Donia Robinson
Alpharetta,GA
Summary
Senior Claims Management Professional with over 20 years of experience in claims handling, negotiations, and customer service. Highly detail-oriented with exceptional leadership, organizational, and communication skills. Extensive experience in subrogation investigations and a deep understanding of insurance principles, laws, and procedures across multiple lines of business.
Overview
31
31
years of professional experience
1
1
Certification
Work History
Workers Compensation Claims Manager
Amtrust Insurance
06.2023 - 09.2024
- Receive initial notification of claims and guide employees on how to effectively manage the situation.
- Oversee the investigation of claims for cause and compensability.
- Actively track open claims, ensuring they are managed promptly and efficiently.
- Authorize settlements beyond Claims Examiner authority, ensuring all payments are made within the applicable timeframes.
- Analyze and compile monthly reports to monitor performance and claim trends.
- Respond to inquiries and complaints from customers, regulatory agencies, and other stakeholders in a timely and professional manner.
- Conduct monthly claim audits for each team member, providing constructive feedback for continuous improvement.
Senior Claims Examiner
Amtrust Insurance
04.2017 - 09.2024
- Manage a complex caseload of lost time claims, developing action plans to ensure compliance with regulations and industry best practices.
- Collaborate with clients, healthcare providers, and attorneys to facilitate claim resolution and reduce overall claim costs.
- Conduct thorough investigations for subrogation and second injury fund opportunities, optimizing financial recovery.
- Prepare defense strategies for workers' compensation hearings, working closely with legal teams to negotiate favorable settlements.
Litigation Consultant Specialist
Sedgwick CMS
04.2013 - 04.2017
- Dedicated Wal-Mart Account/ Winn Dixie Account
- Led the litigation process for a high-volume caseload of lost time claims, ensuring effective legal coordination and timely benefit administration.
- Developed tailored action plans for complex claims, focusing on minimizing litigation risks and streamlining claim resolution.
- Collaborated with legal counsel, clients, and medical professionals to manage claims and implement return-to-work programs.
- Prepared cases for workers’ compensation hearings, offering strategic guidance for defense and settlement negotiations.
Senior Workers Compensation Claim Specialist
AIG Insurance
01.1994 - 01.2013
- Managed a national portfolio of high-value lost time claims, driving claim resolution through coordination with employers, attorneys, and healthcare providers.
- Created and executed detailed action plans that adhered to regulatory guidelines and reduced overall claim liabilities.
- Investigated claims for subrogation and second injury fund potentials, leading to significant financial recoveries.
- Provided strategic support in workers' compensation hearings, ensuring well-prepared defense strategies and efficient settlement negotiations.
Education
Bachelor of Science Degree in Technical Management -
DeVry University
Alpharetta, GAAssociates Degree in Hospitality Management - undefined
Monroe College
New Rochelle, NY01.1994
Skills
- Claims Management Expertise
- Regulatory Compliance
- Litigation Management
- Subrogation and Financial Recovery
- Leadership and Team Management
- Communication and Negotiation
- Risk Management
- Client Relationship Management
- Problem-Solving and Decision Making
Certification
Licensed in eight states:
- Georgia
- Alabama
- Connecticut
- New Hampshire
- Rhode Island
- North Carolina
- West Virginia
- Arkansas
Accomplishments
- Nominated in 1994 edition of WHO’S WHO among students in American Junior Colleges
- Recipient of Monroe College President’s Honor list for superior Academic performance.
- Awarded the Employee of the month award on several occasion.
- Received individual recognition from senior management for proactive communication in connection with processing customer reviews and claims handling.
Timeline
Workers Compensation Claims Manager
Amtrust Insurance
06.2023 - 09.2024
Senior Claims Examiner
Amtrust Insurance
04.2017 - 09.2024
Litigation Consultant Specialist
Sedgwick CMS
04.2013 - 04.2017
Senior Workers Compensation Claim Specialist
AIG Insurance
01.1994 - 01.2013
Bachelor of Science Degree in Technical Management -
DeVry University
Associates Degree in Hospitality Management - undefined
Monroe College
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