Daphyne Pugh Daniels
Summary
Pursue a position that will allow me to utilize my experience, education, and skills to make a notable contribution to the organization. Seeking to obtain a full-time position that offers professional challenges utilizing my strong interpersonal skills, excellent time management, and problem-solving skills. Highly organized and efficient in a fast-paced environment, and an effective communicator at all organizational levels. Thinks critically, solves problems, and delivers excellent customer service.
Overview
31
31
years of professional experience
Work History
Claims Manager
PMA Insurance Company
10.2019 - Current
- Leader for the southeast region's workers' compensation claims team of 4 supervisors and 21 claim professionals handling and overseeing WC claims for FL, GA, AL, MS, TN, KY, VA, NC, and SC
- Facilitate accountability for the entire staff to exceed expectations by fostering clear communication for the efficient execution of goals.
- Established performance goals for employees and provided feedback on methods for reaching those milestones.
- Monitored metrics and developed actionable insights to improve efficiency and performance.
Claim Service Manager
PMA Insurance Company
09.2017 - 10.2019
- Served as the liaison between our clients, distribution partners, claims, and managed care to ensure we deliver the service that we promise
- Took ownership of customer issues and followed problems through to resolution.
- Developed and maintained positive relationships with customers to build rapport and trust.
- Maintained positive customer relations by addressing problems head-on and implementing successful corrective actions.
Senior Quality Assurance Specialist
PMA Management Corporation
03.2011 - 09.2017
- Provided assistance to the Florida, Georgia, Carolinas, and Nashville offices by performing annual office audits, new employee audits, and new account audits
- Developed target training based on the results of the audits, and created any training necessary identified through individual audits
- Monitored and reviewed excess claims
- Completed any special assignments requested timely, and continue to be an accessible resource as an extension of the regional claims teams in the territory to ensure success.
- Analyzed quality and performance data to support operational decision-making.
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
Regional Claim Supervisor
PMA Management Corporation
03.2008 - 03.2011
- Supervised 4 lost time adjusters, 3 medical only adjusters, 1 claims assistant, and 1 EDI specialist
- Provided guidance and recommendations to the adjusters to ensure appropriate file handling, as well as result in outstanding customer service with retention of clients
- Provided a teamwork approach to claim handling that assured success of the Florida team.
- Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows.
- Handled customer complaints, resolved issues, and adjusted policies to meet changing needs.
Workers Compensation Unit Manager
AIG Claims Management Services
01.2006 - 03.2008
- Maintained a claim count of 30 lost time files and handled them to conclusion
- Supervised the Gevity PEO unit which consisted of 6 lost time adjusters, and 2 claim assistants; reviewed all lost time claims and ensured that payments are issued timely
- Also ensured all claims were handled appropriately for the best resolution; resolved customer service issues; maintained open communication with the Gevity account to ensure retention and account service satisfaction.
Workers Compensation Disability Specialist II
AIG Clams Management Services
12.2002 - 01.2006
- Handled worker's compensation claims for AIG insureds/self-insureds where the injured worker was losing time from work by providing ultimate customer service to both the employer and employee
- Reviewed new files to determine current status of injury claim and to develop plan of action.
- Provided information to the injured worker about the entitlement of benefits due from the claim, provided benefits due to the injured worker timely, evaluated and managed the cost of the claim
- Ensured the best probable financial outcome for the claim.
Workers Compensation Claim Representative
Hartford Insurance Company
11.1999 - 12.2002
- Handled worker's compensation claims for Hartford Insureds by providing ultimate customer service
- Provided information about worker's compensation, monitor claim, and made sure appropriate medical treatment was being administered to injured worker
- Investigated, evaluated, and managed the cost of the claims within 3 states, as well as facilitated expedient appropriate return to work of the injured worker.
Merchandising Manager/Senior Merchandising Manager
JCPenney Company
11.1992 - 11.1999
- Responsible for generating $3.2 million in the home and kids' apparel lines, staffing in those areas, and performed the human resource duties required in the hiring process
- Accountable for opening store, safes, and maintaining entire store operations
- Acted as store manager in charge to ensure customers received premium service and enjoyed their shopping experience.
- Established monthly goals and communicated performance expectations during team meetings to optimize sales.
- Monitored stock levels and product sales to determine purchasing needs.
Education
Completed the Florida Worker's Compensation Board Certification Program – CWC & CWCL Designations -
11.2008
All Lines Claims Adjuster, ACA -
04.2003
WC Licensed Adjuster -
02.2000
B. S. degree in Food and Resource Economics -
University of Florida
Gainesville, FL05.1992
Skills
- Quality Assurance
- Claims Auditing
- Team Motivation
- Procedure Implementation
- Active Listening
- Team Collaboration
- Critical Thinking
- MS Office
- Team Leadership
- Coaching and Mentoring
Timeline
Claims Manager
PMA Insurance Company
10.2019 - Current
Claim Service Manager
PMA Insurance Company
09.2017 - 10.2019
Senior Quality Assurance Specialist
PMA Management Corporation
03.2011 - 09.2017
Regional Claim Supervisor
PMA Management Corporation
03.2008 - 03.2011
Workers Compensation Unit Manager
AIG Claims Management Services
01.2006 - 03.2008
Workers Compensation Disability Specialist II
AIG Clams Management Services
12.2002 - 01.2006
Workers Compensation Claim Representative
Hartford Insurance Company
11.1999 - 12.2002
Merchandising Manager/Senior Merchandising Manager
JCPenney Company
11.1992 - 11.1999
Completed the Florida Worker's Compensation Board Certification Program – CWC & CWCL Designations -
All Lines Claims Adjuster, ACA -
WC Licensed Adjuster -
B. S. degree in Food and Resource Economics -
University of Florida
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