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
Sioux Falls, SD
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
Overland Park, KS
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
Saint Paul, MN
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
Saint Paul, MN
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
Saint Paul, MN
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
Hartford, CT
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
Groton, CT
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
Norwich, CT
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
New London, CT
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