Audrey Ellering
Saint Paul,MN
Summary
Experienced Workers' Compensation and General Liability Insurance Specialist successful at managing high caseloads in fast-paced environments. Organized, driven and adaptable with excellent planning and problem-solving abilities. Offering 11 years of experience and willingness to take on any challenge.
Overview
17
17
years of professional experience
Work History
Claims Representative
RAS Insurance
08.2023 - Current
- Worked productively in fast-moving work environment to process large volumes of workers' compensation claims.
- Effectively managed claims in multiple jurisdictions including Wisconsin, Minnesota, and Iowa.
- Provided exceptional customer service, addressing concerns and resolving issues promptly.
- Maintained compliance with industry regulations by adhering to established procedures and guidelines in claims handling.
- Collaborated with cross-functional teams to expedite complex claims investigations and resolutions.
- Negotiated favorable settlements with claimants, resulting in cost savings for the company.
Senior Claims Representative
ESIS Insurance Company
08.2022 - 08.2023
- Managed workers' compensation claims as a Third Party Administrator handling multiple jurisdictions including Wisconsin, Iowa, and Missouri.
- Successfully managed large caseload resolving a backlog of claims for a high-profile self-insured client while maintaining strict deadlines and delivering consistent results under pressure situations.
- Followed up with customers on unresolved issues.
- Collaborated with legal and medical professionals to gather necessary information for claim assessments.
Technical Specialist
Northfield Insurance a Travelers Company
08.2021 - 08.2022
- Managed a high-volume caseload of Excess and Surplus Commercial General Liability Claims while maintaining quality service standards and efficient resolution timelines.
- Conducted thorough investigations of claims to determine coverage, liability, and damages.
- Enhanced client satisfaction with timely and accurate claim resolutions.
- Resolved disputed damage estimates by negotiating amicable agreements between insurance companies and policyholders.
- Collaborated with legal teams for successful litigation outcomes in complex cases.
- Demonstrated adaptability in handling a diverse range of general liability claims, resulting in well-rounded expertise and strong problem-solving skills.
- Reviewed police reports, medical treatment records, and physical property damage to determine extent of liability.
Claims Case Manager Investigative Claims Unit
Travelers Insurance
02.2018 - 08.2021
- Managed caseload of Workers' Compensation claims where coverage or compensability was in question handling multiple jurisdictions including Minnesota, South Dakota, Wisconsin, and Iowa.
- Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
- Worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial.
- Managed complex claims, ensuring accurate and timely resolutions through thorough investigations and negotiations.
- Coordinated independent medical examinations to verify injury severity when required.
- Evaluated coverage and conducted thorough investigations of suspicious claims.
- Consistently met or exceeded performance metrics for claims handling quality, productivity, and customer service.
- Contributed to team success by participating in regular training sessions, sharing best practices, and mentoring new adjusters.
- Presented Investigative Claims Unit role to current and prospective customers.
- Represented the company as a volunteer for various community and youth programs.
Medical Case Manager
Travelers Insurance
11.2013 - 02.2018
- Coordinated care of injured workers by liaising with medical providers to organize treatments and program resources.
- Reduced healthcare costs through efficient utilization of resources and identification of unnecessary treatments or procedures.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Performed prior authorization review of services requiring notification.
- Served as a vital liaison between injured workers, employers, healthcare providers, and claims adjusters, fostering effective communication and coordination among all parties involved in the claim process.
- Collaborated with employers and healthcare providers to facilitate safe and timely return to work reducing indemnity costs of claims.
Staff Nurse
Saint Francis Hospital and Medical Center
07.2012 - 11.2013
- Provided skilled nursing care in an Acute Rehabilitation and Brain Injury unit.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
- Collaborated with physicians, pharmacists and therapists to deliver quality, evidence-based care.
- Directed patient care by initiating and following through with plan of care, continuing care, and discharge instructions.
- Performed various nursing interventions such as wound dressing, vital sign monitoring, and specimen collection.
- Assessed physical, psychological, physiologic, and cognitive status of patients.
- Monitored patients' conditions and reported changes in physical presentation, appearance, and behavior to discuss treatment with physicians.
Nurse Consultant
Bright Horizons
06.2009 - 01.2012
- Oversaw health services for daycare center children and staff.
- Administered medication to children as prescribed by physicians to provide necessary treatment and manage health conditions.
- Monitored ongoing medical conditions such as asthma or diabetes, adjusting care plans accordingly to maintain optimal child wellness levels.
- Supported children with special needs by coordinating individualized healthcare plans and working closely with the interdisciplinary team.
- Managed immunization compliance within the center population to prevent the spread of communicable diseases.
- Served as liaison between families, staff, and healthcare providers on behalf of children.
- Screened for infectious diseases to help prevent spreading within daycare center.
- Assessed child health and identified potential health concerns to provide appropriate care.
- Streamlined documentation processes for maintaining accurate child health records, ensuring compliance with regulations.
- Maintained upkeep on defibrillators, blood pressure monitors and first aid kits to keep resources in working condition for emergencies.
- Enhanced center safety by collaborating with staff, parents, and community partners in developing emergency response plans.
- Developed care plans and made referrals as necessary for children with health concerns or injuries.
- Served as a resource for faculty and staff by providing training on first aid, CPR, and other health-related topics.
Registered Nursing Supervisor
Norwichtown Rehab and Healthcare
05.2008 - 06.2009
- Oversaw daily operations of the department, ensuring smooth workflow and timely completion of tasks.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
Registered Nurse, Telemetry and Pediatrics Unit
Lawrence & Memorial Hospital
06.2007 - 05.2008
- Provided skilled nursing care as part of a medical management team on a medical/surgical floor.
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
- Provided support for patients'' families during difficult medical decisions or end-of-life care, serving as a liaison between the healthcare team and loved ones.
- Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use, and disease management.
- Offered exceptional care and support to individuals recovering from acute incidents and dealing with chronic conditions.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
Education
Bachelor of Science - Nursing
University of Connecticut
Storrs, CTSkills
- Teamwork orientation
- Continuous learning mindset
- Conflict resolution techniques
- Medical terms and procedure knowledge
- Claims Investigation
- ICD-10 Coding Knowledge
- HIPAA compliance awareness
- Proficiency in Microsoft Office, Excel, Strataware, and experience with various claim handling platforms
Timeline
Claims Representative
RAS Insurance
08.2023 - Current
Senior Claims Representative
ESIS Insurance Company
08.2022 - 08.2023
Technical Specialist
Northfield Insurance a Travelers Company
08.2021 - 08.2022
Claims Case Manager Investigative Claims Unit
Travelers Insurance
02.2018 - 08.2021
Medical Case Manager
Travelers Insurance
11.2013 - 02.2018
Staff Nurse
Saint Francis Hospital and Medical Center
07.2012 - 11.2013
Nurse Consultant
Bright Horizons
06.2009 - 01.2012
Registered Nursing Supervisor
Norwichtown Rehab and Healthcare
05.2008 - 06.2009
Registered Nurse, Telemetry and Pediatrics Unit
Lawrence & Memorial Hospital
06.2007 - 05.2008
Bachelor of Science - Nursing
University of Connecticut