LaTasha Holloway
Fairfield,OH
Summary
Organized and driven All Lines Claims Adjuster for multiple states reciprocal to TX. I have over 20 plus years of experience with the insurance and medical industry. Worked 6 years at Humana Insurance- National Certified Pharmacy Technician. 6 years as a Financial Service Representative for Cincinnati Children's Hospital.
Overview
6
6
years of professional experience
Work History
Sr. Claims Adjuster-Lost Time
Mitsui Sumitomo Insurance
Cincinnati, OH
09.2023 - Current
- Analyzed policy provisions, endorsements, exclusions and conditions to determine claim validity.
- Negotiated settlements with claimants in order to achieve a fair resolution of claims.
- Reviewed medical records, police reports and other documents related to the claims file.
- Provided technical expertise in interpreting laws, regulations and court decisions pertaining to claims settlement activities.
- Assessed liability exposures and recommended corrective action when necessary.
- Prepared detailed reports outlining findings of investigation for review by management team members.
- Developed strategies for expediting the processing of large volumes of claims while maintaining quality standards.
- Maintained communication with clients throughout the life cycle of their claim regarding status updates and resolution options.
- Drafted correspondence including letters, memos, emails and other documents related to the claims process.
- Interacted with attorneys representing both insureds and carriers during litigation proceedings.
- Monitored trends in legal environment which may affect interpretation of policy language or industry practices.
- Attended continuing education classes and seminars related to professional development within the field of Claims Adjusting.
- Advised colleagues regarding best practices when handling difficult cases or challenging circumstances.
- Monitored changes in federal and state laws governing wage attachment processes and procedures.
- Ensured compliance with all applicable laws governing wage payment practices including minimum wage requirements (TTD, PPI, PPD, settlement issuance, vendor payments).
Senior Claims Adjuster - Medical Only
Mitsui Sumitomo Insurance
Cincinnati, OH
03.2023 - 09.2023
- Receives new claim assignments, analyzes the nature of the claim/loss to determine required investigation and handling. Determines and identifies coverage issues or questions of claim compensability.
- Responsible for direct-handling medical-only claims in full compliance with special claims handling requirements & MSMM clam handling business guidelines.
- Conducts an investigation to collect all necessary information for assigned claims and appropriately evaluates completed investigation and case facts to determine merits of each claim.
- Requests job process investigation while maintaining strong rapport between business and client needs.
- Initiate and manage reserves, timely and appropriately handling of claims per turn around time guidelines according to state and client business needs.
- Maintains diaries, investigate subrogation process and ensures all adjuster licensing and regulations are met.
Client Account Specialist/Account Manager Trainee
CorVel Corporation
Kenwood, OH
02.2020 - 03.2023
- Handles Book of Business consisting of 407 clients (employers) throughout the state of Ohio, some with national exposure.
- Claim adjuster-Work directly with BWC (Bureau of Workers Compensation) CSS, attorneys, providers, injured workers and clients in regards to work related injury claims.
- Maintain accelerated level of retention which includes contact via email, phone, face to face and virtual with clients (employers)
- Process and investigate all incoming claims, develop well documented action plans with strategy of safe and early return to work status, and complete claim resolution
- Functions include obtaining all pertinent required details and documentation relating to the injury and claim review
- Analyzing compensability and benefit entitlements, install appropriate plan of action to manage and mitigate cost exposure, with objective to swiftly move claim to full resolution.
- File all appropriate and required time sensitive forms, medical documentation, and appeals with BWC
- Give recommendations to carrier/TPA for ways to manage claim costs, reserve settings & adjustments, and concurrence of settlement authority
- Review and post medical, legal, and miscellaneous documentation to contain accurate and thorough note keeping in claim file, maintain appropriate diaries and hearing/trial dates
- Collaborate and handle of all litigated requests from assigned Defense attorneys
- Conducted market research and reported on competitors.
- Supported sales team members to drive growth and development.
Claims Adjuster
Sedgwick
Blue Ash, OH
05.2018 - 02.2020
- Adjusts medical-only claims and minor lost-time workers compensation claims under close supervision. Work with return to work team for transition back to full duty status.
- Determined liability, compensability and benefits due on each claim.
- Delivered quality customer service to assigned, insured and claimants throughout entire claims lifecycle to promote service times.
- Tracked and reported on patterns of claims and repeat offenders to help eliminate system abuse.
Education
High School Diploma -
Sycamore High School
Cincinnati, OH05.1994
Some College (No Degree) - BSN Incomplete
Xavier University
CincinnatiSkills
- Business development
- Interpersonal and written communication
- Internal auditing on claims
- Claims file management processes
- Provide training for new employees
- Relationship Building
- Problem Anticipation and Resolution
- Sales and marketing team building
- Client retention
- Advertising strategies
- Salesforce, EMR/HER, Microsoft Teams, EPIC/ISIS
Affiliations
- Volunteered for the Cincinnati Youth Collaboration (6 years)
- Love the arts, fashion, design, reading, writing, painting
- Love learning-yes, this is my hobby!
Timeline
Sr. Claims Adjuster-Lost Time
Mitsui Sumitomo Insurance
09.2023 - Current
Senior Claims Adjuster - Medical Only
Mitsui Sumitomo Insurance
03.2023 - 09.2023
Client Account Specialist/Account Manager Trainee
CorVel Corporation
02.2020 - 03.2023
Claims Adjuster
Sedgwick
05.2018 - 02.2020
High School Diploma -
Sycamore High School
Some College (No Degree) - BSN Incomplete
Xavier University
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