Denise Donovan
Rogers,AR
Summary
Workers compensation professional with 28 years of experience managing moderate to medically complex injury claims, facilitating prompt return to work for employers and employees. Skilled in building relationships, handling complex litigation, and achieving results. Expertise in litigation management, negotiation, and thorough knowledge of legal principles. Proven track record of efficiently managing case preparation processes while reducing costs through process improvements.
Overview
32
32
years of professional experience
1
1
Certification
Work History
Litigation Manager
Walmart, Inc (WCS)
Bentonville, AR
08.2022 - Current
- Handled statewide litigation, coordinating efforts across multiple retail centers.
- Dedicated manager to 3 distribution centers in MO.
- Support locations with injured associates' return to work in our Temporary Alternative Duty Program.
- Specialized in resolving complex claims involving medical and litigation factors.
- Developed streamlined processes to optimize teamwork.
- Mentored new adjusters for professional growth and enhanced their skillset to include best practices when handling difficult cases or challenging circumstances.
- Conducted research on applicable laws, regulations, and precedents for use in cases.
- Prepared written summaries of cases for senior management review.
- Analyzed case information to identify potential risks or opportunities.
- Negotiated settlements with opposing counsel when appropriate.
- Managed the litigation process from filing to resolution, including all pleadings and discovery.
- Attended meetings with clients regarding current litigation matters.
- Tracked status of cases using software systems.
- Provided guidance on ethical considerations related to proposed courses of action.
- Monitored changes in local, state, and federal legislation that could affect pending or future litigation matters.
- Attend hearings and mediations, as well as coordinated mediation days, to bring resolution to our claim files, to reduce our pending, and/or to resolve pending litigated issues.
- Participated in internal training sessions designed to improve knowledge about applicable laws and procedures.
Senior Claims Adjuster, Workers Compensation Claims
EMC Insurance Company
Des Moines, IA
06.2019 - 07.2022
- Managed claims for large national clients across multiple states, including IA, IL, KY, KS, MN, MO, NE, and SD.
- Assessed compensability and set case reserves.
- Collaborated with defense counsel to craft tailored litigation plans for each jurisdiction.
- Negotiated settlements with claimants in order to achieve a fair resolution of claims.
- Reviewed medical records, police reports and other documents related to the claims file.
- Provided technical expertise in interpreting laws, regulations and court decisions pertaining to claims settlement activities.
- Prepared detailed reports outlining findings of investigation for review by management team members.
- Resolved discrepancies between insureds' expectations of coverage versus actual coverage under applicable state statute.
- Participated in mediations as necessary to ensure equitable outcomes for all parties involved.
- Maintained communication with clients throughout the life cycle of their claim regarding status updates and resolution options.
- Advised colleagues regarding best practices when handling difficult cases or challenging circumstances.
- Investigated complex property and casualty claims to determine appropriate coverage, liability and damages.
- Analyzed policy provisions, endorsements, exclusions and conditions to determine claim validity.
Senior Claims Adjuster, Workers Compensation Claims
Sedgwick CMS
Columbus, OH
01.2019 - 12.2019
- Dedicated adjuster managed claims for large national client in Kentucky and Alabama locations.
- Coordinated efforts with Leave Supervisor and Manager to determine appropriate reserves.
- Collaborated with a telephonic case manager to oversee the claim's medical component.
- Develop litigation strategies, ensuring resolution, while managing claim expenses.
- Negotiated settlements with claimants in order to achieve a fair resolution of claims.
Senior Claims Adjuster, Workers Compensation Claims
Travelers
Indianapolis, IN
01.2014 - 12.2014
- Establish case reserves suitable to the exposure, report on claims to senior management, agents, insureds, and loss control.
- Reviewed medical records, police reports and other documents related to the claims file.
- Participated in mediations as necessary to ensure equitable outcomes for all parties involved.
- Maintained communication with clients throughout the life cycle of their claim regarding status updates and resolution options.
- Strategized litigation approaches optimizing both case outcomes and cost-control measures
- Negotiated settlements with pro se claimants to achieve fair resolutions.
Senior Claims Adjuster, Workers Compensation
FCCI INSURANCE
Sarasota, FL
01.2011 - 12.2014
- Performed field inquiries to collect accident information from involved parties. Identified potential for subrogation recovery through comprehensive accident assessments.
- Set appropriate case reserves matching exposure levels.
- Collaborated with defense counsel to devise effective litigation strategies.
- Managed intricate legal cases in South Florida
- Facilitated settlement days for litigated claims resolution.
- Coordinated with legal teams to design effective defense strategies for policyholders.
- Reserved claims to ultimate net loss within 45 days with minimal development.
- Worked with other adjusters to identify and mediate their cases, ripe for settlement.
- Mediated cases for all adjusters in South Florida.
- Maintained impeccable standards for EDI submissions.
- Increased efficiency of In-Network and PPO usage by 15%.
- Outperformed benchmarks set for corporate claim assessments.
- Designed new procedures to manage Texas claims efficiently.
- Elevated the rate of settlements, outperforming past results by 30%.
Senior Claims Adjuster, Workers Compensation
Gallagher Bassett Services Inc.
Orlando & Miami Dade, FL
01.2007 - 12.2010
- Oversaw resolution of multiple client lost-time cases.
- Prepared 90-day reports detailing the current status of open claims.
- Reported carrier details as per client's Special Handling Instructions.
- Collaborated extensively with Miami-Dade County Public Schools between 2008 and 2010.
- Instituted guidelines to streamline litigation efforts within claim operations.
- Ensured uniformity and adherence in communications to outside counsel.
- Devised in-house protocols, enhancing support staff efficiency.
- Established tracking systems for managing doctor appointment schedules, physical therapy sessions, MRI scans, and transportation arrangements.
- Adjusted all catastrophic claims.
Claims Consultant
IOA – INSURANCE OFFICE OF AMERICA
Lake Mary, FL
01.2006 - 12.2007
- Delivered exceptional service to an array of clients and IOA agents.
- Served as an intermediary for the Risk Manager and the insurance carrier.
- Attended claim reviews with client and carrier to ensure mutually agreed outcomes.
- Marketed services to prospective clients through collaboration with agents.
- Performed thorough research on complex claims by interviewing involved parties, with clients.
- Formulated effective plans for addressing disputes involving insureds and external entities.
- Developed strategies for resolving disputes between insureds and third parties in a timely manner.
- Prepared reports summarizing investigations and outlining recommendations for resolution of claims.
- Provided guidance to customers regarding their coverage options and procedures for filing a claim.
- Resolved customer inquiries promptly while ensuring compliance with applicable laws and regulations governing the insurance industry.
Senior Claims Adjuster
GUARANTEE INSURANCE COMPANY
Lake Mary, FL
01.2005 - 12.2006
- Managed lost-time indemnity claims for diverse clients with unique handling requirements.
- Managed indemnity payment disbursements.
- Investigated complex WC claims to determine compensability within FL WC statute.
- Achieved equitable claim outcomes through effective settlement negotiations
- Provided technical expertise in interpreting laws, regulations and court decisions pertaining to claims settlement activities.
- Prepared detailed reports outlining findings of investigation for review by senior management team members..
- Resolved discrepancies between insureds' expectations of coverage versus actual coverage provided under policies and FL WC state statute.
- Participated in mediations and arbitrations as necessary in order to ensure equitable outcomes for all parties involved.
- Developed strategies for expediting the processing of large volumes of claims while maintaining quality standards.
- Maintained communication with clients throughout the life cycle of their claim regarding status updates and resolution options.
Senior Claims Adjuster
BLUE CROSS BLUE SHIELD
Lake Mary, FL
01.2000 - 12.2005
- Investigated claims across Wal-Mart, Sam's Club, and Neighborhood Markets in Orlando.
- Collaborated with location and home office management for claim resolution.
- Attended live mediations, depositions, and hearings.
- Educated colleagues regarding best practices when handling difficult cases or challenging circumstances.
- Promoted to Claim Supervisor, which involved supervision of 4 employees.
- Responsible for developing training and onboarding for all new employees, and assisting management with daily operations.
Senior Claims Adjuster, Workers Compensation
Travelers
Orlando, FL
01.1997 - 12.1999
- Investigated complex WC claims to determine appropriate coverage and compensability.
- Provided technical expertise in interpreting laws, regulations and court decisions pertaining to claims settlement activities.
- Monitored trends in the legal arena that may affect the disposition of the claim and resolution.
- Advised colleagues regarding best practices when handling difficult cases or challenging circumstances.
- Prepared detailed reports outlining findings of investigation for review by management team members.
- Participated in mediations, depositions, and testified at trials as necessary.
- Developed strategies for expediting the processing of large volumes of claims while maintaining quality standards.
- Maintained communication with clients throughout the life cycle of their claim regarding status updates and resolution options.
- Negotiated settlements with pro se claimants in order to achieve a fair resolution of claims.
Senior Claims Adjuster
CRIMS/PCA Solutions
Orlando, FL
01.1993 - 12.1997
- Applied knowledge of WC statute in order to determine compensability and evaluate financial exposure related to each claim.
- Participated in mediations as necessary in order to ensure equitable outcomes for all parties involved.
- Developed strategies for expediting the processing of large volumes of claims while maintaining quality standards.
- Maintained communication with clients throughout the life cycle of their claim regarding status updates and resolution options.
- Drafted correspondence including letters, memos, emails and other documents related to the claims process.
- Attended continuing education classes and seminars related to professional development.
- Handled and processed variety of claims.
- Spoke to witnesses and claimants and interviewed for pertinent information.
Skills
- Mediation and Negotiation Proficiency
- Negotiation Expertise
- Strategic Thought Process
- Complex litigation experience
- Analytical Decision-Making
- Extreme Ownership
- Flexible Problem-Solving
- Effective Relationship Management
- Legal Hearings Expertise
- Effective Team Engagement
- Guiding Team Growth
Certification
- Board Certified Workers’ Compensation
- Accredited Claims Adjuster
- CWCL Designation
Timeline
Litigation Manager
Walmart, Inc (WCS)
08.2022 - Current
Senior Claims Adjuster, Workers Compensation Claims
EMC Insurance Company
06.2019 - 07.2022
Senior Claims Adjuster, Workers Compensation Claims
Sedgwick CMS
01.2019 - 12.2019
Senior Claims Adjuster, Workers Compensation Claims
Travelers
01.2014 - 12.2014
Senior Claims Adjuster, Workers Compensation
FCCI INSURANCE
01.2011 - 12.2014
Senior Claims Adjuster, Workers Compensation
Gallagher Bassett Services Inc.
01.2007 - 12.2010
Claims Consultant
IOA – INSURANCE OFFICE OF AMERICA
01.2006 - 12.2007
Senior Claims Adjuster
GUARANTEE INSURANCE COMPANY
01.2005 - 12.2006
Senior Claims Adjuster
BLUE CROSS BLUE SHIELD
01.2000 - 12.2005
Senior Claims Adjuster, Workers Compensation
Travelers
01.1997 - 12.1999
Senior Claims Adjuster
CRIMS/PCA Solutions
01.1993 - 12.1997
- Board Certified Workers’ Compensation
- Accredited Claims Adjuster
- CWCL Designation
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