Ana Lopez Esquivel
Long Beach,CA
Overview
12
12
years of professional experience
Work History
Senior WC Claims Examiner for Captive Program
SEDGWICK CMS
01.2025 - Current
- Managed a caseload of over 130 claims on a CA Insured account who covered various industries such as hotels, restaurants, retail stores and warehouses.
- Utilized Juris and SIR Mail for claims handling and documentation; ensured ICERS and Diary management was addressed to meet weekly expectations, maintained examiner penalties to a minimum.
- California (REMOTE)
Senior WC Claims Examiner – PRISM account
ATHENS ADMINISTRATORS
Orange, CA
02.2024 - 12.2024
- Managed a diverse caseload for CA school districts, claim desk handles up to 135 files and includes indemnity new loss, litigated multiple injury, future medical, and high exposure claims.
- Utilize SIMS for claims documentation and diary management. Consistently meet monthly expectations for closure (three-month average over 150%) and address pending bills and mail within 5 days of receipt.
- Prepare and participate in quarterly claim reviews with client and employer. Present recommendations for navigating claim through medical discovery and analyze reporting and legal evidence to address issues of compensability, apportionment and MMI exposure.
- Complete Settlement Authority Requests and obtain auth for STIPs and C&Rs, work with defense counsel to secure early resolution on files where appropriate.
- Calculate benefits per Ed Code and salary continuation benefits paid on file for first 60 days, use Schedule of Values to rate out permanent disability. Issue out timely and appropriate benefit notices per state regulations.
- ORANGE, CA
Senior WC Claims Examiner for Everest
SEDGWICK CMS
Orange, CA
09.2022 - 01.2024
- Managed a caseload of over 130 claims on a CA Insured account who covered various industries such as hotels, restaurants, retail stores and warehouses.
- Utilized Juris and SIR Mail for claims handling and documentation; ensured ICERS and Diary management was addressed to meet weekly expectations, maintained examiner penalties to a minimum.
- Set adequate reserves based on Official Disability Guidelines (ODG) analytics, ensured client notification and approval was requested for reserves over examiner authority per client handling instructions.
- Completed detailed claim status reports and attended remote reviews with clients, brokers and defense attorneys to discuss recent legal updates and report findings on claims and potential pathways for resolution.
- Identified coverage issues and address Petitions for Joinder and Petitions for Contribution.
- ORANGE, CA
Executive Assistant
BAMF GLOBAL TECHNOLOGIES INC.
Newport Beach, CA
12.2020 - 08.2022
- Streamlined administrative processes to enhance productivity and executive support.
- Managed the COO's calendar, email correspondence, and travel/site visit schedules to ensure smooth office operations.
- Acted as the primary point of contact for Labor Compliance, Insurance, and Accounts Receivables requests, ensuring timely resolution.
- Coordinated onsite and remote team meetings and recorded detailed meeting minutes for accurate documentation.
- Assisted with project material orders, equipment rentals, and subcontractor payments to support project efficiency.
- NEWPORT BEACH, CA
Team Lead for Self-Insured Client
SEDGWICK CMS
Long Beach, CA
01.2019 - 01.2020
- Acted as a second level of appeal for resolving claimant issues for a team of seven examiners.
- Completed Supervisor reviews every 90 days on claim to ensure accurate file documentation, coding, and compliance. Responsible for releasing payments in PERT and authoring reserve changes over $75K for team.
- Assisted in interviewing and training new hires, contributing to the team’s growth.
- Participated in monthly leadership meetings to provide insights and drive initiatives.
- Ensured recommended actions discussed in claim reviews were completed to maximize client satisfaction.
- LONG BEACH, CA
Claims Examiner for Self-Insured Client
SEDGWICK CMS
Long Beach, CA
01.2015 - 01.2019
- Successfully completed 4-month IAP Claims Training program and managed caseload over 100 claims, covered and later inherited 'Settlement Champion' desk for over 150 complex, litigated files.
- Completed Settlement Authority Requests (SARs) and worked with assigned Marsch Consultant on high exposure files to identify settlement obstacles.
- Calculated benefits and issued state-required notices, maintained audit scores above 85%.
- Documented potential 'red flags' during initial investigation and followed up with sub rosa investigations, particularly for behavioral health alleged injuries.
- Assisted in pro per injured workers with explaining QME process, settlement documents, benefit notices and Medicare addendums as needed to secure claim resolution favorable to all parties.
- LONG BEACH, CA
Management Trainee/Intern
Enterprise Rent-A-Car
Long Beach, CA
06.2014 - 08.2015
- Provided pick-up and drop off services for customers; performed check in and check out for vehicles.
- Booked rental reservations, sold protection packages and explained rental contracts.
Timeline
Senior WC Claims Examiner for Captive Program
SEDGWICK CMS
01.2025 - Current
Senior WC Claims Examiner – PRISM account
ATHENS ADMINISTRATORS
02.2024 - 12.2024
Senior WC Claims Examiner for Everest
SEDGWICK CMS
09.2022 - 01.2024
Executive Assistant
BAMF GLOBAL TECHNOLOGIES INC.
12.2020 - 08.2022
Team Lead for Self-Insured Client
SEDGWICK CMS
01.2019 - 01.2020
Claims Examiner for Self-Insured Client
SEDGWICK CMS
01.2015 - 01.2019
Management Trainee/Intern
Enterprise Rent-A-Car
06.2014 - 08.2015