Antonia Gilbertson
Stevens Point,WI
Summary
Accomplished Worker's Compensation Claims Adjuster with a robust background at Sentry Insurance, showcasing expertise in claims investigation and exceptional empathy in customer interactions with a proven track record in maintaining compliance and enhancing customer satisfaction through innovative solutions. With demonstrated success in mentoring and critical thinking, I can significantly contribute to team development and efficient claims resolution.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Workers Compensation Claims Adjuster II
Sentry Insurance
09.2022 - Current
- Manage a caseload of 156 claims. (125 Indemnity and 31 medical only)
- Calculate wage information to provide lost time benefits. (ex: Temporary total disability benefits, temporary partial disability benefits, impairment awards, etc. )
- Maintain a Texas Worker's Compensation license.
- Manage direct writer and TPA accounts.
- Filing and sending appropriate state forms. (UT, MN, & NE)
- Examined claims forms and other records to determine insurance coverage.
- Maintained compliance with state regulatory requirements through meticulous documentation and adherence to company policies.
- Provided exceptional customer service during emotionally difficult situations for policyholders following accidents or natural disasters.
- Conducted thorough investigations of complex insurance claims, gathering evidence and analyzing relevant documentation.
- Contributed to a positive work environment through active participation in team meetings and collaborating on cross-functional projects.
- Reviewed police reports, medical treatment records, and physical property damage to determine the extent of liability.
- Mentored junior adjusters on best practices and industry regulations, contributing to their professional growth and development.
Workers Compensation Claims Adjuster I
Sentry Insurance
06.2022 - 08.2022
- Practice adherence to state-specific laws and regulations.
- Wage calculations and providing temporary total disability benefits.
- Following specific instructions provided by direct writers' insurance and TPA policies.
- Ensure claims have up-to-date dispositions/diaries, medical records, and payments.
- Filing and sending appropriate state forms. (UT, MN, & NE)
- Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Analyzed information gathered by investigation and reported findings and recommendations.
- Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
- Worked with investigators and attorneys to obtain evidence, witness statements, and other documentation in preparation for compensability determination.
First Notice of Loss Claims Representative
Sentry Insurance
11.2019 - 06.2022
- File claims with insureds, claimants, and third parties for workers' compensation claims, motor vehicle accidents, motorcycle accidents, John Deer machinery/equipment, industrial machinery, and product loss.
- Created and maintained auto insurance policies for customers.
- Followed up with customers on unresolved issues.
- Improved customer satisfaction by providing timely and accurate claim status and resolution information.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Trained and mentored new employees.
Head Cashier
Menards
05.2016 - 04.2019
- Mentored new cashiers, providing comprehensive training that resulted in increased productivity.
- Helped customers complete purchases, locate items, and join reward programs.
- Handled escalated customer concerns with professionalism and empathy, working diligently toward satisfactory resolutions.
Education
Bachelor of Science - Social Work
University of Wisconsin, Stevens Point
Stevens Point, WI05-2021
Bachelor of Science - Psychology & Human Services
University of Wisconsin, Stevens Point
Stevens Point, WI05-2019
Skills
- Claims processing
- Caseload management
- Critical thinking
- Claims investigation
- Highly motivated
- Team collaboration
- Advanced oral and written communication skills
- Decision-making
- Multitasking and organization
- Empathy and patience
- Negotiation techniques
- Conflict resolution
Certification
- Texas Workers Compensation Claims Adjuster License 2024
Timeline
Workers Compensation Claims Adjuster II
Sentry Insurance
09.2022 - Current
Workers Compensation Claims Adjuster I
Sentry Insurance
06.2022 - 08.2022
First Notice of Loss Claims Representative
Sentry Insurance
11.2019 - 06.2022
Head Cashier
Menards
05.2016 - 04.2019
Bachelor of Science - Social Work
University of Wisconsin, Stevens Point
Bachelor of Science - Psychology & Human Services
University of Wisconsin, Stevens Point