Antoinette Walker
Columbia,SC
Summary
Workers Compensation Insurance professional with 27 years experience as a Claims Adjuster and Administrative Assistant utilizing strong analytical and communications skills in the management of claims.
Overview
20
20
years of professional experience
Work History
Insurance Analyst III
SC State Accident Fund
Lexington, SC
02.2019 - Current
- Determine compensability on Medical and Lost Time Workers Compensation claims for SC State, County and Municipal employers.
- Communicate with injured workers, employers, attorneys, medical providers and other parties in verbal and written form to obtain information for management of claims.
- Direct medical treatment and pay related medical and indemnity benefits in fair and timely manner.
- File required forms in accordance with SC Workers Compensation laws.
- Analyze claims for Third Party and other recovery potential.
- Negotiate and pay settlements within designated authority level.
- Review claims for closure.
Claims Associate
Sedgwick
Columbia, SC
12.2015 - 02.2019
- Determine compensability on Medical Only Workers Compensation claims for clients in multiple states based on Workers Compensation laws in each jurisdiction.
- Direct medical treatment and pay related medical benefits in fair and timely manner.
- File required forms in accordance with Workers Compensation laws in each jurisdiction.
- Communicate with clients, injured workers, attorneys, medical providers and other parties in verbal and written form for completion and management of claims.
- Review files for closure.
Claims Adjuster II
Companion Property & Casualty
Columbia, SC
05.2006 - 12.2013
- Investigate Workers' Compensation claims in SC, TN, GA, DC and VA to determine whether to pay or deny claims.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Confer with legal counsel on claims requiring litigation.
- Resolve complex, severe exposure claims, using high service oriented file handling.
- Settle and pay claims within designated authority level.
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
Claims Analyst I
SC State Accident Fund
Columbia, SC
02.2000 - 04.2006
- Investigate Workers' Compensation Claims for SC state, city and county employees to determine whether to pay or deny.
- Enter claim payments, reserves and new claims on computer system, inputting concise yet sufficient file documentation.
- Contact or interview claimants, doctors, medical specialists, or employers to get additional information.
- Settle and pay claims within designated authority level.
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
Education
CBCS - Medical Billing and Coding
Centura College
Columbia, SC06.2015
Master of Arts - Rehabilitation Counseling
SC State University
Orangeburg, SC12.1998
Bachelor of Arts - Psychology
University of South Carolina - Columbia
Columbia, SC05.1992
Skills
- SC Claims Adjuster License
- Microsoft Word
- Advanced oral and written communication skills
- Critical thinking/problem solver
- Team Player
- Self-motivated Independent worker
Timeline
Insurance Analyst III
SC State Accident Fund
02.2019 - Current
Claims Associate
Sedgwick
12.2015 - 02.2019
Claims Adjuster II
Companion Property & Casualty
05.2006 - 12.2013
Claims Analyst I
SC State Accident Fund
02.2000 - 04.2006
CBCS - Medical Billing and Coding
Centura College
Master of Arts - Rehabilitation Counseling
SC State University
Bachelor of Arts - Psychology
University of South Carolina - Columbia