigation & Compensability Analysis

• Medical & Legal Billing Authorization

• Regulatory Compliance (PA, NJ, DE, MD, DC)

• Telephonic & Electronic Case Management

Professional Experience

Medical Only Insurance Adjuster II

Pennsylvania Manufacturers'Association (PMA) - Blue Bell, PA January 2019 - Present

• Investigate claim compensability and manage ongoing medical aspects of accepted and denied claims.

• Communicate regularly with injured workers, employer representatives, and medical providers.

• Authorize appropriate medical and legal billing payments.

• Provide documentation and information to support litigation and settlement negotiations.

• Manage telephonic and electronic case files.

• Handle workers' compensation claims forth e City of Philadelphia, Heart and Lung, and Reg 32.

• Manage WCAIS files transmitted to the Bureau of Workers' Compensation in Pennsylvania.

• Authorize prescriptions through Express Scripts.

• Supply PMA documentation to the City of Philadelphia via OASIS. Claims Adjuster - Claim Services

American International Group (A/G)-Wilmington, DE

January 2004 - December 2018

• Managed workers' compensation claims from inception through resolution.

• Acted as a liaison between employers, medical providers, claimants, and attorneys.

• Ensured compliance with state regulations and company procedures.

• Reviewed medical documentation and authorized appropriate payments. Support Claims Clerk

American International Group (AIG) -Essington, PA

January 2001 - December 2003

• Served as a liaison between companies, physicians, claimants, and attorneys.

• Prepared, processed, and submitted claims documentation accurately and timely.

• Fielded calls regarding claim issues and routed information appropriately.

• Properly coded and processed payments.

• Maintain confidentiality and organized claimant files. Claims Assistant

American International Group (A/G)-Wilmington, DE

January 1999 - December 2000

• Responded to inquiries regarding payments and medical bills.

• Established and maintained claimant files.

• Assisted with adjudication of lost-time versus medical-only claims.

• Supported Claims Adjusters with daily claim management.

• Maintained strong organizational skills while multitasking in a fast-paced environment.

Education

Associates Degree -Art & Computer Science

Delaware County Community College] 1990 -1992

Academic Diploma

Cardinal O'Hara High School I 1986 -1990

Certifications

• Workers' Compensation Certification - Pennsylvania

• Workers' Compensation Certification - New Jersey

• Knowledge of Workers' Compensation Requirements: Delaware, Maryland, Washington D.C.

Technical Skills

• Microsoft Excel

• MicrosoftWord

• Outlook

• Windows OS

• Medical Billing & Coding

• Insurance & Claims Database Systems

• Typing & Data Entry

Personal Attributes

• Personable and approachable

• Strong interpersonal and communication skills

• Highly organized and detail-oriented

• Motivated and determined

• Flexible and adaptable

• Strong multitasking abilities

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