CARLOS GOMEZ
Pacoima,USA
Summary
Detail-oriented Workers’ Compensation Adjuster with 3 years of experience managing California and Oregon claims, offering a unique perspective from both the insurance and legal sides of the industry. Former legal assistant at a claimant-side law firm, bringing in-depth understanding of injured workers' rights, litigation procedures, and case development. Skilled in investigating claims, interpreting medical and legal documentation, determining compensability, and negotiating fair settlements in compliance with state regulations. Proven ability to handle complex caseloads efficiently while maintaining empathy, professionalism, and strong communication with all stakeholders.
Overview
5
5
years of professional experience
1
1
Certification
Work History
Legal Assistant / Case Development Manager
Thomas, Coon, Newton & Frost
08.2023 - 09.2025
- Logged and saved all incoming mail (physical and digital) to CMS; created and tracked internal deadlines for team visibility
- Conducted all Spanish-language intakes and served as intake specialist for the Workers’ Compensation department
- Managed onboarding of new clients, including retainer preparation, Notice of Representation, and insurer communication
- Requested hearings, submitted settlement documents, tracked settlement status, and communicated with ALJs via WCB portal
- Scheduled doctor conference calls and requested special examinations as needed
Legal Assistant
Glass Law Group
05.2023 - 08.2023
- Manage all new intakes and file all new claims and proceedings with the WCAB.
- Arrange and assist in confirming all matters in QME and AME process.
- Monitor and assist in senior attorneys calendars and follow up with all existing clients.
Workers Compensation Claims Adjuster
ESIS
02.2022 - 02.2023
- Managed workers’ compensation claims from inception to resolution, including administering lost wage benefits and coordinating treatment authorizations
- Verified in-network provider treatment and ensured timely medical care for injured workers
- Maintained strong client service and communication with medical providers, attorneys, and legal officials
- Delivered professional claim presentations and reviews to brokers and corporate clients, both in-person and via teleconference
- Conducted thorough investigations to determine claim validity, gathering evidence and collaborating with stakeholders effectively
- Negotiated fair and timely settlements with claimants and their legal representatives, ensuring compliance with state regulations and company policies
COVID-19 Contact Tracer
Los Angeles County Department of Public Health
08.2020 - 07.2021
- Conducted interviews with confirmed COVID-19 cases to identify close contacts and potential exposure risks
- Provided public health guidance, isolation/quarantine instructions, and resource referrals to affected individuals
- Maintained accurate and confidential case records in compliance with HIPAA and public health protocols
- Collaborated with healthcare providers, laboratories, and public health officials to ensure timely case follow-up
- Utilized data management systems to track case status, exposure timelines, and contact outcomes
- Communicated sensitively and effectively with diverse populations, often in high-stress or emotionally charged situations
Skills
- Communication and client service
- Bilingual (English and Spanish)
- Microsoft Suite Programs
- Extensive knowledge of Workers' Compensation law in CA and OR
- Strong understanding of Standard Claim Forms (CPT/ICD-10, HCPCS, PDR)
Certification
- California State University Northridge - B.S. of Public Health / Health Administration (Dec. 2020)
- Los Angeles County Department of Public Health - COVID 19 Contact Tracer Certification
- Simi Institute for Careers -Medical Insurance Billing Certificate (Jan. 2022)
- Des Moines University - Medical Terminology Certification
Affiliations
- Oregon Hispanic Bar Association - Member (Sep. 2024 - Sep. 2025)
- Northwest Workers' Justice Project - Member (Oct. 2023 - Sep. 2025)
Languages
English
Native or Bilingual
Spanish
Full Professional
Timeline
Legal Assistant / Case Development Manager
Thomas, Coon, Newton & Frost
08.2023 - 09.2025
Legal Assistant
Glass Law Group
05.2023 - 08.2023
Workers Compensation Claims Adjuster
ESIS
02.2022 - 02.2023
COVID-19 Contact Tracer
Los Angeles County Department of Public Health
08.2020 - 07.2021
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