Charissa Janney-Smith

Investigate, Evaluate an adjust workers' compensation claims in accordance within state laws and established claims handling standards.

Establish reserves and provide recommendations to establish authority levels.

Review, approve and provide oversight of medical, legal, damage estimates on invoices to determine reasonable and related to claim.

Assess and monitor subrogation claims for resolution.

address payments on claims in accordance with claim procedures and using payment programs.

Negotiate settlements in accordance with Corporate claim standards, client standards and within the state laws.

Assist in selections, referrals and supervision of designated workers compensation claims to outside vendors and manage ongoing treatment issues.

Review and maintain personal diary on claims system.

Prepare reports detailing claim status, payments and reserves.

Provide notices of qualifying claims to excess/reinsurance carriers.

Filing proper state forms per jurisdiction.

Conduct claims reviews with clients per clients request.

• Corrected codes to properly classify workers compensation claims.
• Consulted police and hospital records when needed.
• Interviewed claimants and witnesses to gather factual information.
• Researched claims and incident information to deliver solutions and resolve problems.
• Handled complaints and grievances using negotiating and problem-solving skills.
• Worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial.
• Used various systems to program, set up functions and enter data for claims.
• Followed up on potentially fraudulent claims initiated by claims representatives.
• Directed claims negotiations within allowable limit of approved authority and supported successful litigations for advanced issues.
• Examined claims forms and other records to determine insurance coverage.
• Collected information from customers to complete claims and legal files.
• Reviewed new files to determine current status of injury claim and to develop plan of action.
• Negotiated settlement agreements to resolve disputes.
• Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
• Verified accuracy of records to maintain accuracy of records database.
• Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
• Maintained claims data in various computer systems.
• Incorporated detailed objectives to achieve action plans and strategies.
• Interviewed agents and claimants to correct errors or omissions and investigate questionable claims.
• Maintained contact with claimants and attorneys to determine treatment status.
• Evaluated original investigation reports and documents to resolve secondary concerns.
• Organized, planned and documented materials for claims.
• Conducted day-to-day administrative tasks to maintain information files and process paperwork.
• Maintained knowledge of benefits claim processing, claims principles, medical terminology, and procedures and HIPAA regulations.
• Monitored and updated claims status in claims processing system.
• MANAGED CALIFORNIA WORKERS COMPENSATION CLAIMS FOR 13.5 YEARS.
• Manage payments files for insurance claim payment release.

• Interviewed claimants and witnesses to gather factual information.
• Finalized files for insurance claim payment release.
• Researched claims and incident information to deliver solutions and resolve problems.
• Examined photographs and statements.
• Ordered information to complete workers compensation files.
• Used various systems to program, set up functions and enter data for claims.
• Identified insurance coverage limitations with thorough examinations of claims documentation and related records.
• Organized, planned and documented materials for workers compensation claims.
• Followed up on potentially fraudulent claims initiated by claims representatives.
• Directed claims negotiations within allowable limit and supported successful litigations for advanced issues.
• Examined claims forms and other records to determine insurance coverage.
• Documented information gathered in field and uploaded data to company database for efficient processing using various software.
• Collected information from customers to complete claims and legal files.
• Conducted day-to-day administrative tasks to maintain information files and process paperwork.
• Analyzed information gathered by investigation and reported findings and recommendations.
• Reviewed new files to determine current status of injury claim and to develop plan of action.
• Negotiated settlement agreements to resolve disputes.
• Delivered exceptional customer service to policyholders by communicating important information and patiently listening to issues.
• Conducted comprehensive interviews of witnesses and claimants to gather facts and information.
• Incorporated objectives to achieve action plans and strategies.
• Prepared state formed documents for managers or legal personnel.
• Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
• Maintained contact with claimants and attorneys to determine treatment status.
• Evaluated original investigation reports and documents to resolve secondary concerns.
• Corrected codes to properly classify workers compensation claims.

• Managed West Virginia Workers Compensation Claim file with the same job description as Cambridge and Sedgwick. During the privatization of West Virginia Workers Compensation System.

• Interviewed claimants and witnesses to gather factual information.
• Researched claims and incident information to deliver solutions and resolve problems.
• Ordered [Type] information to complete [Type] files.
• Handled complaints and grievances using negotiating and problem-solving skills.
• Worked with private investigators and attorneys on preparation of evidence, witness statements, and other documentation in preparation for trial.
• Used [Type] systems to program, set up functions and enter data for claims.
• Organized, planned and documented materials for [Type] claims.
• Followed up on potentially fraudulent claims initiated by claims representatives.
• Investigated and assessed damage to property and reviewed property damage estimates.
• Directed and coordinated various investigations conducted by field investigation team.
• Examined claims forms and other records to determine insurance coverage.
• Conducted day-to-day administrative tasks to maintain information files and process paperwork.
• Analyzed information gathered by investigation and reported findings and recommendations.
• Reviewed new files to determine current status of injury claim and to develop plan of action.
• Maintained claims data in [Type] systems.
• Incorporated [Type] objectives to achieve action plans and strategies.
• Maintained contact with claimants and attorneys to determine treatment status.

• Examined forms to determine insurance coverage and validity.
• Analyzed information gathered from investigations and reported findings.
• Attended hearings and depositions.
• Applied general law and evaluated facts and evidence in relation to individual cases.
• Processed legal orders. .