Heather Taylor
Frisco
Summary
Experienced claims professional with strong track record in managing complex claims processes and ensuring accurate settlements. Skilled in policy interpretation, risk assessment, and dispute resolution. Known for fostering team collaboration and adapting to changing needs while maintaining results-focused approach. Valued for strong analytical abilities, customer-centric mindset, and effective communication skills.
Overview
11
11
years of professional experience
Work History
Workers Compensation Senior Claims Specialist
Corvel Corporation
01.2024 - Current
- Managed full-cycle workers’ compensation claims, including indemnity and medical, ensuring compliance with jurisdictional regulations and carrier best practices
- Determined compensability through detailed investigations, analyzing medical records, employment data, and incident reports to support accurate claim decisions
- Identified and pursued subrogation opportunities to maximize recovery and reduce claim costs
- Served as primary point of contact for claim stakeholders, including injured workers, employers, medical providers, and legal counsel, delivering clear and timely communication
- Trained and mentored entry-level claims adjusters, improving onboarding efficiency and adherence to claims handling standards
- Executed claims in alignment with best practice guidelines and client-specific handling instructions, maintaining high-quality file management and documentation
- Prepared and presented comprehensive claim review reports to internal teams and clients, highlighting exposure, strategy, and resolution pathways
- Drafted professional correspondence, including coverage letters, status updates, and settlement documentation
- Negotiated settlements and prepared stipulations, balancing cost containment with fair claim resolution
- Completed and submitted all required state forms (including WC-1, WC-3, WC-77) in accordance with Hawaii regulatory requirements
- Reviewed and audited medical billing for accuracy and appropriateness prior to submission for payment processing
Senior Workers Compensation Adjuster- California claims
Sedgwick/Wal-Mart and Sam’s Club dedicated account
05.2023 - 01.2024
- Managed indemnity and medical claims across HI and CA, ensuring compliance and timely resolution
- Conducted compensability investigations and identified subrogation opportunities to reduce claim costs
- Served as primary contact for claimants, employers, providers, and attorneys, delivering clear and timely communication
- Executed claims in alignment with best practices and client-specific handling guidelines
- Prepared claim review reports and presented findings with strategic recommendations
- Negotiated settlements and prepared stipulations
- Completed and submitted required state forms (WC-1, WC-3, WC-77) in compliance with Hawaii regulations
- Reviewed medical bills for accuracy prior to bill review and payment
Senior Workers Compensation Adjuster
Gallagher Bassett- Sompo International dedicated account
01.2022 - 05.2023
- Managed indemnity and medical claims across HI and CA, ensuring compliance and efficient resolution
- Conducted compensability investigations and identified subrogation opportunities
- Acted as primary contact for claimants, clients, providers, and attorneys
- Executed claims in line with best practices and client-specific guidelines
- Prepared and presented claim reviews with clear reporting
- Negotiated settlements and drafted stipulations and correspondence
- Completed and submitted required state forms (WC-1, WC-3, WC-77) in compliance with Hawaii regulations
- Reviewed medical bills for accuracy prior to payment processing
- Review medical bills for submittal to bill review for payment
Senior Workers Compensation Adjuster
Sedgwick/Wal-Mart and Sam’s Club dedicated account
12.2020 - 01.2022
- Licensed in the State of Hawaii
- Investigate workers’ compensation compensability- for HI indemnity and medical claims for all 13 stores in the State
- Review claims for subrogation recovery potential
- Handle incoming claims calls (i.e. bill providers, claimant questions, claim status, client questions, attorneys)
- Execute the claims per the best practice guidelines and special handling instructions
- Prepare reports and present on legal reviews
- Fill out State of Hawaii workers’ compensation forms as related to the claim and submit to the state (i.e. WC1, WC77, WC3)
- Prepare pertinent cover letters
- Negotiate/prepare settlement stipulations
- Review medical bills for submittal to bill review for payment
Workers Compensation Adjuster
John Mullen
05.2020 - 12.2020
- Licensed in the State of Hawaii
- Investigate workers’ compensation compensability- for HI indemnity and medical claims
- Review claims for subrogation recovery potential
- Handle incoming claims calls (i.e. bill providers, claimant questions, claim status, client questions, attorneys)
- Execute the claims per the best practice guidelines and special handling instructions
- Fill out State of Hawaii workers’ compensation forms as related to the claim and submit to the state (i.e. WC1, WC77, WC3)
- Prepare reports and present on claim reviews
- Prepare pertinent cover letters
- Negotiate/prepare settlement stipulations
- Review medical bills for submittal to bill review for payment
Workers Compensation Adjuster
Proservice
07.2018 - 04.2020
- Licensed in the State of Hawaii
- Investigate workers’ compensation compensability- for HI indemnity and medical claims
- Prepare reinsurance reports
- Review claims for subrogation recovery potential
- Handle incoming claims calls (i.e. bill providers, claimant questions, claim status, client questions, attorneys)
- Execute the claims per the best practice guidelines and special handling instructions
- Fill out State of Hawaii workers’ compensation forms as related to the claim and submit to the state (i.e. WC1, WC77, WC3)
- Prepare pertinent cover letters
- Prepare settlement stipulations
- Review medical bills for submittal to bill review for payment
- Assist with the training of incoming workers’ compensation adjusters
Workers Compensation Adjuster
First Insurance- FIRMS (TPA)
02.2017 - 07.2018
- Licensed in the State of Hawaii
- Investigate workers’ compensation compensability- for HI indemnity and medical claims for Zurich Insurance
- Lead adjuster on insured accounts
- Review claims for subrogation recovery potential
- Handle incoming claims calls (i.e. bill providers, claimant questions, claim status, client questions, attorneys)
- Execute the claims per the best practice guidelines and special handling instructions for each individual client
- Prepare reports and present on claim reviews
- Reconcile and pay accounts payable as related to the claim
- Schedule Independent Medical Examination appointments
- Fill out State of Hawaii workers’ compensation forms as related to the claim and submit to the state (i.e. WC1, WC77, WC3)
- Print out and prep medical reports/documents to send to independent medical evaluation physician and attorneys along with pertinent cover letters
- Subpoena records
- Prepare settlement stipulations
- Review medical bills for submittal to bill review for payment
Unemployment Specialist
Altres- Honolulu, HI
Honolulu, HI
12.2016 - 02.2017
- Investigate submitted unemployment claims
- Complete and monitor state unemployment forms including BP35 request for separation information, B52 request for low earnings report, UCBP348 Verification of partial Unemployment status and L1PCR21R Monetary determination of Unemployment benefits
- Respond to request for separation information calls and inquiries from State claims examiners and conduct investigations with clients to determine reason for separation and submit reports to examiners
- Prepare clients and act as employer representative during appeal hearings with the Department of Labor and Industrial Relations Employment Security Appeal Referees Office. Appeal hearing duties include: preparation of Clients for witness testimony, submission of documentation and exhibits to hearing case file, presentation of employer’s case, questioning of employer’s witness and cross examination and questioning of claimant
Workers’ Compensation Claims Coordinator
ProService Hawaii – Honolulu, HI
Honolulu, HI
07.2015 - 12.2016
- Completed and monitored state unemployment forms including BP35 request for separation information, B52 request for low earnings report, UCBP348 Verification of partial Unemployment status and L1PCR21R Monetary determination of Unemployment benefits
- Investigate submitted unemployment claims
- Prepare clients and act as employer representative during appeal hearings with the Department of Labor and Industrial Relations Employment Security Appeal Referees Office. Appeal hearing duties include: preparation of Clients for witness testimony, submission of documentation and exhibits to hearing case file, presentation of employer’s case, questioning of employer’s witness and cross examination and questioning of claimant
- Responded to request for separation information calls and inquiries from State claims examiners and conducted investigations with clients to determine reason for separation and submit reports to examiners
- Maintain State unemployment website for ProService Hawaii entities under different Department of labor account numbers to maintain weekly reports of earnings
- Assist claims adjusters with claims correspondence and other duties deemed necessary
- Handle incoming claims calls (i.e. bill providers, claimant questions, claim status, client questions)
- Reconcile and pay accounts payable as related to the claim
- Schedule Independent Medical Examination appointments
- Familiar with WC5, WC77, WC1, WC3, WC4 forms and which actions need to be taken
- Print out and prep medical reports/documents to send to independent medical evaluation physician, Department of Labor, medical management nurse, attorneys and rehabilitation counselor
- Subpoena records
- Negotiated final settlements with claimants
- Assisted the Director of Claims with their caseload (i.e. talked to claimants, clients and DCD)
- Worked in Origami and Navrisk software programs
- Assists with intake for new workers’ compensation claims as needed
- Coordinates post-accident drug testing as needed
- Completed three point initial contact with claimant, client and medical provider
- Run ISO (Insurance Services Office) reports
Skills
- Claims management expertise
- Insurance policy sales
- Legal compliance
- Policy interpretation
Timeline
Workers Compensation Senior Claims Specialist
Corvel Corporation
01.2024 - Current
Senior Workers Compensation Adjuster- California claims
Sedgwick/Wal-Mart and Sam’s Club dedicated account
05.2023 - 01.2024
Senior Workers Compensation Adjuster
Gallagher Bassett- Sompo International dedicated account
01.2022 - 05.2023
Senior Workers Compensation Adjuster
Sedgwick/Wal-Mart and Sam’s Club dedicated account
12.2020 - 01.2022
Workers Compensation Adjuster
John Mullen
05.2020 - 12.2020
Workers Compensation Adjuster
Proservice
07.2018 - 04.2020
Workers Compensation Adjuster
First Insurance- FIRMS (TPA)
02.2017 - 07.2018
Unemployment Specialist
Altres- Honolulu, HI
12.2016 - 02.2017
Workers’ Compensation Claims Coordinator
ProService Hawaii – Honolulu, HI
07.2015 - 12.2016
Additional work experience
- Management/Supervisor
- Sales
- Real Estate Appraiser