Carl L. Saunders
Tampa,FL
Summary
Experienced Workers Compensation Adjuster specializing in loss time claims management. Managed complex litigated claims from inception to closure, ensuring effective communication with stakeholders and delivering exceptional customer service. Maintained an active All Lines FL 6-20 license with reciprocity across 30 states, contributing to successful outcomes in both California and Florida workers' compensation claims.
Overview
1
1
Certification
13
13
years of professional experience
Work History
Claims Examiner
Sedgwick
08.2023 - Current
- Calculated and assigned reserves to claims, managing adequacy throughout the claim process to ensure financial accuracy.
- Investigated complex workers comp claims, gathering information to determine liability and facilitate resolution.
- Manages the litigation process. Ensures timely and effective claims resolution
- Calculates and pays benefits due. Approves and makes timely claim payments.
- Updated claimants and clients on claim status and processing activities, enhancing communication and transparency.
- Prepares necessary state filing within statutory limits
Claims Representative II
Berkshire Hathaway Guard Insurance, Complex Claims Unit
02.2022 - 06.2023
- Managed workers compensation claims from inception to closure, ensuring seamless transitions from other representatives.
- Evaluated claims data to determine necessary reserve amounts to ensure financial accuracy.
- Negotiated claim settlements with designated authority to achieve favorable outcomes.
- Issued indemnity benefits and other checks associated with the claim.
- Interviewed employers, claimants & all involved parties.
- Evaluated facts obtained from investigation to determine compensability.
- Reviewed claims with team leader and suggested action plans to reach resolution.
- Reviewed claims with team leader and suggested action plans to reach resolution.
Workers Compensation Claims Adjuster
CorVel Corporation
02.2021 - 02.2022
- Evaluated facts supplied by investigation to determine the extent of liability of the insured.
- Negotiated settlement of claims with designated authority
- Prepared reports on investigation, settlements and denials of claims
- Reviewed bills relating to lost wages, doctors, pharmacies, attorney fees and vendors.
- Collaborated with team leader to identify issues in claims and develop actionable plans for resolution.
- Facilitated negotiations for claims settlements, ensuring alignment with designated authority and adherence to policy guidelines.
Workers Compensation Claims Adjuster
Packard Claims Administration
03.2019 - 01.2021
- Managed caseloads to get the injured employees back to working full duty or agree to settle.
- Managed caseloads to facilitate return of injured employees to full duty or settlement agreement.
- Negotiated settlement of claims with designated authority.
- Prepared & presented reports on investigation, settlements and denials of claims.
- Negotiated claim settlements with designated authority to achieve fair resolutions.
Personal Injury Investigator
Self Employed (1099)
01.2017 - 03.2019
- Gathered information on the injured party, the accident and injuries sustained.
- Collected detailed information on injured parties, accidents, and injuries to support case evaluations.
- Documented various types of damages through photography to aid in case evaluations.
- Scheduled appointments to meet with potential clients involved in accidents.
- Addressed questions clients may have pertaining to their case and injury.
- Collaborated with attorneys to resolve case issues and facilitate timely resolutions.
Workers Compensation Claims Adjuster
ES/S
02.2014 - 12.2016
- Conducted interviews with employers, claimants, and involved parties to gather comprehensive case information.
- Reviewed claims with team leader and discussed problems and suggested action plans.
- Conducted detailed interviews with employers, claimants, and all involved parties to gather essential information for case assessments.
- Reviewed bills relating to lost wages, doctors, pharmacies, attorney fees and vendors.
- Prepared reports on investigation, settlements and denials of claims
Education
Bachelor of Business Administration - Marketing
Jacksonville University
Jacksonville, FLSkills
- Claims management
- Claims negotiation
- Keen analytical and interpretive skills
- Team collaboration
- Effective communication skills
- Good interpersonal skills
- PC literate, including Microsoft Office products
- Quick learner
Certification
- OSHA 10 certification, January 2017
- Active all lines 6-20 adjuster license.
Timeline
Claims Examiner
Sedgwick
08.2023 - Current
Claims Representative II
Berkshire Hathaway Guard Insurance, Complex Claims Unit
02.2022 - 06.2023
Workers Compensation Claims Adjuster
CorVel Corporation
02.2021 - 02.2022
Workers Compensation Claims Adjuster
Packard Claims Administration
03.2019 - 01.2021
Personal Injury Investigator
Self Employed (1099)
01.2017 - 03.2019
Workers Compensation Claims Adjuster
ES/S
02.2014 - 12.2016
Bachelor of Business Administration - Marketing
Jacksonville University