Gerard Lunanuova
Pittsburgh,Pennsylvania
Summary
Claims professional with 5+ years of experience managing complex workers’ compensation and insurance claims, now leading a team supporting a high-demand Fortune 500 client. Proven track record of exceeding audit standards, optimizing claim outcomes, and driving team performance across key metrics. Strong analytical background with expertise in liability evaluation, reserve management, and cross-functional collaboration. Recognized for delivering consistent, high-quality results in fast-paced, client-driven environments.
Overview
9
9
years of professional experience
Work History
Workers Compensation Team Lead
Sedgwick CMS
Pittsburgh, PA
03.2025 - Current
- Lead, coach, and develop a team of 4 claims adjusters supporting a dedicated, high-demand Fortune 500 client account (United Airlines), driving performance across audit quality, closing ratios, and customer satisfaction
- Oversee claim strategy and reserve decisions across the team’s caseload, ensuring accurate liability assessment and effective cost containment
- Monitor and manage team performance against key KPIs, including audit scores, timeliness, and claim outcomes; implement targeted coaching to address gaps and elevate results
- Serve as primary escalation point for complex and high-exposure claims, partnering directly with client stakeholders and defense counsel to drive resolution
- Conduct semi-annual performance reviews and provide ongoing mentorship to support adjuster development and progression
- Participate in hiring processes, including candidate interviews and selection decisions, contributing to team growth and talent quality
- Collaborate with senior leadership to reinforce best practices and improve workflows within a fast-paced, client-driven environment
Workers Compensation Claims Adjuster
Sedgwick CMS
Pittsburgh, PA
03.2022 - 03.2025
- Managed a high-volume caseload of approximately 125 workers’ compensation claims across four jurisdictions (NJ, PA, VA, MA)
- Selected to handle all four jurisdictions concurrently—unique among team members—reflecting strong performance, trust, and ability to navigate varied regulatory environments
- Analyzed liability, exposure, and compensability to drive timely and cost-effective claim resolutions
- Established and adjusted claim reserves to ensure accurate financial forecasting and alignment with claim exposure
- Served as primary point of contact for claimants, defense counsel, and clients, maintaining clear and consistent communication throughout the claim lifecycle
- Evaluated and authorized benefit payments in compliance with jurisdictional requirements and internal guidelines
- Consistently achieved audit scores exceeding 90%, outperforming the 80% benchmark and demonstrating strong adherence to quality and compliance standards
Associate, Group Claims Operations |
New York Life Insurance Co
Pittsburgh, PA
05.2019 - 02.2022
- Analyzed and adjudicated Group Accidental Death & Dismemberment claims, ensuring accurate and timely benefit determinations
- Synthesized complex claim documentation and investigative findings to support decision-making in technically involved cases
- Managed a high-volume workload while consistently meeting strict deadlines and service level expectations
- Collaborated with internal teams to ensure efficient claim processing and adherence to company policies
Forensic Scientist
Texas Department Of Public Safety
Garland, TX
06.2017 - 04.2019
- Conducted forensic biology analyses on evidentiary items, ensuring accuracy and adherence to strict laboratory protocols
- Maintained chain of custody documentation for all evidence, ensuring integrity and legal defensibility
- Partnered with Lean Six Sigma teams to streamline laboratory workflows, improving turnaround time for Sexual Assault Kit analysis
- Produced detailed forensic reports summarizing findings and supporting investigative and legal processes
- Collaborated with state and local law enforcement agencies on active investigations
- Testified as an expert witness, presenting scientific findings clearly and credibly in legal proceedings
Education
Master of Science - Forensic Science And Law
Duquesne University
Pittsburgh05-2017
Bachelor of Science - Biology
Duquesne University
Pittsburgh, PA05-2016
Skills
- Claims & Systems: JURIS, SIR, SRO, Workbench
- Technical Tools: Microsoft Excel, PowerPoint, Adobe Acrobat
- Other: Google Workspace
- Customer relations
- Attention to detail
- Coaching and mentoring
- Performance monitoring and improvement
Timeline
Workers Compensation Team Lead
Sedgwick CMS
03.2025 - Current
Workers Compensation Claims Adjuster
Sedgwick CMS
03.2022 - 03.2025
Associate, Group Claims Operations |
New York Life Insurance Co
05.2019 - 02.2022
Forensic Scientist
Texas Department Of Public Safety
06.2017 - 04.2019
Master of Science - Forensic Science And Law
Duquesne University
Bachelor of Science - Biology
Duquesne University