Cheryl Grzyb
Manalapan
Summary
Detail-oriented WC Claims Adjuster with expertise in claims evaluation and regulatory compliance. Proven track record in negotiating fair settlements and maintaining accurate documentation. Strong communicator who effectively collaborates with clients and legal teams to expedite claims processing.
Overview
17
17
years of professional experience
Work History
Senior WC Claims Adjuster
Enlyte
San Diego
03.2026 - Current
- Investigated insurance claims, analyzing coverage and liability to prepare comprehensive reports that informed payment or denial decisions.
- Reviewed and adjusted claims, ensuring fair and prompt settlements for clients.
- Negotiated settlements with claimants or their representatives in order to resolve disputes quickly and economically.
- Communicated effectively with clients regarding claim status and procedures.
- Evaluated claims to determine coverage and liability under policies.
- Maintained detailed records of claims activities in claims management systems.
- Gathered information from various third parties to determine claim acceptability.
- Reviewed medical records and reports to support claim evaluations and decisions.
- Conducted witness interviews to assist claim information gathering process.
- Coordinated with medical professionals to assess injury claims and determine compensation.
- Collaborated with legal teams to gather necessary documentation for claims processing.
- Reviewed medical records, police reports and other documents related to claim investigations.
- Analyzed facts of loss including photographs, diagrams and other evidence to identify potential sources of recovery.
- Utilized computer systems such as Microsoft Office Suite and specialized software programs used by the company.
- Determined reserves for each claim based on estimated costs of settlement or defense.
- Negotiated and settled claims according to information presented through reports, research, and data verification.
- Ensured timely follow-up on all open matters; kept stakeholders informed regarding status updates.
- Communicated with personnel and legal counsel on claims involving litigation.
- Communicated with reinsurance brokers to obtain claim information for processing.
- Adhered strictly to departmental guidelines; ensured that all activities were compliant with applicable state laws.
- Participated in discussions about current cases during claim committee meetings to address issues. and issues in claim committee meetings.
- Prepared detailed reports on investigation findings and claim status for internal use.
- Delivered exceptional customer service to clients by communicating information and actively listening to concerns.
- Cultivated partnerships with attorneys and vendors to streamline claims processing and improve service delivery.
- Analyzed and audited open claims to calculate additional payments owed.
- Completed required investigations on referred files within established timeframes.
- Decreased loss ratios through fair and timely claim processing.
- Attended continuing education classes in order to stay abreast of changes in industry standards.
- Reduced loss ratios through fair and prompt processing of claims.
- Managed caseload effectively, prioritizing urgent or high-value claims for prompt attention.
- Drafted statement of loss to summarize damages, payments and underlying policy coverage.
- Investigated questionable claims to determine payment authorization.
- Researched relevant laws, regulations, legal decisions and precedents to determine appropriate course of action.
- Worked collaboratively with team members across multiple departments; identified areas where processes could be improved.
- Communicated with reinsurance brokers to obtain claim information for processing.
- Participated in discussions about current cases during claim committee meetings to address issues. and issues in claim committee meetings.
WC Claims Adjuster
Middlesex County Municipal Joint Insurance Fund
Old Bridge
06.2013 - 10.2025
- Maintained thorough knowledge of industry regulations and guidelines governing claims handling practices.
- Coordinated services with clients, nurse case managers, litigation attorneys, and excess carriers to expedite claims resolution and ensure timely outcomes.
- Coordinated treatment plans with Nurse Case Managers, reviewed medical documentation, and authorized necessary treatments to support prompt claimant reintegration into the workforce.
- Negotiated settlements with policyholders or claimants within approved authority limits and managed litigation of legal claim petitions to achieve full settlement and closure.
- Notified excess insurance carriers upon SIR met to ensure timely filing of paperwork and reimbursement for their portion of payment.
WC Claims Adjuster
York Insurance Company
Robbinsville
06.2012 - 06.2013
- Objective thorough knowledge of industry regulations and guidelines governing claims handling practices for the State of NJ.
- Handled timely phone calls from assigned Client Bed Bath & Beyond injured laborers, establishing WC Claim Accounts to facilitate medical care coordination with appropriate providers, including clinics and specialty services.
- Maintained clear records of daily and weekly medical or legal statuses for each open WC claimant.
- Presented quarterly updates to Client Board of Directors and colleagues regarding status of all assigned open cases via conference calls, ensuring stakeholders remained informed on claims progress.
WC Claims Adjuster
Middlesex County Municipal Joint Insurance Fund
Old Bridge
11.2009 - 06.2012
- Maintained thorough knowledge of industry regulations and guidelines governing claims handling practices of New Jersey.
- Coordinated services among clients, nurse case managers, litigation attorneys, and excess carriers to expedite claims resolution.
- Establish treatment care with Nurse Case Managers, oversee Doctor medical notes, review and authorize treatment to establish getting Claimants back to work in a timely fashion.
- Negotiated settlements with policyholders or claimants within approved authority limits and litigated legal claim petitions on behalf of clients for full settlement and closure.
- Notified excess insurance carriers upon SIR completion and filed necessary paperwork for reimbursement of payments.
Education
High School -
North Arlington High School
North Arlington, NJSkills
- Claims investigation
- Claims evaluation
- Coverage evaluation
- Settlement facilitation
- Litigation management
- Medical report analysis
- Claims administration
- Record maintenance
- Regulatory adherence
Timeline
Senior WC Claims Adjuster
Enlyte
03.2026 - Current
WC Claims Adjuster
Middlesex County Municipal Joint Insurance Fund
06.2013 - 10.2025
WC Claims Adjuster
York Insurance Company
06.2012 - 06.2013
WC Claims Adjuster
Middlesex County Municipal Joint Insurance Fund
11.2009 - 06.2012
High School -
North Arlington High School