SANDRA WESTFALL
Columbus,OH
Summary
Having been a claims examiner for over 20 years, and employed with only 2 companies shows I’m a faithful and loyal employee. At Big Lots I worked as a Senior Workers’ Compensation Examiner with a high volume of claims that I would complete from start to finish, assisting the employee’s and to make a decision on the files in a timely manor. In my short time at Sedgwick I was hired as a LOA representative. I began my career working on the Verizon account learning a new set of job skills and then was placed on the Ikea account. I have learned the new system and new job responsibilities. I have also been given the opportunity to learn the paid parental leave side of the business.
Overview
23
23
years of professional experience
Work History
Disability Account Reprensative
Segwik
Hilliard, OH
02.2021 - Current
- Used predictive modeling to increase and optimize customer experiences and revenue.
- Advocated on behalf of client stakeholders to make changes and introduce initiatives to achieve superior account performance.
- Assessed accuracy of new data sources and data gathering techniques.
- Worked with stakeholders throughout organization to identify opportunities for leveraging company data to drive business solutions and customer value.
LOA Representative
Sedgwick
Hilliard, Oh
12.2019 - 01.2021
- I assist on the FMLA side of the business to assist employees while they are off work
- I collect the appropriate medical documentation to support the claim
- I send out the appropriate paperwork to the employee and the company
- I also work on the paid parental leave claims
- I collect the appropriate documentation to support the leave
- I enter in payment information and document the claims
- I handle multiple files and am responsible to send out company and state documents in a timely manor as well as to make sure payments are issued in a timely manor.
Senior Workers’ Compensation Examiner
Big Lots
Columbus, Oh
09.1998 - 05.2019
- I handled a high volume of claims
- I was responsible to collect medical documentation and reivew the material including ICD codes to support the claim and make a determination in a timely manor
- I would send out FMLA information to the employee and send out appropriate claim documentation
- I would speak to the employee and the TPA as well as any attorneys or nurses that was assigned to the file.
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Reviewed questionable claims by conducting claimant interviews
- Reviewed new files to determine current status of injury claim and to develop plan of action.
Education
High -
Teays Valley High School
06.1991
High - undefined
Fairfield Career Center
06.1991
Skills
- Performance Evaluations
- Profitability Assessments
- Networking Events
- Operational Records Review
Timeline
Disability Account Reprensative
Segwik
02.2021 - Current
LOA Representative
Sedgwick
12.2019 - 01.2021
Senior Workers’ Compensation Examiner
Big Lots
09.1998 - 05.2019
High -
Teays Valley High School
High - undefined
Fairfield Career Center
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