Erica Garcia
Ontario,CA
Summary
Workers’ Compensation Claims Professional with 9 years of experience managing Future Medical and Medical Only claims. Demonstrated expertise in claim investigation, reserve management, benefits administration, and regulatory compliance. Experienced in collaborating with municipalities, excess carriers, defense counsel, and medical providers to ensure timely, strategic, and cost effective claim resolution. Recognized for strong negotiation skills, sound judgment, attention to detail, and the ability to successfully manage high volume caseloads in fast paced environments.
Overview
11
11
years of professional experience
Work History
Workers’ Compensation Claims Examiner
Sedgwick
Ontario, CA
10.2021 - Current
- Manage full lifecycle of Future Medical claims
- Establish and adjust reserves based on exposure evaluation and cost projections, monitor reserves as claim values increase or decrease.
- Monitor 180 day diaries to ensure timely claim review and statutory compliance.
- Review and monitor all medical bills, addressing payments and disputes in accordance with California state statutes.
- Review and process claimant mileage reimbursement requests in compliance with regulations.
- Handle complex claim situations and implement strategic resolutions.
- Manage and address liens in accordance with statutory requirements.
- Calculate and issue indemnity benefits in compliance with California Labor Code, such as the Cost of living adjustment each year for PTD and Life Pension benefits.
- Coordinate medical treatment and communicate with physicians, attorneys, and employers.
- Prepare and issue legally required notices to maintain regulatory compliance.
- Provide timely reporting to excess carriers including Safety National and PRISM.
Workers’ Compensation Claims Examiner
AdminSure
Ontario, CA
10.2017 - 10.2021
- Administered Future Medical and Medical Only claims for public entity clients.
- Conducted compensability investigations and exposure analysis.
- Set, monitored, and adjusted claim reserves.
- Processed indemnity payments and ensured statutory compliance.
- Maintained communication with injured workers, employers, and medical providers.
- Prepared documentation and provided excess carrier reporting.
Office Administrator
McBride’s RV Storage
Chino, CA
02.2015 - 10.2017
- Managed billing, collections, and financial reporting.
- Maintained customer records and handled client communications.
- Resolved customer concerns promptly to ensure satisfaction.
- Oversaw inventory processes including purchasing and supply management.
Education
Bachelor of Science - Business Management
University of Phoenix
12.2025
Undergraduate Certificate - Human Resource Management
University of Phoenix
08.2023
Certificate - undefined
Department of Industrial Relations – Office of Self-Insurance Plans
08.2023
Skills
- Workers’ Compensation Claims Management
- Future Medical & Medical-Only Claims
- SAWW COLA Benefits Administration
- Reserve Analysis & Monitoring
- California Labor Code Compliance
- Lien Management
- Medical Bill Review & Mileage Reimbursement Processing
- Excess Carrier Reporting
- Microsoft Office (Word, Excel, Outlook, Teams)
- IVOS Claims Management System
Timeline
Workers’ Compensation Claims Examiner
Sedgwick
10.2021 - Current
Workers’ Compensation Claims Examiner
AdminSure
10.2017 - 10.2021
Office Administrator
McBride’s RV Storage
02.2015 - 10.2017
Bachelor of Science - Business Management
University of Phoenix
Undergraduate Certificate - Human Resource Management
University of Phoenix
Certificate - undefined
Department of Industrial Relations – Office of Self-Insurance Plans