Claudia Schiller

• Review and evaluate all incoming claims for coverage and/or liability.
• Secure necessary information for full investigation, when required.
• Review and analyze medical records for possible apportionment.
• Gather relevant information from clients, including employers.
• Analyze medical reports prepared by physicians evaluating injured workers' disability claims.
• Assist attorneys during hearings by providing needed documents or materials.
• Interact with clients via telephone and email to answer questions regarding case status and provide updates.
• Maintain electronic files for all pending cases in accordance with established procedures.
• Conduct research on applicable laws, regulations, judicial decisions and legal articles related to Workers' Compensation cases.
• Verify accuracy of wage calculations for disability payments.

As a senior claims examiner I handled high exposure claims from inception to settlement.

My responsibilities included:

• Investigation of coverage and compensability as well as subrogation possibilities.
• Set timely/accurate reserves to ensure reserving activities are consistent with the case facts and company best practices.
• Timely administer medical and indemnity benefits throughout the life of the claim.
• Comply with all applicable statutory guidelines, rules and regulations.
• Control legal activity with defense counsel through the litigation process while managing legal fees and costs.
• Evaluate claims for settlement and negotiation settlements.
• Provide customer service to clients and business partners.
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As a claims supervisor my responsibilities included:

• Continued to handle some catastrophic claims to conclusion.
• Provided guidance, assistance and training to new staff on the proper procedures.
• Maintain a diary to follow claim progress within the team unit. As well as provide guidance and feedback on plan of action.
• Managed a team of 8 claim representatives to ensure accuracy and timely completion of all claims processing activities.
• Report directly to claims manager the overall work product of the team unit.

• Manage the investigation, litigation, disposition and settlement of high exposure claims involving catastrophic injuries/deaths, complex coverage and compensability issues.
• Analyze and submit reserve recommendations to ensure that funds are adequate and in line with company standards and procedures.
• Identify subrogation and other recovery opportunities.
• Maintain a diary to follow claim progress on all claims.
• Provide timely and accurate claim payments.
• Negotiated settlements between applicants and or their counsel.
• Resolve customer inquiries in a timely manner regarding the status of their claims.
• Corresponded regularly with insureds, claimants, attorneys, physicians, employers and other parties involved in the claim process.

• Analyzed and processed worker's compensation claims to determine benefits due.
• Maintained a work diary to ensure all claims were continuously monitored.
• Determined timely and accurate compensability decisions within statutory requirements.
• Timely administered medical and indemnity benefits throughout the life of the claim.
• Prioritized early resolution opportunities, evaluate claim exposure and negotiate settlement.