Summary
Work History
Skills
Certification
Education and Training
Timeline
Generic

Audrey Mauldin

Melissa,TX

Summary

Risk Management Associate with 13 years of workers' compensation claims handling experience in multiple jurisdictions, with a proven record of successful outcomes. Reduced the aged-pending claims inventory in assigned regions by over 30% in less than one year. Ensured that Sedgwick met 100% of the established goals set by the DFA Risk Management team for 2024 in assigned regions. Adept at developing training manuals to ensure compliance with internal best practices and regulatory requirements. Actively working to finish the ARM designation.

Work History

Senior Claims Analyst, Corporate Risk Management

Dairy Farmers of America
Dallas, Texas
02.2024 - Current
  • Collaborated with Plant Managers, EHS Managers, HR Managers, and other management for locations to create safety plans while addressing claim frequency, patterns, and trends. We also ensured that injured employees felt secure in returning to work after an injury.
  • Identified potential risks regarding workers' compensation claims that could be mitigated in the future with policy changes.
  • Monthly calls were set to present and review open workers' compensation claims for each location. Further discussion was held to analyze the future costs and how they would impact the location, along with plans for claim resolution.
  • Worked with Sedgwick adjusters as the primary liaison for the locations to ensure needed information was provided for claims investigation purposes.
  • Routinely reviewed and audited all open workers' compensation claims to ensure they were handled in accordance with company standards as set forth in the Special Handling Instructions.
  • Monthly calls were set to present and review open workers' compensation claims for each locations. Further discussion was held to analyze the future costs and how they would impact the location, along with plans for claim resolution.
  • Provided reserve and settlement authority to the Sedgwick adjusters along with recommendations to achieve optimal claim outcomes and cost-savings for all parties involved.
  • Partnered with peers to address employee concerns, mediate any disagreements, and counseled employees about the claims process with the expected steps in the process.
  • Oversaw the administration and handling of workers' compensation claims across seventeen states while staying updated on any regulatory changes that would potentially impact claims handling.
  • Coordinated with all other internal departments to address any needs such as legal, payroll, or human resources-related items.

Senior Account Claims Representative

PMA Companies
Plano, TX
05.2019 - Current
  • Managed a caseload of complex, high-exposure, and high-dollar workers' compensation claims from initial filing to resolution.
  • Conducted thorough investigations to determine liability, the validity, and extent of claims. Assessed appropriate benefits for the injured workers.
  • Developed and implemented training programs for new hires and existing team members to ensure compliance with internal best practices.
  • Provided mentoring, support, coaching, and guidance to fellow team members to develop all necessary skills to be successful in the appropriate jurisdictions.
  • Acted as a liaison between clients and insurance providers, maintaining strong relationships and resolving issues promptly.
  • Collaborated with medical professionals and employers to coordinate appropriate treatment plans.
  • Developed and implemented strategies to reduce claim duration and improve overall claims management process.
  • Worked jointly with legal counsel, medical professionals, and vocational experts to negotiate settlements and minimize costs.
  • Negotiated settlement agreements with claimants and their attorneys, ensuring compliance with state regulations.
  • Utilized strong negotiation skills to settle complex claims. Obtained settlement authority of $1.4 million for a claim which is the highest currently awarded in the region.
  • Ensured proper filing of required jurisdictional forms and EDI timely.
  • Exceeded all internal quality assurance audits with frequent 100% scores on all areas consistently.
  • Handling of Texas, Oklahoma, Arkansas, Arizona, Colorado, and Louisiana claims.

Workers' Compensation Claims Adjuster

ESIS
Dallas, TX
05.2018 - 04.2019
  • Handling of Texas and Mississippi lost-time workers' compensation claims of all complexities.
  • Negotiation of settlements in represented and pro se claimants to resolve files with finality.
  • Ensured proper filing of required jurisdictional forms and EDI timely.

Workers' Compensation Claims Adjuster

The Best IRS
Irving, TX
01.2016 - 04.2018
  • Handling of Pennsylvania, New Jersey, Mississippi, and DC lost-time workers' compensation claims of all complexities. (This was a long-term temporary assignment for State Farm while they migrated their claims handling over to a TPA.)
  • Negotiation of settlements in represented and pro se claimants to resolve files with finality.
  • Ensured proper filing of required jurisdictional forms and EDI timely.

Adjuster II

Texas Mutual Insurance Company
Irving, TX
10.2015 - 11.2016
  • Handling of Texas lost-time workers' compensation claims of all complexities.
  • Ensured proper filing of required jurisdictional forms and EDI timely.

Claims Specialist

CorVel Corporation
Addison, TX
03.2013 - 10.2015
  • Handling of Texas, Oklahoma, and Arkansas lost-time workers' compensation claims of all complexities.
  • Negotiation of settlements in represented and pro se claimants to resolve files with finality.
  • Ensured proper filing of required jurisdictional forms and EDI timely.

Adjuster II

Zurich Insurance
Addison, TX
2011 - 2012
  • Handling of Defense Base Act (DBA), United States Longshore & Harbor (USL&H), Jones' Act, and foreign voluntary lost-time workers' compensation claims of moderate complexity.

Skills

  • Analytical skills
  • Professionalism and integrity
  • Critical thinking
  • Team leadership experience
  • Problem solving
  • Continuous improvement mindset

Certification

  • Texas
  • Oklahoma
  • Arkansas

Education and Training

other

Timeline

Senior Claims Analyst, Corporate Risk Management

Dairy Farmers of America
02.2024 - Current

Senior Account Claims Representative

PMA Companies
05.2019 - Current

Workers' Compensation Claims Adjuster

ESIS
05.2018 - 04.2019

Workers' Compensation Claims Adjuster

The Best IRS
01.2016 - 04.2018

Adjuster II

Texas Mutual Insurance Company
10.2015 - 11.2016

Claims Specialist

CorVel Corporation
03.2013 - 10.2015

Adjuster II

Zurich Insurance
2011 - 2012
Audrey Mauldin