Albertina Dudley
Houston,TX
Summary
Motivated Senior Claims Adjuster committed to training and supporting new adjusters become confident and knowledgeable in their role. Service oriented and skilled at solving complex problems. Skilled at performing detailed evaluations of claims and case loads while providing exceptional customer service to policy holders and injured workers. Trained and knowledgeable about Texas workers' compensation rules and standards. Looking to obtain a Senior Lead Adjuster position.
Overview
19
19
years of professional experience
Work History
Senior Claims Adjuster
Texas Mutual
08.2022 - Current
- I establish relationships with policy holders to foster timely claim resolution.
- I interview policy holders, claimants and witnesses to gather factual information.
- I deliver exceptional customer service to policyholders and claimants by communicating important information and patiently listening to issues.
- I review medical records, surveillance and other online evidence to verify make a thorough decision for each claim.
- I work in collaboration with special investigative adjusters and outside personnel to get as much evidence as possible to make a proper decision.
- I work with nurse case managers to assist the claimant to get necessary and proper medical treatment.
- I collaborate with our medical directors to determine proper and necessary treatment and make decisions around new medical diagnoses and conditions.
- I prepared summaries of damage, payments, and policy coverage.
- I work with legal personnel; to effectively manage litigation to drive files to positive closure.
- I successfully bring claim to final resolution for an optimal outcome.
Return to Work Workers' Compensation Adjuter
Travelers Insurance
10.2019 - 08.2022
- I manage the file with an emphasis on file quality (including timely contact and proper documentation along with proactive resolution of outstanding issues)
- I achieve a positive result by returning the injured worker to work and coordinating the appropriate medical treatment in collaboration with internal nurses
- I work closely with accounts to create a strategy to get injured worker back to work in a job best fit for the employee when the doctor allows
- I discuss with the accounts how to move the employee forward after the injury or claim has resolved
- I work in collaboration with specialty resources (medical, investigative and legal) to proactively pursue claim resolution opportunities such as return to work, dispute resolution, discontinue benefits and settlement
- I develop strategies to manage losses involving issues of statutory benefit entitlement, medical diagnoses, Medicare Set Aside to achieve resolution through the best possible outcomes
- I collaborate with internal nurse resources in order to integrate the delivery of medical services to overall claim strategy
- I prepare necessary letters and state filings within statutory limits
- I pursue all offset opportunities and subrogation
- I evaluate all claims for potential fraud
- I proactively manage inventory with documented plans of action to ensure timely and appropriate file closing or reassignment
- I effectively manage litigation to drive files to an optimal outcome
- Claim Professional – Workers’ Compensation – Investigative Claim Unit
Investigative Claims Adjuster - Workers' Comp
Travelers Insurance
08.2013 - 10.2019
- I provide exceptional, to the insured and the injured worker of National Accounts as well as Oil and Gas and Longshore Employers
- I investigate injuries that occur to employees while at work
- Also investigate the policy to verify coverage is available for this incident in TX, LA and AR
- I take statements and interview the injured worker, medical specialist and witnesses
- I review medical records, photos and all pertinent information to complete my investigation
- I will include the Travelers Investigation Service (TIS) to assist when needed to go out and conduct face to face interviews and take scene photos
- I make payments for indemnity benefits and work with the nurses to get the injured worker back to full duty
- I assist my team by helping to train new hires and interns
- I am a part of the ERT team to assist with catastrophic events as they arise locally and other areas of the country
- I speak with accounts as a part of the Trav Comp team to make presentations to potential customers of the workers’ compensation product
- Auto Dept
- Business Insurance, Personal Insurance and PIP
Auto Claims Adjuster
Travelers Insurance
04.2005 - 08.2013
- I provide exceptional, to insured customers of Travelers Insurance and claimant customers
- I investigate automobile accident claims to determine liability and injuries
- I pay on claims to indemnify our insured customers and provide liability to claimant customers we are liable to
- I also investigate injuries to determine causality and then pay out what is owed on medical expenses and lost wages
- Also a part of the job is to work with the special investigative team to determine if fraud is involved in the claim
- I handle claims for both business insurance and personal insurance
- For business insurance claims I have learned to work with National Accounts, CAEs and reviewing SAC instructions to properly and effectively handle the claim
- I maintain my adjuster’s license to handle all lines of insurance for 3 states; Texas, Louisiana and Oklahoma
- I have sat with adjusters in Worker’s Compensation department to gain knowledge in this department.
Education
Associates of Science - Communication Disorders
Eastern New Mexico University
Portales, NM05.2014
Bachelors of Arts and - Mass Communications, Humanities
Southern University And A&M College
Baton Rouge, LA05.2003
Skills
- Staff Development
- Staff Training
- Verbal and Written Communication
- Strong Communication and Interpersonal Skills
- Professional Development
- Personal, Casualty and Property Loss Insurance
Accomplishments
I am currently a participant of the Aspiring Leaders Program. I am learning so much about emotional intelligence and leadership competencies that will support me as a future leader.
I have volunteered and participated in additional leadership opportunities such as leading our team meetings and assisting with completing average weekly wage reviews and 15 day reviews.
I have completed several volunteer experiences which is a sense of pride to give back and support our community.
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Senior Claims Adjuster
Texas Mutual
08.2022 - Current
Return to Work Workers' Compensation Adjuter
Travelers Insurance
10.2019 - 08.2022
Investigative Claims Adjuster - Workers' Comp
Travelers Insurance
08.2013 - 10.2019
Auto Claims Adjuster
Travelers Insurance
04.2005 - 08.2013
Associates of Science - Communication Disorders
Eastern New Mexico University
Bachelors of Arts and - Mass Communications, Humanities
Southern University And A&M College