Summary
Overview
Work History
Education
Skills
References
Timeline
Generic

Ilonna Merchant

Claims Adjuster
Lithonia,Ga

Summary

Motivated Senior Claims Adjuster committed to diligently investigating, evaluating and negotiating workers compensation claims for policyholders. Adept at training and supporting new adjusters. Trained and knowledgeable in all state, federal and local laws. Skilled in recognizing potential fraudulent claims.

Overview

27
27
years of professional experience

Work History

Senior Claims Adjuster

MCIM Insurance company
02.2022 - 06.2024
  • Responsible for handling claims from beginning to end; responsible for 24 hour/3 point contact on all claims and investigating thoroughly; responsible for determining compensability; pay diary, file state forms, EDI filings, calculate average weekly wage, compensation rate/total partial disability/permanent partial disability; negotiate settlements with chosen counsel; prepare information for claim reviews, complete status reports, complete reinsurance reports and present to clients
  • Jurisdiction: IN, IL GA

Senior Claims Adjuster

Next Level Administrators
10.2016 - 02.2022
  • Responsible for handling claims from beginning to end; responsible for 24 hour/3 point contact on all claims and investigating thoroughly; responsible for determining compensability; pay diary, file state form; calculate average weekly wage/compensation rate/total partial disability/permanent partial disability; negotiate settlements with chosen counsel; prepare information for claim reviews, complete all status reports; prepare large case reviews and present them to clients
  • Jurisdictions: GA, PA

Out of State Sr. Claims Manager

FFVA Mutual
10.2014 - 10.2016
  • Work closely with loss control and underwriter; attend marketing/pre-inspection visits; complete presentations with employers and agents to confirm claims concepts are understood and followed; coordinate and execute investigation, disposition and settlement of complex litigated and non-litigated claims from receipt to conclusion with little supervision; evaluate claims and suits through contact with insureds, claimants, witnesses and experts; set reserves and authorize payment and negotiate settlements within authority limit; oversee legal defense and medical management; work with attorneys, account representatives, agents, doctors and insureds; oversee 4 Ga adjusters living in Fl; participate in customer service calls and court appearances; provide superior customer service and claim handling, travel as needed
  • Jurisdiction: GA

Senior Claims Professional

KeyRisk Management
09.2008 - 10.2014
  • Responsible for handling claims from beginning to end; responsible for 8 hour/3 point contact on all claims and investigating thoroughly; responsible for determining compensability; pay diary, file state form; calculate average weekly wage/compensation rate/total partial disability/permanent partial disability; set up independent medical exams; negotiate settlements with chosen counsel; prepare information for claim reviews, complete all status reports; prepare large case reviews and present them to upper management as well as clients in-person, claims 101 presentations for very big clients
  • Jurisdictions: TN, Al, GA (majority GA and AL)

Senior Case Claims Manager

Wausau Insurance
08.2004 - 09.2008
  • Responsible for being the Team Lead for a team of 7 adjusters; responsible for being the Team Manager back up; responsible for completing quality control diaries on team members claims to ensure best practices were met and to ensure the state laws were followed; responsible for assigning all claims to the team members within the allocated jurisdictions and providing direction on how to handle; responsible for leading team meetings to confirm team metrics were met; responsible for completing settlement evaluations and approve settlement authorization for all team members; responsible for completing all financial notes and confirming all claims are reserved properly; responsible for preparing large loss reports to accounts as well as managers; responsible for attending settlement mediations and trials; responsible for a case load of 100 files as a Case Manager
  • Jurisdictions: Al, GA, VA

Sr. Claims Representative Specialist II

AIG Claims Service
02.2002 - 08.2004
  • Responsible for handling claims from beginning to end; responsible for 24 hour/3 point contact on all claims and investigating thoroughly; responsible for determining compensability; pay diary, file state form; calculate average weekly wage/compensation rate/total partial disability/permanent partial disability; set up independent medical exams; negotiate settlements with panel counsel; determine subrogation potential and pursue; prepare and present information for claim reviews
  • Jurisdictions: MA, VT, ME, CT, RI, NH

Associate Claims Specialist

R&SA
08.1997 - 02.2002
  • Responsible for 24 hour/3 point contact on all claims and investigating them thoroughly, pay diary, filed state forms, calculated average weekly wage, compensation rate, permanent partial disability, handled claims up to 20 weeks lost time until after transfer to GA office handled files until closure, set up independent medical examinations, put together and compiled claims kits for insured, negotiated settlement with in-house counsel and presented information for claims reviews
  • Jurisdictions: PA, GA, Al

Education

Resident Agent Life License -

Risk Management Inc.

Workers Compensation Certification License -

Risk Management Inc.

Associates in Specialized Business Degree in Secretarial Sciences (Legal) -

ICM School of Business

Majored in Communications -

Oakwood College

Skills

  • Professionalism and Integrity
  • Team Leadership Qualities
  • Computer Software Proficiency
  • Attention to Detail Focus

References

References available upon request

Timeline

Senior Claims Adjuster

MCIM Insurance company
02.2022 - 06.2024

Senior Claims Adjuster

Next Level Administrators
10.2016 - 02.2022

Out of State Sr. Claims Manager

FFVA Mutual
10.2014 - 10.2016

Senior Claims Professional

KeyRisk Management
09.2008 - 10.2014

Senior Case Claims Manager

Wausau Insurance
08.2004 - 09.2008

Sr. Claims Representative Specialist II

AIG Claims Service
02.2002 - 08.2004

Associate Claims Specialist

R&SA
08.1997 - 02.2002

Resident Agent Life License -

Risk Management Inc.

Workers Compensation Certification License -

Risk Management Inc.

Associates in Specialized Business Degree in Secretarial Sciences (Legal) -

ICM School of Business

Majored in Communications -

Oakwood College

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Ilonna MerchantClaims Adjuster